A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications. (May 2018)

• Record Type: Journal Article
• Authors: Collu, Maria Antonietta; Esteller, Eduard; Lipari, Fiorella; Haspert, Raul; Mulas, Demetrio; Diaz, Miguel Angel; Dwivedi, Raghav C.
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 108(2018:May)
• Page Start: 113
• Page End: 119
• Publication Date: 2018-05
• Subjects: Drug induced sleep endoscopy -- Obstructive sleep apnoea syndrome -- Decision-making -- Children -- Adenotonsillectomy -- Upper airway; ADHD attention-deficit/hyperactivity disorder -- AHI apnoea-hypopnoea index -- BIS bispectral index -- CI confidence interval -- CPAP continuous positive airway pressure -- DISE Drug-Induced Sleep Endoscopy -- ENT ear nose and throat -- FESS functional endoscopic sinus surgery -- IT inferior turbinates -- OR odds ratio -- OSAS Obstructive Sleep Apnoea Syndrome -- PSG polysomnography -- PSQ pediatric sleep questionnaire -- SD standard deviation -- T&A tonsillectomy and adenoidectomy -- TB tongue base -- UA upper airway -- VAS visual analog scale; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2018.02.038
• Languages: English
• ISSNs: 0165-5876

Abstract

Abstract: Objective: To evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered. Methods: A case-control study of DISE in 150 children with OSAS. Pre-operative OSA were assessed through detailed history, Chervin questionnaire, physical examination and overnight polysomnography. The group of study was divided into three subgroups according to clinical and polysomnographyc criteria: conventional OSAS, disproportional OSAS and persistent OSAS. Endoscopic evaluation of the upper airway during DISE was scored using Chan classification. Surgical treatment was tailored individually upon the basis of sleep endoscopy findings: performance of any surgery other than tonsillectomy and adenoidectomy (T&A) was considered as a change of the treatment plan. Cases and controls were compared considering presence and absence of DISE-directed extra surgery, respectively. Results: 150 patients with mean age (SD) 56.09 (23.94) months and mean apnoea-hypopnea index (AHI) of 5.79 (6.52) underwent DISE. The conventional subgroup represented the 58.67% of the sample (n = 88), while the disproportional one counted for the 26.67% (n = 40), and the persistent one for 14.66% (n = 22) of the population. Sleep endoscopy changed the surgical plan in 4.5% of conventional OSAS, 17.5% of disproportional OSAS and 72.7% of persistent OSAS (p < 0.005). Overall, a change of the treatment plan operated by DISE was associated with a non-conventional OSAS status (OR = 6; 95% CI = 1.6–26.4). Conclusions: DISE is a safe procedure in children suffering from OSAS, and, despite being unnecessary in conventional cases of OSA, DISE should be considered not only in syndromic children, as previously demonstrated, but also in the general non-syndromic pediatric population, in the case of non-conventional OSA patients, and in children with persistent OSAS.