Skip to main content

Advertisement

SpringerLink
Log in

Drug-induced sedation endoscopy in surgically naïve infants and children with obstructive sleep apnea: impact on treatment decision and outcome

  • ENT • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Adenotonsillectomy (AT) is the first-line treatment for obstructive sleep apnea (OSA) in children irrespective of clinical upper airway (UA) findings. We aimed to investigate whether drug-induced sedation endoscopy (DISE) changes treatment decision and outcome in otherwise healthy children and infants with OSA.

Methods

Retrospective analysis of prospectively collected data on polysomnography, DISE, and treatment in surgically naïve, otherwise healthy infants (n = 34) and children (n = 75) with OSA. Treatment success is defined as post-treatment obstructive apnea/hypopnea index (oAHI) < 5 h−5−1, and cure is defined as oAHI < 2 h−1.

Results

Based upon UA findings during DISE, AT was performed in 22 infants and 57 children. oAHI improved from 16.5 h−1 (8.1–28.3) to 0.8 h−1 (0.3–4.2) (p = 0.01) in infants and from 28.6 h−1 (23.4–34.9) to 0.7 h−1 (0.4–1.8) (p < 0.001) in children. AT was successful in 84.2% of infants and 91.4% of children. A cure was obtained in 68.4% of infants and 78.7% of children. DISE changed the treatment decision in 1/3rd of infants and 1/4th of children, and they did not undergo AT. In the non-AT group, isolated adenoidectomy/tonsillectomy or non-surgical treatment was successful in 86.6% of children and in 100% of infants. Cure was achieved in 66.6% of children and 75% of infants.

Conclusions

DISE performed in otherwise healthy and surgically naïve infants and children with OSA altered the therapeutic decision making in up to 1/3rd to 1/4th of the cases and resulted in comparable treatment outcomes as standard treatment by AT. The present data suggest that DISE may provide individually tailored treatment of OSA in otherwise healthy infants and children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):e714–e755. https://doi.org/10.1542/peds.2012-1672

    Article  PubMed  Google Scholar 

  2. Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47(1):69–94. https://doi.org/10.1183/13993003.00385-2015

    Article  PubMed  Google Scholar 

  3. Ye J, Liu H, Zhang GH, Li P, Yang QT, Liu X, Li Y (2010) Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol 119(8):506–513

    Article  PubMed  Google Scholar 

  4. Mitchell RB, Kelly J (2007) Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 137(1):43–48. https://doi.org/10.1016/j.otohns.2007.03.028

    Article  PubMed  Google Scholar 

  5. Boudewyns A, Abel F, Alexopoulos E, Evangelisti M, Kaditis A, Miano S, Villa MP, Verhulst SL (2017) Adenotonsillectomy to treat obstructive sleep apnea: is it enough? Pediatric Pulmonol 52(5):699–709. https://doi.org/10.1002/ppul.23641

    Article  CAS  Google Scholar 

  6. Manickam PV, Shott SR, Boss EF, Cohen AP, Meinzen-Derr JK, Amin RS, Ishman SL (2016) Systematic review of site of obstruction identification and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea. Laryngoscope 126(2):491–500. https://doi.org/10.1002/lary.25459

    Article  PubMed  Google Scholar 

  7. Myatt HM, Beckenham EJ (2000) The use of diagnostic sleep nasendoscopy in the management of children with complex upper airway obstruction. Clin Otolaryngol 25(3):200–208

    Article  CAS  PubMed  Google Scholar 

  8. Boudewyns A, Verhulst S, Maris M, Saldien V, Van de Heyning P (2014) Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome. Sleep Med 15(12):1526–1531. https://doi.org/10.1016/j.sleep.2014.06.016

    Article  CAS  PubMed  Google Scholar 

  9. Gazzaz MJ, Isaac A, Anderson S, Alsufyani N, Alrajhi Y, El-Hakim H (2017) Does drug-induced sleep endoscopy change the surgical decision in surgically naive non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study. J Otolaryngol Head Neck Surg 46(1):12. https://doi.org/10.1186/s40463-017-0190-6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Friedman NR, Parikh SR, Ishman SL, Ruiz AG, El-Hakim H, Ulualp SO, Wootten CT, Koltai PJ, Chan DK (2017) The current state of pediatric drug-induced sleep endoscopy. Laryngoscope 127(1):266–272. https://doi.org/10.1002/lary.26091

    Article  PubMed  Google Scholar 

  11. Galluzzi F, Pignataro L, Gaini RM, Garavello W (2015) Drug induced sleep endoscopy in the decision-making process of children with obstructive sleep apnea. Sleep Med 16(3):331–335. https://doi.org/10.1016/j.sleep.2014.10.017

    Article  PubMed  Google Scholar 

  12. Galluzzi F, Pignataro L, Gaini RM, Garavello W (2015) Response to the letter “potential role for drug induced sleep endoscopy (DISE) in pediatric OSA”. Sleep Med 16(9):1179. https://doi.org/10.1016/j.sleep.2015.04.010

    Article  PubMed  Google Scholar 

  13. Boudewyns A, Verhulst S (2015) Potential role for drug-induced sleep endoscopy (DISE) in paediatric OSA. Sleep Med 16(9):1178. https://doi.org/10.1016/j.sleep.2015.04.022

    Article  PubMed  Google Scholar 

  14. Brodsky L (1989) Modern assessment of tonsils and adenoids. Ped Clin N Am 36(6):1551–1569

    Article  CAS  Google Scholar 

  15. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172

    PubMed  PubMed Central  Google Scholar 

  16. Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R, Paruthi S, Muzumdar H, Gozal D, Thomas NH, Ware J, Beebe D, Snyder K, Elden L, Sprecher RC, Willging P, Jones D, Bent JP, Hoban T, Chervin RD, Ellenberg SS, Redline S, Childhood Adenotonsillectomy T (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 368(25):2366–2376. https://doi.org/10.1056/NEJMoa1215881

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Alsufyani N, Isaac A, Witmans M, Major P, El-Hakim H (2017) Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing. J Otolaryngol Head Neck Surg 46(1):37. https://doi.org/10.1186/s40463-017-0213-3

    Article  PubMed  PubMed Central  Google Scholar 

  18. Miller C, Purcell PL, Dahl JP, Johnson K, Horn DL, Chen ML, Chan DK, Parikh SR (2016) Clinically small tonsils are typically not obstructive in children during drug-induced sleep endoscopy. Laryngoscope. https://doi.org/10.1002/lary.26447

  19. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, Nickinovich DG, Prachand V, Ward DS, Weaver EM, Ydens L, Yu S, American Society of Anesthesiologists Task Force on Perioperative Management (2006) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 104(5):1081–1093 quiz 1117–1088

    Article  PubMed  Google Scholar 

  20. Thevasagayam M, Rodger K, Cave D, Witmans M, El-Hakim H (2010) Prevalence of laryngomalacia in children presenting with sleep-disordered breathing. Laryngoscope 120(8):1662–1666. https://doi.org/10.1002/lary.21025

    Article  PubMed  Google Scholar 

  21. Boudewyns A, Van de Heyning P, Verhulst S (2017) Drug-induced sedation endoscopy in children <2 years with obstructive sleep apnea syndrome: upper airway findings and treatment outcomes. Eur Arch Otorhinolaryngol 274(5):2319–2325. https://doi.org/10.1007/s00405-017-4481-3

    Article  CAS  PubMed  Google Scholar 

  22. Shteamer JW, Dedhia RC (2017) Sedative choice in drug-induced sleep endoscopy: a neuropharmacology-based review. Laryngoscope 127(1):273–279. https://doi.org/10.1002/lary.26132

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    A. Boudewyns & P. Van de Heyning

  2. Department of Anesthesiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

    V. Saldien

  3. Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

    S. Verhulst

Authors
  1. A. Boudewyns
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Saldien
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Van de Heyning
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Verhulst
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Boudewyns.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in the participants of this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (B30020107827).

Informed consent

Informed consent was obtained from all parents or legal caregivers of the individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boudewyns, A., Saldien, V., Van de Heyning, P. et al. Drug-induced sedation endoscopy in surgically naïve infants and children with obstructive sleep apnea: impact on treatment decision and outcome. Sleep Breath 22, 503–510 (2018). https://doi.org/10.1007/s11325-017-1581-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1581-7

Keywords

Search

Navigation