Effectiveness of pediatric drug-induced sleep endoscopy for REM-predominant obstructive sleep apnea

Dl, Smith; He, Shan; Peddireddy, Nithin S.; Manickam, Periakaruppan V.; Heubi, Christine H; Shott, Sally R.; Cohen, Aliza P.; Ishman, Stacey L.

doi:10.1007/s11325-020-02056-7

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…In addition, the available evidence showcasing its usefulness and efficiency is insufficient. The majority of literature regarding this subject is constituted by small case series or retrospective studies [17][18][19][20][21][22][23][24][25][26][27][28]. Despite evidence demonstrating that DISE impacts the decisions made regarding surgery in children, it remains unclear how many sleep doctors actually use this procedure and if the results from interventions guided by DISE surpass those from conventional methods.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Iannella,

Magliulo,

Greco

et al. 2024

Children

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Objectives: To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE. Methods: A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations. Results: A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral. Conclusion: Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.

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Section: Discussionmentioning

confidence: 99%

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Iannella,

Magliulo,

Greco

et al. 2024

Children

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“…A recent study examined the effectiveness of pediatric DISE using dexmedetomidine and ketamine (including identification of sites of obstruction) for children showed that using dexmedetomidine/ketamine was useful to predict at least one site of obstruction, even for those with REMpredominant OSA. 14 Evidence continues to accumulate on the safety and efficacy of dexmedetomidine sedation in children undergoing a variety of procedures, especially those examining upper airway dynamics. [15][16][17][18] Several studies in children/adolescents with Down syndrome and We often performed ciné images with it in place in patients with significant airway obstruction and repeated the ciné images after the removal of the nasal trumpet if the patient was able to tolerate it.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of dexmedetomidine sedation for drug‐induced sleep ciné magnetic resonance imaging studies in pediatric obstructive sleep apnea patients

Narayanasamy

Winograd-Gomez

Joshi

et al. 2021

Pediatric Anesthesia

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Background: Dexmedetomidine is utilized as a sedative agent for drug-induced sleep cine magnetic resonance imaging studies due to its ability to mimic natural sleep and lack of respiratory depressant effects. The outcomes of dexmedetomidine sedation such as respiratory complications and unplanned admissions in obstructive sleep apnea patients undergoing these studies are currently unknown. Aim: To describe the outcomes of dexmedetomidine sedation for outpatient druginduced sleep magnetic resonance imaging in pediatric patients with obstructive sleep apnea. Methods: This is a retrospective chart review conducted in pediatric patients with obstructive sleep apnea undergoing outpatient drug-induced sleep ciné magnetic resonance imaging studies with dexmedetomidine sedation. Demographics, comorbidities, polysomnography study results, vital signs, respiratory complications, airway interventions, successful completion of the scan, and unplanned hospital admissions were measured. Main Results: We analyzed 337 patients aged 2-18 years (median age of 11 years). The imaging was completed with dexmedetomidine as the sole sedative agent in 61% (N = 207) patients. Ketamine was administered as additional sedative agent in 36% (N = 122) of the patients. There was no difference in sedation-related adverse events and respiratory complications with regard to the severity of sleep apnea with the exception of mild desaturation episodes (SpO2 85%-90%). Patients who received additional sedative agents had significantly longer recovery room stay (71.5 [44] vs 55 How to cite this article: Narayanasamy S, Winograd-Gomez V, Joshi H, et al. Outcomes of dexmedetomidine sedation for drug-induced sleep ciné magnetic resonance imaging studies in pediatric obstructive sleep apnea patients.

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“…Demographic and PSG data: Demographic and polysomnography (PSG) data, including age, gender, height, weight, American Society of Anesthesiologists (ASA) physical status, Body Mass Index (BMI), respiratory disturbance index (RDI), apnea hypopnea index (AHI), severity of OSAHS and Mallampati Score ( Smith et al, 2020 ), were gathered.…”

Section: Methodsmentioning

confidence: 99%

The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial

Zheng

Sang

et al. 2022

Front. Pharmacol.

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Background and Purpose: Data and high-quality studies of anesthetic methods for children with obstructive sleep apnea hypopnea syndrome (OSAHS) who undergo drug-induced sleep endoscopy (DISE) are limited. Research on pediatric DISE using esketamine has never been reported before. To test the safety and efficacy of esketamine during DISE in children with OSAHS, we compare esketamine (Group K) with dexmedetomidine (Group D) in this study.Methods: 100 children with ASA Ⅰ∼Ⅱ grade, prepared for an elective adenotonsillectomy under general anesthesia, were enrolled in this study and randomized into two groups. Midazolam 0.1 mg/kg was administered intravenously for both groups. In Group D a 1 μg/kg bolus of dexmedetomidine was given over 10 min followed by the infusion rate 1 μg/kg/hr to the end of DISE. Group K received a 1.0 mg/kg IV bolus of esketamine over 10 s followed by the infusion rate 1 mg/kg/hr to the end of DISE.Results: Group K had a higher percentage of success than Group D (p = 0.008). The onset time of Group K was shorter than that of Group D (p = 0.000). The University of Michigan Sedation Scale (UMSS) score of Group K was higher than that of Group D (p = 0.005). The risk of adverse effects (AEs) was lower in Group K (p = 0.000). In Group D, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) all decreased, while in Group K, SBP, DBP, and HR hardly changed.Conclusion: Esketamine in comparison to dexmedetomidine provides more effective and safer depth of anesthesia for OSAHS pediatric DISE by ensuring short onset time, deep sedation, and few AEs.Clinical Trial Registration: ClincalTrials.gov, identifier NCT04877639

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Effectiveness of pediatric drug-induced sleep endoscopy for REM-predominant obstructive sleep apnea

Cited by 5 publications

References 31 publications

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

Outcomes of dexmedetomidine sedation for drug‐induced sleep ciné magnetic resonance imaging studies in pediatric obstructive sleep apnea patients

The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial

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