Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Arganbright, Jill M.; Lee, Jason C.; Weatherly, Robert A.

doi:10.1016/j.wjorl.2021.05.002

Cited by 12 publications

(14 citation statements)

References 50 publications

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“…Although drug-induced sleep endoscopy (DISE) is certainly a quite promising diagnostic procedure for investigating upper airway mechanics during sleep in pediatric and adult populations showing obstructive sleep apneas ( 65 , 66 ), this technique was, unfortunately, not performed on our RTT population because of lack of local ethical approval. This point may be a possible study limitation, although we should stress that causes of apneas and upper airway mechanics during sleep were not a primary focus of this study.…”

Section: Discussionmentioning

confidence: 99%

Breathing Abnormalities During Sleep and Wakefulness in Rett Syndrome: Clinical Relevance and Paradoxical Relationship With Circulating Pro-oxidant Markers

et al. 2022

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BackgroundBreathing abnormalities are common in Rett syndrome (RTT), a pervasive neurodevelopmental disorder almost exclusively affecting females. RTT is linked to mutations in the methyl-CpG-binding protein 2 (MeCP2) gene. Our aim was to assess the clinical relevance of apneas during sleep-wakefulness cycle in a population with RTT and the possible impact of apneas on circulating oxidative stress markers.MethodsFemale patients with a clinical diagnosis of typical RTT (n = 66), MECP2 gene mutation, and apneas were enrolled (mean age: 12.5 years). Baseline clinical severity, arterial blood gas analysis, and red blood cell count were assessed. Breathing was monitored during the wakefulness and sleep states (average recording time: 13 ± 0.5 h) with a portable polygraphic screening device. According to prevalence of breath holdings, the population was categorized into the wakefulness apnea (WA) and sleep apnea (SA) groups, and apnea-hypopnea index (AHI) was calculated. The impact of respiratory events on oxidative stress was assessed by plasma and intra-erythrocyte non-protein-bound iron (P-NPBI and IE-NPBI, respectively), and plasma F2-isoprostane (F2-IsoP) assays.ResultsSignificant prevalence of obstructive apneas with values of AHI > 15 was present in 69.7% of the population with RTT. The group with SA showed significantly increased AHI values > 15 (p = 0.0032), total breath holding episodes (p = 0.007), and average SpO2 (p = 0.0001) as well as lower nadir SpO2 (p = 0.0004) compared with the patients with WAs. The subgroups of patients with WA and SA showed no significant differences in arterial blood gas analysis variables (p > 0.089). Decreased mean cell hemoglobin (MCH) (p = 0.038) was observed in the group with WAs. P-NPBI levels were significantly higher in the group with WA than in that with SAs (p = 0.0001). Stepwise multiple linear regression models showed WA being related to nadir SpO2, average SpO2, and P-NPBI (adjusted R2 = 0.613, multiple correlation coefficient = 0.795 p < 0.0001), and P-NPBI being related to average SpO2, blood PaCO2, red blood cell mean corpuscular volume (MCV), age, and topiramate treatment (adjusted R2 = 0.551, multiple correlation coefficient = 0.765, p < 0.0001).ConclusionOur findings indicate that the impact of apneas in RTT is uneven according to the sleep-wakefulness cycle, and that plasma redox active iron represents a potential novel therapeutic target.

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Section: Discussionmentioning

confidence: 99%

Breathing Abnormalities During Sleep and Wakefulness in Rett Syndrome: Clinical Relevance and Paradoxical Relationship With Circulating Pro-oxidant Markers

et al. 2022

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“…During DISE, an endoscope is passed through the nares to assess the nasopharynx, oropharynx, larynx, and in some cases the trachea. The procedure is often carried out either with propofol or dexmedetomidine sedation, which simulates natural sleep and can demonstrate lesions causing obstruction that may not be evident on an awake in-office flexible laryngoscopy[ 8 ].…”

Section: Aerodigestive Program Servicesmentioning

confidence: 99%

Making the case for multidisciplinary pediatric aerodigestive programs

Kanotra¹,

Weiner²,

Rahhal³

2022

WJG

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Multidisciplinary pediatric aerodigestive centers have been proposed to address the needs of children with complex multi-system problems affecting the respiratory and upper gastrointestinal tracts. The setup of a multidisciplinary service allows for the complex coordination needed between different subspecialties. This allows for rapid communication and family-centered decision making and agreement on further diagnostic and/or therapeutic next steps such as offering triple endoscopy when indicated. Triple endoscopy entails performing rigid upper airway assessment, flexible bronchoscopy and upper gastrointestinal endoscopy and has been linked to reduced time to diagnosis/treatment, reduced costs and anesthesia exposure. This review summarizes the available literature on the structure and benefits of multidisciplinary pediatric aerodigestive services.

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“…More recently, DISE utilization has expanded for surgically naïve pediatric patients in specific scenarios, such as patients at high risk for persistent OSA (Down syndrome, obesity, neurologic disorders, etc. ), patients with severe OSA yet small tonsils and adenoids, patients with known sleep‐state dependent laryngomalacia; or patients being evaluated as potential candidates for a hypoglossal nerve stimulator procedure 13–16 …”

Section: Introductionmentioning

confidence: 99%

“…), patients with severe OSA yet small tonsils and adenoids, patients with known sleep‐state dependent laryngomalacia; or patients being evaluated as potential candidates for a hypoglossal nerve stimulator procedure. 13 , 14 , 15 , 16 …”

Section: Introductionmentioning

confidence: 99%

“…), patients with severe OSA yet small tonsils and adenoids, patients with known sleep-state dependent laryngomalacia; or patients being evaluated as potential candidates for a hypoglossal nerve stimulator procedure. [13][14][15][16] The purpose of this study is to expand upon the findings of a previous study conducted by the senior author that demonstrated sleep endoscopy's utility in improving surgical outcomes for pediatric OSA.…”

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confidence: 99%

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Drug‐induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2‐year follow up

Frederick

Brandt

Sheyn

2022

Laryngoscope Investig Oto

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Objective: To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA.Methods: This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate-severe OSA who underwent DISE at the time of initial sleep surgery.Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1.Results: A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI % of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85. Conclusion:This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI.

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Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Cited by 12 publications

References 50 publications

Breathing Abnormalities During Sleep and Wakefulness in Rett Syndrome: Clinical Relevance and Paradoxical Relationship With Circulating Pro-oxidant Markers

Breathing Abnormalities During Sleep and Wakefulness in Rett Syndrome: Clinical Relevance and Paradoxical Relationship With Circulating Pro-oxidant Markers

Making the case for multidisciplinary pediatric aerodigestive programs

Drug‐induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2‐year follow up

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