Polysomnography outcomes of sleep endoscopy–directed intervention in surgically naïve children at risk for persistent obstructive sleep apnea

Kirkham, Erin M.; Filipek, Natalia; Horn, David L.; Johnson, Kaalan; Chen, Maida L.; Parikh, Sanjay R.

doi:10.1007/s11325-019-02006-y

Cited by 27 publications

(36 citation statements)

References 43 publications

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“…Based on the DISE findings, 42% underwent AT, while 58% underwent treatment other than AT, including 18% who had multilevel surgery. 16 This study demonstrates the ability of DISE to change the surgical management for pediatric patients with OSA who are surgically naı ¨ve. With this knowledge, the question then becomes whether DISE should be completed on all children prior to AT.…”

Section: Dise Scoring Systemsmentioning

confidence: 77%

“…Studies have shown a benefit in performing DISE prior to AT in patients who have a relatively high risk of persistent OSA following AT, including those with obesity, Down syndrome, craniofacial anomalies, and neurologic impairment. 14 , 15 , 16 DISE in these patients can be useful in guiding management should residual disease persist following AT. 16 However, opponents of this algorithm argue that airway dynamics change significantly following AT, such that the results of the pre-procedure DISE are low yield as the airway dynamics will be greatly changed following AT.…”

Section: Indications For Disementioning

confidence: 99%

“… 14 , 15 , 16 DISE in these patients can be useful in guiding management should residual disease persist following AT. 16 However, opponents of this algorithm argue that airway dynamics change significantly following AT, such that the results of the pre-procedure DISE are low yield as the airway dynamics will be greatly changed following AT. 13 Other situations where DISE can be helpful in surgically naïve patients include children with severe symptoms of sleep-disordered breathing (SDB) or those with OSA and small tonsils/adenoids on exam.…”

Section: Indications For Disementioning

confidence: 99%

“…23 For adults, propofol is the anesthetic most frequently used for DISE and is titrated to a bispectral index between 50 and 75. 9 For pediatric DISE, propofol has historically been criticized for its potential to cause excessive dosedependent muscle relaxation and airway collapse; however, in 2020, Kirkham et al 16 retrospectively compared DISE findings for children sedated with propofol versus DEX and did not find a significant difference in the degree of upper airway obstruction. Midazolam is a commonly used benzodiazepine for DISE but may cause both central apnea and peripheral muscle relaxation and obstruction.…”

Section: Anesthetic Protocolsmentioning

confidence: 99%

See 3 more Smart Citations

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

Arganbright

Lee

Weatherly

2021

World j. otorhinolaryngol.-head neck surg.

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Section: Dise Scoring Systemsmentioning

confidence: 77%

Section: Indications For Disementioning

confidence: 99%

Section: Indications For Disementioning

confidence: 99%

Section: Anesthetic Protocolsmentioning

confidence: 99%

See 2 more Smart Citations

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

Arganbright

Lee

Weatherly

2021

World j. otorhinolaryngol.-head neck surg.

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“…In more recent years, and particularly since 2006 when we initially described the relatively high prevalence of residual OSA after T&A [11,12], confirmation and realization that, although the severity of OSA will routinely improve after surgery, it can persist in a significant proportion of patients has definitely settled in [13][14][15][16]. Indeed, persistent OSA after T&A may occur between 13% to 29% among children defined as low-risk patients, while residual OSA may be present in up to 75% in higher-risk groups such as in obese children [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Other risk factors for persistence of OSA after surgical intervention include age >7 years, asthma, nocturnal enuresis, allergic rhinitis, and the severity of OSA prior to T&A [20,[31][32][33][34].…”

Section: Adenotonsillectomy (Tanda)mentioning

confidence: 86%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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Drug-Induced Sleep Endoscopy Differences by Age in Surgically Naive Children With Sleep-Disordered Breathing

Herzig

Hildebrand

Nguyen

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceDrug-induced sleep endoscopy (DISE) is increasingly used to guide treatment decisions in children with sleep-disordered breathing (SDB). Previous reports of DISE findings in children have typically included a broad age range, but it is unclear how these patterns of obstruction vary with age.ObjectiveTo compare patterns of airway obstruction observed during DISE in 3 age groups of surgically naive children with SDB.Design, Setting, and ParticipantsThis cross-sectional analysis of a prospective cohort of surgically naive nonsyndromic children with SDB or obstructive sleep apnea [OSA] at risk for residual disease after adenotonsillectomy (defined as having at least 1 of these criteria: severe OSA, older than 7 years, obesity, or Black race) who were recruited between May 1, 2015, and February 28, 2020, was conducted at a tertiary children’s hospital. Data analysis was conducted from September 2021 to February 2022.ExposuresDISE.Main Outcomes and MeasuresDISE findings were rated at 6 anatomic sites using the Sleep Endoscopy Rating Scale (SERS). The association between age and severity of obstruction at each anatomic site and overall were compared using correlation (Kendall τ) and ordinal logistic regression analysis.ResultsData from 288 children (144 girls [50%]; 20 American Indian/Alaska Native [7%], 4 Asian [1%], 19 Black [7%], 93 Hispanic [33%], 2 Middle Eastern [1%], 6 Native Hawaiian/Pacific Islander [2%], and 203 White [70%] individuals; median [IQR] age, 9.2 [7.0-11.7] years) were stratified by participant age into preschool (age 2-5 years; 27 [9%]), younger school-aged (age 5-10 years; 146 [51%]), and older school-aged (age 10-18 years; 115 [40%]). Among these subgroups, the prevalence of multilevel obstruction was 59%, 51%, and 30%, respectively. Increasing age was inversely correlated with obstruction of the nasal airway (τb, −0.19; 95% CI, −0.29 to −0.09), nasopharynx (τb, −0.20; 95% CI, −0.31 to −0.10), velopharynx (τb, −0.16; 95% CI, −0.26 to −0.06), and overall obstruction (SERS total score: τb, −0.24; 95% CI, −0.33 to −0.14). An adjusted analysis demonstrated an inverse association between age and nasopharyngeal obstruction (odds ratio [OR], 0.84; 95% CI, 0.76 to 0.92), SERS total score (OR, 0.83; 95% CI, 0.76 to 0.90), and the number of sites of complete obstruction (OR, 0.87; 95% CI, 0.87 to 0.95).Conclusions and RelevanceThis cross-sectional analysis of data from a prospective cohort study of surgically naive children with SDB found that preschool-aged children had more frequent multilevel obstruction, more severe overall obstruction, and nasopharyngeal obstruction compared with older children. Understanding the most common sites of obstruction and expected changes with age could inform personalized treatment for children with SDB.

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Polysomnography outcomes of sleep endoscopy–directed intervention in surgically naïve children at risk for persistent obstructive sleep apnea

Cited by 27 publications

References 43 publications

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

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

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Drug-Induced Sleep Endoscopy Differences by Age in Surgically Naive Children With Sleep-Disordered Breathing

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