title: Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  To describe the pattern of upper airway (UA) obstruction during drug-induced sedation endoscopy (DISE) and to evaluate the outcome of DISE-directed treatment.
  
  
  METHODS
  Prospective study of DISE in surgically naive obstructive sleep apnea syndrome (OSAS) children without syndromic comorbidity or craniofacial abnormalities. Treatment was individually tailored according to UA findings during DISE and polysomnographic data. Reported values are median (lower-upper quartile).
  
  
  RESULTS
  Thirty-seven children aged 4.1 years (2.1-6.0), with body mass index z-score 0.3 (-0.9 to 0.9), and obstructive apnea-hypopnea index (oAHI) 9.0/h (6.1-19.3) were included. Adenotonsillar obstruction was found in 33 cases (89%) as an isolated entity or as part of a multi-level obstruction. These children were treated with adenotonsillectomy (n = 28), adenoidectomy (n = 3), or tonsillectomy (n = 2). The remaining four patients received non-surgical treatment. Pre-postoperative polysomnographic data in 22 patients showed a significant improvement in oAHI from 8.6/h (6.7-20.7) to 1.0/h (0.6-2.0) (P = 0.001). Only two of these 22 children had residual OSAS (oAHI ≥ 5/h), indicating a success rate of 91%.
  
  
  CONCLUSIONS
  Based on UA findings during DISE, a non-surgical treatment was proposed for 11% of children. A 91% success rate was obtained in those treated with (adeno)tonsillectomy. These data suggest that DISE may be helpful to identify patients most likely to benefit from UA surgery.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Antwerp, Antwerp University, Belgium. Electronic address: an.boudewyns@uza.be.
authors.forename: A
authors.initials: A
authors.lastname: Boudewyns
authors.affiliation: Department of Pediatrics, University Hospital Antwerp, Antwerp University, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Verhulst
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Antwerp, Antwerp University, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Maris
authors.affiliation: Department of Anesthesiology, University Hospital Antwerp, Antwerp University, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Saldien
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Antwerp, Antwerp University, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Van de Heyning
mesh_terms: D000233:Adenoidectomy; D000402:Airway Obstruction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002675:Child, Preschool; D016292:Procedural Sedation; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000209:etiology*; D014068:Tonsillectomy
keywords: Adenotonsillectomy; Endoscopy; Obstructive sleep apnea; Pediatric; Upper airway