title: Drug induced sleep endoscopy in the decision-making process of children with obstructive sleep apnea.
abstract: Tonsillectomy and adenoidectomy (T&A) is currently recommended in children with Obstructive Sleep Apnea (OSA). However, the condition persists after surgery in about one third of cases. It has been suggested that Drug Induced Sleep Endoscopy (DISE) may be of help for planning a more targeted and effective surgical treatment but evidence is yet weak. The aim of this review is to draw recommendation on the use of DISE in children with OSA. More specifically, we aimed at determine the proportion of cases whose treatment may be influenced by DISE findings. A comprehensive search of articles published from February 1983 to January 2014 listed in the PubMed/MEDLINE databases was performed. The search terms used were: "endoscopy" or "nasoendoscopy" or "DISE" and "obstructive sleep apnea" and "children" or "child" or "pediatric." The main outcome was the rate of naive children with hypertrophic tonsils and/or adenoids. The assumptions are that clinical diagnosis of hypertrophic tonsils and/or adenoids is reliable and does not require DISE, and that exclusive T&A may solve OSA in the vast majority of cases even in the presence of other concomitant sites of obstruction. Five studies were ultimately selected and all were case series. The median (range) number of studied children was 39 (15-82). Mean age varied from 3.2 to 7.8 years. The combined estimate rate of OSA consequent to hypertrophic tonsils and/or adenoids was 71% (95%CI: 64-77%). In children with Down Syndrome, the combined estimated rate of hypertrophic tonsils and/or adenoids was 62% (95%CI: 44-79%). Our findings show that DISE may be of benefit in a minority of children with OSA since up to two thirds of naive cases presents with hypertrophic tonsils and/or adenoids. Its use should be limited to those whose clinical evaluation is unremarkable or when OSA persists after T&A.
authors.affiliation: Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Galluzzi
authors.affiliation: Department of Otorhinolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pignataro
authors.affiliation: Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy.
authors.forename: Renato Maria
authors.initials: RM
authors.lastname: Gaini
authors.affiliation: Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy. Electronic address: werner.garavello@unimib.it.
authors.forename: Werner
authors.initials: W
authors.lastname: Garavello
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D004724:Endoscopy; D006801:Humans; D006993:Hypnotics and Sedatives; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D014068:Tonsillectomy
chemical_list: D006993:Hypnotics and Sedatives
keywords: Children; DISE; Endoscopy; Nasoendoscopy; Obstructive sleep apnea