Airway Obstruction during Drug-Induced Sleep Endoscopy Correlates with Apnea-Hypopnea Index and Oxygen Nadir in Children.
To determine if standardized intraoperative scoring of anatomic obstruction in children with obstructive sleep apnea correlates with the apnea-hypopnea index (AHI) and lowest oxygen saturation on preprocedural polysomnogram (PSG). A secondary objective was to determine if age, presence of a syndrome, or previous adenotonsillectomy affect this correlation.



Case series with chart review.



Two tertiary care children's hospitals.



Patients with a preprocedural PSG who underwent drug-induced sleep endoscopy (DISE) over a 4-year period.



All DISEs were graded in a systematic manner with the Chan-Parikh (C-P) scoring system. AHI and nadir oxygen saturations were extracted from preprocedural PSG. Data were analyzed with a multivariate linear regression model that controlled for age at time of sleep endoscopy, syndrome diagnosis, and previous adenotonsillectomy.



A total of 127 children underwent PSG prior to DISE: 56 were syndromic, and 21 had a previous adenotonsillectomy. Mean AHI was 13.6 ± 19.6 (± SD), and mean oxygen nadir was 85.4% ± 9.4%. Mean C-P score was 5.9 ± 2.7. DISE score positively correlated with preoperative AHI (r = 0.36, P < .0001) and negatively correlated with oxygen nadir (r = -0.26, P = .004). The multivariate linear regression models estimated that for every 1-point increase in C-P score, there is a 2.6-point increase in AHI (95% confidence interval: 1.4-3.8, P < .001) and a 1.1% decrease in the lowest oxygen saturation (95% confidence interval: -1.7 to -0.6, P < .001).



The C-P scoring system for pediatric DISE correlates with both AHI and lowest oxygen saturation on preprocedural PSG.
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA Riley Hospital for Children, Indianapolis, Indiana, USA.
John P
JP
Dahl
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA Seattle Children's Hospital, Seattle, Washington, USA.
Craig
C
Miller
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA Seattle Children's Hospital, Seattle, Washington, USA.
Patricia L
PL
Purcell
Department of Otolaryngology-Head and Neck Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA.
David A
DA
Zopf
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA Seattle Children's Hospital, Seattle, Washington, USA.
Kaalan
K
Johnson
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA Seattle Children's Hospital, Seattle, Washington, USA.
David L
DL
Horn
Seattle Children's Hospital, Seattle, Washington, USA Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Maida L
ML
Chen
Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA Benioff Children's Hospital, San Francisco, California, USA.
Dylan K
DK
Chan
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA Seattle Children's Hospital, Seattle, Washington, USA sanjay.parikh@seattlechildrens.org.
Sanjay R
SR
Parikh
D000233:Adenoidectomy; D000367:Age Factors; D000402:Airway Obstruction; D000768:Anesthesia, General; D002140:California; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood*; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery*; D014068:Tonsillectomy; D014861:Washington
D010100:Oxygen
drug-induced sleep endoscopy; obstructive sleep apnea; pediatrics; polysomnogram; sleep-disordered breathing