title: Drug-induced sedation endoscopy in children <2 years with obstructive sleep apnea syndrome: upper airway findings and treatment outcomes.
abstract: Few data are available about the pattern of upper airway (UA) obstruction in children <2 years with obstructive sleep apnea syndrome (OSAS). Also, the role of adenoidectomy versus adenotonsillectomy (AT) is poorly defined in this age group. We performed drug-induced sedation endoscopy (DISE) in young OSAS children to investigate the pattern of UA obstruction and the value of DISE in therapeutic decision making. Retrospective analysis of ≤2-year-old children undergoing DISE-directed UA surgery. OSAS severity and the treatment outcomes were documented by polysomnography. Data are available for 28 patients, age 1.5 years (1.3-1.8), BMI-z score 0.5 (-0.7 to 1.3) with severe OSAS, obstructive apnea/hypopnea index (oAHI) 13.8/hr (7.5-28.3). All but 3 had (>50%) obstruction at the level of the adenoids, and all but 5 had (>50%) tonsillar obstruction. DISE-directed treatment consisted of adenoidectomy (n = 4), tonsillectomy (n = 1), and AT (n = 23). There was a significant improvement in respiratory parameters. Twenty children (71.4%) had a postoperative oAHI <2/hr. None had palatal or tongue base obstruction. Five children had a circumferential UA narrowing (hypotonia), 2 of them had residual OSAS. DISE showed a collapse of the epiglottis in 6 and late-onset laryngomalacia in 4. These findings did not affect surgical outcome. Adenotonsillar hypertrophy is the major cause of UA obstruction, and DISE-directed UA surgery was curative in 71,4% of children ≤2 years. We suggest that DISE may be helpful in surgical decision making. Circumferential UA narrowing may result in less favorable surgical outcomes.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium. an.boudewyns@uza.be.
authors.forename: A
authors.initials: A
authors.lastname: Boudewyns
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Van de Heyning
authors.affiliation: Department of Pediatrics, Antwerp University Hospital, University of Antwerp, 2650, Antwerp, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Verhulst
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000066491:Clinical Decision-Making; D004334:Drug Administration Schedule; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D017286:Polysomnography / Q000379:methods; D015742:Propofol / Q000627:therapeutic use*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Adenotonsillectomy; Drug-induced sedation endoscopy; Infants; Obstructive sleep apnea syndrome; Upper airway surgery