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Updated: Aug 29, 2026
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Investigations in paediatric obstructive sleep apnoea: do we need them?
1Department of Otolaryngology, Royal Free Hospital, Pond Street, London NW3 2QG, UK. helen_myatt@hotmail.com
Insights
Most children with obstructive sleep apnoea (OSA) improve after adenotonsillectomy. However, further investigation is needed for children with complex cases or specific syndromes to identify obstruction sites and ensure effective treatment.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Respiratory Physiology
Background:
- Adenotonsillectomy cures 90% of pediatric obstructive sleep apnea (OSA).
- A significant minority of children, especially those with Down syndrome, cerebral palsy, or craniofacial syndromes, do not improve with surgery.
- Identifying the site and severity of obstruction is crucial for non-responders.
Purpose of the Study:
- To outline diagnostic strategies for pediatric OSA.
- To highlight the limitations of standard screening tools.
- To introduce a classification for upper airway obstruction sites in pediatric OSA.
Main Methods:
- Detailed history and parental questionnaires for initial screening.
- Pulse oximetry as a preliminary screening tool.
- Formal sleep studies, including polysomnography for severity assessment.
- Sleep nasendoscopy under light anesthesia to determine obstruction site.
- Micro-laryngobronchoscopy for suspected distal airway obstruction.
Main Results:
- While adenotonsillectomy is effective for most, 10% of otherwise normal children and a higher proportion with specific syndromes require further investigation.
- Pulse oximetry is useful but insufficient for complex cases.
- Sleep nasendoscopy is effective in identifying the site of obstruction.
- A new classification system for documenting obstruction sites in pediatric OSA is proposed.
Conclusions:
- Children with persistent or complex OSA require advanced diagnostic methods beyond adenotonsillectomy.
- Accurate identification of obstruction site and severity is essential for effective management.
- Sleep nasendoscopy and polysomnography are key investigations for these challenging cases.
Abstract:
Ninety percent of normal children with obstructive sleep apnoea (OSA) improve, or are cured, with adenotonsillectomy. However, 10% of apparently normal children show no improvement following this operation and it has a very poor outcome in Down's syndrome, where only about one in six children improve. Adenotonsillectomy is also rarely curative in children with cerebral palsy or craniofacial syndromes. In these children investigations of the site and severity of their obstruction is necessary. Taking a detailed history and asking the parents to fill in a questionnaire for data collection will identify most children with OSA. Pulse oxymetry has some limitations but is a good screening tool. It does not provide enough information for the management of children with complex upper airway obstruction who are likely to have on going problems with OSA throughout their childhood despite intervention. For these children formal sleep studies are needed. Full polysomnography is the gold standard investigation to ascertain the severity of OSA. To ascertain the site of upper airway obstruction during sleep, sleep nasendoscopy has been found to be an excellent tool. This is performed under a light general anaesthetic in main theatres and is demonstrated using video footage in the presentation. This is a new classification to document the site of airway obstruction in paediatric OSA. A micro-layryngobronchoscopy is also required in any child who has daytime noisy breathing, a previous history of cardiac malformation or Down's syndrome, in whom a more distal site of airway obstruction may be present.
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