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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
A new scoring system for upper airway pediatric sleep endoscopy
Dylan K Chan1, Bryan J Liming2, David L Horn3
1Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
Insights
A new scoring system for pediatric drug-induced sleep endoscopy quantifies airway obstruction, showing good reliability and validity. This tool aids in diagnosing sleep-related breathing disorders and planning surgical interventions.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Respiratory Medicine
Background:
- Sleep-associated upper-airway obstruction is a significant cause of morbidity in children.
- Standardized, quantitative assessment of airway anatomy is crucial for surgical planning and research in pediatric sleep disorders.
Purpose of the Study:
- To design, implement, and evaluate a scoring system for quantifying airway obstruction during pediatric drug-induced sleep endoscopy (DISE).
Main Methods:
- A retrospective case series of children with sleep-related breathing disorder undergoing polysomnography and DISE.
- Flexible fiber-optic laryngoscopy was performed, with videos assessed by 4 raters using a 4-point scale for obstruction at 5 airway locations.
- Internal reliability (interrater and intrarater ICCs) and external validity (correlation with polysomnography indices) were evaluated.
Main Results:
- The scoring system demonstrated substantial agreement among raters (70% of ICCs > 0.6).
- Higher total obstruction scores correlated with lower oxygen saturation nadir (P = .04).
- Multilevel airway obstruction identified by the system was associated with significantly worse polysomnography indices (P = .02).
Conclusions:
- The proposed scoring system is easy to use, achieves good internal reliability and external validity for quantifying obstruction in pediatric DISE.
- Standardized reporting of DISE outcomes will improve clinical communication and interpretation of findings.
- This system aids in informing site-directed surgical interventions for obstructive sleep apnea in children.
Importance:
Sleep-associated upper-airway obstruction in children is a significant cause of morbidity. Development of a simple, standardized, quantitative technique to assess anatomic causes of sleep-related breathing disorder is important for surgical planning, clinical communication, and research.
Objective:
To design, implement, and evaluate a scoring system to quantify airway obstruction in pediatric drug-induced sleep endoscopy.
Design, Setting, And Participants:
This study was a retrospective case series conducted at a tertiary pediatric hospital. The patients were children with sleep-related breathing disorder who underwent polysomnography and drug-induced sleep endoscopy.
Interventions:
Flexible fiber-optic laryngoscopy was performed. Endoscopic examinations were recorded on video and assessed by 4 independent raters based on a scoring template.
Main Outcomes And Measures:
Five locations in the upper aerodigestive tract (adenoid, velum, lateral pharyngeal wall, tongue base, and supraglottis) were evaluated on a 4-point scale for minimum and maximum obstruction. Internal reliability was assessed by calculating interrater and intrarater intraclass correlation coefficients (ICCs). For external validation, aggregate and site-specific scores were correlated with preoperative polysomnographic indices.
Results:
Videos recorded of sleep endoscopies from 23 children (mean age, 2.2 years) were reviewed and rated. Children had an average apnea-hypopnea index of 24.8. Seventy percent of interrater and intrarater ICC values (7 of 10 for each set) were above 0.6, demonstrating substantial agreement. Higher total obstructive scores were associated with lower oxygen saturation nadir (P = .04). The scoring system was also used to quantitatively identify children with multilevel airway obstruction, who were found to have significantly worse polysomnographic indices compared with children with single-level obstruction (P = .02).
Conclusions And Relevance:
The proposed scoring system, which is designed to be easy to use and allow for subjectivity in evaluating obstruction at multiple levels, nonetheless achieves good internal reliability and external validity. Implementing this system will allow for standardization of reporting for sleep endoscopy outcomes, as well as aid the practicing clinician in the interpretation of sleep endoscopy findings to inform site-directed surgical intervention in cases of complicated obstructive sleep apnea.
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