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Updated: Mar 22, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Drug-induced sleep endoscopy in children with Prader-Willi syndrome
Ming-Chin Lan1,2, Yen-Bin Hsu3,4, Ming-Ying Lan3,4
1Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Insights
Children with Prader-Willi syndrome (PWS) and obstructive sleep apnea (OSA) often have tongue base collapse, which is linked to higher apnea-hypopnea index (AHI) values. Positional therapy may help manage this condition.
Area of Science:
- Pediatric Sleep Medicine
- Genetics and Rare Diseases
- Otolaryngology
Background:
- Prader-Willi syndrome (PWS) is a complex genetic disorder associated with a high prevalence of obesity and sleep-disordered breathing.
- Obstructive sleep apnea (OSA) is a common and serious comorbidity in children with PWS, often requiring intervention.
- Drug-induced sleep endoscopy (DISE) is crucial for identifying specific patterns of upper airway collapse in OSA.
Purpose of the Study:
- To analyze drug-induced sleep endoscopy (DISE) findings in pediatric patients with Prader-Willi syndrome (PWS).
- To correlate specific upper airway collapse patterns identified during DISE with the apnea-hypopnea index (AHI) and body mass index (BMI).
- To investigate the relationship between multilevel airway obstruction and OSA severity in children with PWS.
Main Methods:
- Nine children diagnosed with Prader-Willi syndrome (PWS) underwent drug-induced sleep endoscopy (DISE).
- Airway collapse patterns were systematically classified using the VOTE (Velum, Oropharynx, Tongue base, Epiglottis) system.
- Statistical analysis was performed to examine associations between VOTE findings, AHI, and BMI.
Main Results:
- Multilevel airway obstruction was identified in the majority (66.6%) of children with PWS.
- Velopharyngeal obstruction was universally present (100%), and all patients exhibited positional obstructive sleep apnea (OSA).
- Anterior-posterior tongue base collapse was significantly associated with higher AHI values (P=0.016), while no significant association was found with BMI.
Conclusions:
- Partial or complete anterior-posterior tongue base collapse is a key finding linked to increased OSA severity (higher AHI) in children with PWS.
- Management strategies for PWS patients should prioritize addressing tongue base collapse.
- Positional therapy presents a potential therapeutic option for PWS patients, possibly by mitigating tongue base collapse severity.
Purpose:
Review drug-induced sleep endoscopy (DISE) findings in children with Prader-Willi syndrome (PWS) and correlate the patterns of airway collapse with apnea-hypopnea index (AHI) and body mass index (BMI).
Methods:
A total of nine children with PWS underwent DISE. DISE findings were recorded using the VOTE classification system. The relationship between different patterns of airway collapse with AHI and BMI was analyzed.
Results:
The majority of children with PWS were found to have multilevel obstruction (six out of nine children, 66.6 %). The velum was the most common site of obstruction (nine out of nine children, 100 %). All of the patients had positional obstructive sleep apnea (OSA). Patients with partial or complete anterior-posterior tongue base collapse were associated with a significantly higher AHI (P = 0.016) compared to patients with no anterior-posterior tongue base collapse. Apart from tongue base collapse, no other patterns of airway collapse showed a consistent association with AHI in our results. No patterns of airway collapse showed a significant association with BMI in our study.
Conclusions:
In our study, partial or complete anterior-posterior tongue base collapse was associated with higher AHI values in children with PWS. Therefore, careful attention should be addressed to the management of tongue base collapse. Positional therapy could be a potential treatment for patients with PWS since it may alleviate the severity of tongue base collapse.
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