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Updated: Jan 27, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Diagnostic techniques and surgical outcomes for persistent pediatric obstructive sleep apnea after
Melissa A Socarras1, Barcleigh P Landau2, Megan L Durr2
1Kaiser Permanente, 3600 Broadway Oakland, Oakland, CA, 94611, USA; Summer Clinical Otolaryngology Research Program Participant, University of Illinois at Chicago College of Medicine, USA.
Insights
Upper airway surgery can improve pediatric obstructive sleep apnea (OSA) after adenotonsillectomy, but does not fully resolve it. Imaging like Drug Induced Sleep Endoscopy (DISE) and Cine MRI helps guide surgical planning for persistent OSA.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Medical Imaging
Background:
- Persistent obstructive sleep apnea (OSA) in children after adenotonsillectomy (T&A) presents a significant clinical challenge.
- Identifying the precise location of upper airway obstruction is crucial for effective surgical planning.
- Advanced imaging techniques are increasingly utilized to aid in diagnosis and treatment strategy.
Purpose of the Study:
- To evaluate the efficacy of repeat upper airway surgery in children with persistent OSA post-T&A.
- To assess the impact of imaging modalities like Drug Induced Sleep Endoscopy (DISE) and Cine MRI on surgical outcomes.
- To analyze changes in sleep study parameters following surgical intervention guided by these imaging techniques.
Main Methods:
- A systematic review and meta-analysis of English-language studies published between 2000 and 2018.
- Inclusion of pediatric patients with persistent OSA after T&A, excluding case reports and studies lacking pre/post-operative sleep data.
- Data extraction and analysis following PRISMA standards, with quality assessment using the Newcastle-Ottawa scale and random-effects modeling for meta-analysis.
Main Results:
- Eleven studies involving 214 pediatric patients met the inclusion criteria; 10 studies (198 patients) were included in the meta-analysis.
- Surgical intervention led to a significant decrease in the apnea-hypopnea index (AHI) by -6.51 (p < 0.001) and a significant increase in minimum oxygen saturation by 3.24% (p < 0.001).
- Surgeries guided by DISE and Cine MRI demonstrated significant improvements in sleep study parameters, though direct comparison between techniques was limited by patient comorbidities.
Conclusions:
- Repeat upper airway surgery offers significant improvements in AHI and minimum oxygen saturation for pediatric persistent OSA.
- While surgery improves key sleep study metrics, it does not achieve complete resolution of the condition.
- DISE and Cine MRI are valuable tools for guiding surgical planning in persistent pediatric OSA, contributing to improved patient outcomes.
Objective:
To evaluate the efficacy of upper airway surgery for children with persistent obstructive sleep apnea after adenotonsillectomy and to assess sleep study outcomes when Drug Induced Sleep Endoscopy, Cine MRI, or other imaging procedure is performed to assist in identifying the location of obstruction and planning surgery.
Methods:
Systematic review and meta-analysis was performed. Inclusion criteria was English-language studies with original data including pediatric patients with persistent OSA after T&A. Exclusion criteria included case reports and lack of pre and post-operative sleep study data. Data Sources were PubMed, Cochrane Central, and Embase from 2000 to 2018. PRISMA standards were followed for the selection and review of articles. The Newcastle-Ottawa Quality Assessment scale was used to score the quality of evidence of the studies. All manuscripts were reviewed independently by two investigators. Primary outcome measures were apnea-hypopnea index and minimum oxygen saturation. Data was pooled using a random-effects model.
Results:
Of the 1902 abstracts identified, 11 studies (214 patients) met inclusion criteria for systematic review, 5 with Drug Induced Sleep Endoscopy as the diagnostic technique, 4 with Cine MRI, and 2 with MRI/CT. All studies were case series. Most subjects had syndromic comorbidities and/or obesity. Ten studies (198 patients) were included in the meta-analysis. Overall, there was a change in apnea hypopnea index of -6.51 (95% CI, -8.17 to - 4.85; p < 0.001) and an increase in minimum oxygen saturation by 3.24% (95% CI, 1.49%-4.98%; p < 0.001) following surgical intervention. Both Drug Induced Sleep Endoscopy and Cine MRI directed surgeries resulted in significant improvement in sleep study parameters. The two techniques could not be directly compared due to significant differences in co-morbidity rates between patients.
Conclusions:
Surgery for pediatric persistent obstructive sleep apnea improves apnea hypopnea index and minimum oxygen saturation but does not resolve the disease. This is true when both Drug Induced Sleep Endoscopy and Cine MRI findings were used to direct surgery.
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