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Updated: Jan 2, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Effect of drug induced sleep endoscopy on intraoperative decision making in pediatric sleep surgery
Julia Dmowska1, Stephen Reed Larson1, M Boyd Gillespie1
1Department of Otolaryngology, The University of Tennessee Health Science Center, 910 Madison Ave. Memphis, TN, 38163, USA.
Insights
Drug-induced sleep endoscopy (DISE) helps surgeons make better decisions during pediatric sleep apnea surgery. This can lead to improved post-operative outcomes for children with obstructive sleep apnea (OSA).
Area of Science:
- Otolaryngology
- Sleep Medicine
- Pediatric Surgery
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Accurate intra-operative decision-making is crucial for successful pediatric sleep surgery.
- Drug-induced sleep endoscopy (DISE) is a tool used to assess airway collapse during sleep.
Purpose of the Study:
- To evaluate the impact of DISE on surgical decisions in pediatric patients with OSA.
- To determine if DISE influences the type and extent of surgical interventions.
- To assess the correlation between DISE findings and post-operative outcomes.
Main Methods:
- Retrospective chart review of pediatric patients (3-17 years) with moderate-to-severe OSA.
- Patients underwent DISE immediately prior to initial sleep surgery.
- Analysis of pre- and post-operative polysomnography (PSG) results, including apnea-hypopnea index (AHI).
- Evaluation of surgical interventions based on DISE findings.
Main Results:
- DISE identified specific sites of airway collapse, most commonly the soft palate (65.4%) and base of tongue (42.3%).
- Multilevel collapse was observed in 23.1% of patients.
- Surgical interventions included pharyngoplasty (76.9%) and tongue reduction (11.5%).
- Significant reduction in post-operative AHI compared to pre-operative AHI (p < 0.001).
Conclusions:
- DISE provides valuable information that affects intra-operative decision-making in pediatric sleep surgery for OSA.
- The findings suggest that DISE has the potential to improve post-operative outcomes.
- Further randomized controlled studies are recommended to confirm the benefits of DISE.
Objectives:
To demonstrate the effect of drug induced sleep endoscopy (DISE) on intra-operative decision making during pediatric sleep surgery for obstructive sleep apnea (OSA).
Methods:
A retrospective chart review was performed on pediatric (3-17 years) patients with moderate-to-severe OSA (7.2-71.8) who underwent drug induced sleep endoscopy at the time of initial sleep surgery. The characteristics evaluated included age, race, gender, site of obstruction, type of surgical intervention, pre- and post-operative apnea and hypopnea index. Of the 26 patients that were identified, 18 had both a pre- and post-operative polysomnograms result.
Results:
All patients underwent DISE immediately prior to surgical treatment. The mean pre-operative AHI for the 18 patients with post-operative polysomnogram results was 21.3 (7.2-71.8). The mean post-operative AHI for the 18 patients was 7.6 (0.7-25.1). There was a significant difference between pre- and post-operative AHI (p < 0.001). Of the 26 patients, the most common area of collapse was the soft palate, occurring in 17/26 (65.4%) patients. Base of tongue involvement was found to be present in 11/26 (42.3%) patients, and the epiglottis was involved in 4/26 (15.4%). Evidence of multilevel collapse was observed in 6/26 (23.1%) patients. Patients observed to have palatal collapse underwent a pharyngoplasty (20/26; 76.9%) at the time of adenotonsillectomy. Three (11.5%) patients underwent a tongue reduction.
Conclusion:
This study provides additional evidence that DISE can affect intra-operative decision making, with the potential for improved post-operative outcomes. A randomized controlled study is needed to determine if these outcomes are better than what can be achieved without DISE.
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