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Updated: Dec 31, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Polysomnography outcomes of sleep endoscopy-directed intervention in surgically naïve children at risk for persistent
Erin Kirkham1,2, Cheng-Cheng Ma3, Natalia Filipek3
1Department of Otolaryngology: Head and Neck Surgery, The University of Michigan, Ann Arbor, MI, USA. ekirkham@umich.edu.
Insights
Drug-induced sleep endoscopy (DISE) guided treatment for surgically naive children with obstructive sleep apnea (OSA) led to significant improvements. DISE identified alternative interventions in over half of high-risk children, improving their OSA outcomes.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Sleep Surgery
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Adenotonsillectomy (AT) is a primary treatment for pediatric OSA.
- The utility of Drug-induced sleep endoscopy (DISE) in surgically naive children at high risk for persistent OSA after AT is not well-established.
Purpose of the Study:
- To evaluate the outcomes of DISE-directed interventions in surgically naive children with OSA who were considered at high risk for persistent disease after AT.
- To assess the effectiveness of DISE in guiding surgical or non-surgical management in this specific pediatric population.
Main Methods:
- A case series of 62 surgically naive children with OSA at high risk for persistence after AT was conducted.
- Children underwent DISE-directed intervention between 2012 and 2016.
- Pre- and postoperative polysomnography data were analyzed using paired t tests.
Main Results:
- The study included children with a mean age of 5.9 years; 68% were male, 18% obese, and 38% had syndromic diagnoses.
- DISE led to interventions other than AT in 58% of cases, including multilevel surgery in 18%.
- Significant improvements were observed in key polysomnography parameters, including a reduction in obstructive apnea-hypopnea index (oAHI) from 22.2 to 7.2 (p < 0.01) and an increase in oxygen nadir from 82 to 87 (p < 0.01).
Conclusions:
- DISE is valuable in identifying appropriate interventions for surgically naive children with OSA at high risk for persistence.
- DISE-directed management significantly improved postoperative OSA parameters in this cohort.
- The findings support the use of DISE to tailor treatment strategies in complex pediatric OSA cases.
Purpose:
Drug-induced sleep endoscopy (DISE) is useful in children with obstructive sleep apnea (OSA) that persists after adenotonsillectomy (AT), but its utility in surgically naïve children is unclear. We report polysomnography outcomes of surgically naïve children who underwent DISE-directed intervention because they were considered high risk for persistent OSA after adenotonsillectomy.
Methods:
This study is a case series of 62 surgically naïve children with OSA who were considered high risk for persistence after AT and underwent DISE-directed intervention with pre- and postoperative polysomnography between 2012 and 2016. Analysis was performed with the paired t test.
Results:
Children were on average 5.9 (± 5.5, 0.2-18.6) years old at the time of surgery, 68% male, 18% obese, and 60% white. Thirty-eight percent had a syndromic diagnosis: 19% trisomy 21, 11% hypotonic neuromuscular disorder, and 8% craniofacial condition. The remaining 62% were non-syndromic but underwent DISE because they had at least one risk factor for OSA persistence after AT (age > 7 years, black race, 1+ tonsils, obesity, and/or severe OSA). Forty-two percent underwent AT, while 58% underwent treatment other than AT, including 18% who had multilevel surgery. Children improved significantly in 4 out of 5 polysomnography parameters tested, including obstructive apnea-hypopnea index (oAHI; 22.2 to 7.2, p < 0.01) and oxygen nadir (82 to 87, p < 0.01). Thirty-eight (61%) had a postoperative oAHI < 5; 16 (21%) had a postoperative oAHI < 2.
Conclusion:
DISE resulted in intervention other than AT in 58% of surgically naïve children at high risk for persistent OSA after AT. DISE-directed intervention resulted in significant mean improvement in postoperative OSA.
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