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Updated: Dec 24, 2025

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
07:54

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

Published on: December 6, 2016

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Effectiveness of pediatric drug-induced sleep endoscopy for REM-predominant obstructive sleep apnea

David F Smith1,2,3, Shan He1,4, Nithin S Peddireddy1

  • 1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2018, Cincinnati, OH, 45229-2018, USA.

Sleep & Breathing = Schlaf & Atmung
|April 12, 2020
PubMed

Insights

Dexmedetomidine/ketamine drug-induced sleep endoscopy (DISE) effectively identifies airway obstruction in children with REM-predominant obstructive sleep apnea (OSA). This approach aids in predicting surgical success for pediatric OSA patients without tonsillar hypertrophy.

Area of Science:

  • Pediatric Sleep Medicine
  • Otolaryngology
  • Anesthesiology

Background:

  • Dexmedetomidine (DEX) sedation mimics non-rapid eye movement (NREM) sleep, raising questions about its use in REM-predominant obstructive sleep apnea (OSA).
  • Identifying specific sites of airway obstruction is crucial for effective treatment planning in pediatric OSA.

Purpose of the Study:

  • To evaluate the effectiveness of pediatric drug-induced sleep endoscopy (DISE) using DEX and ketamine in children with REM-predominant OSA.
  • To determine if DISE can identify at least one site of obstruction in these patients.

Main Methods:

  • A retrospective case series of 56 children without tonsillar hypertrophy undergoing DISE.
  • Patients underwent polysomnography (PSG) before and after surgery.
  • DISE utilized dexmedetomidine (DEX) and ketamine for sedation.

Main Results:

  • DISE identified at least one obstruction site in all patients, irrespective of REM- or NREM-predominance.
  • Significant improvements in obstructive apnea-hypopnea index (oAHI) were observed in both REM- and NREM-predominant OSA groups post-surgery.
  • Children with REM-predominant OSA showed significant improvements in saturation nadir, total sleep time, and sleep efficiency.

Conclusions:

  • DISE with DEX/ketamine is effective in identifying airway obstruction in children with OSA, including those with REM-predominance.
  • DISE-guided treatment led to significant improvements in oAHI, sleep metrics, and oxygen saturation post-surgery.
  • This diagnostic tool aids in predicting surgical outcomes for pediatric OSA patients without tonsillar hypertrophy.
Abstract

Keywords:
DISEDrug-induced sleep endoscopyInfantOSAObstructive sleep apneaOutcomesPediatricPersistentREM-predominantRapid eye movement sleep

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