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Updated: Dec 11, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
[Comparison and intervention of differences in upper airway obstruction in children with OSAS between awake and
Shan He1, Ruidong Zhang2, Shuwei Ma1
1Department of Otolaryngology，Shanghai Children's Medical Center Affiliated with Shanghai Jiaotong University School of Medicine，Shanghai，200127，China.
Insights
Drug-induced sleep endoscopy (DISE) effectively identifies upper airway obstructions in pediatric obstructive sleep apnea syndrome (OSAS). DISE-guided surgery led to better respiratory disturbance index improvements compared to standard care.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Surgical Diagnostics
Background:
- Obstructive sleep apnea syndrome (OSAS) in children often involves upper airway obstruction.
- Accurate localization of obstruction is crucial for effective surgical planning in pediatric OSAS.
- Drug-induced sleep endoscopy (DISE) is a tool for assessing airway collapse during sleep.
Purpose of the Study:
- To compare upper airway obstruction sites, degrees, and patterns using DISE versus awake endoscopy in children with OSAS.
- To evaluate the benefit of DISE-guided surgery for pediatric OSAS.
- To analyze differences in obstruction patterns under sedation versus wakefulness.
Main Methods:
- Retrospective case series of pediatric OSAS patients with adenoid hypertrophy and mild tonsillar hypertrophy.
- Patients underwent pre- and post-operative pulse oximetry.
- DISE was performed before adenoidectomy; tonsillectomy was added if oropharyngeal obstruction was identified. A control group without DISE was included.
Main Results:
- DISE revealed significant differences in obstruction patterns at the velum, tongue base, and epiglottis compared to awake endoscopy.
- DISE identified grade 2 oropharyngeal obstruction in 45.2% of cases, often with mild tonsillar hypertrophy.
- Both groups showed improved respiratory disturbance index (RDI) and oxygen saturation post-surgery, with significantly better RDI improvement in the DISE group (P=0.04).
Conclusions:
- DISE is effective in evaluating the sites and severity of upper airway obstruction in pediatric OSAS.
- DISE aids in creating personalized surgical plans for children with OSAS.
- DISE-guided surgery demonstrated superior improvement in RDI compared to non-DISE approaches.
Abstract:
Objective:Drug induced sleep endoscopy（DISE） is a useful tool to locate the upper airway obstructions in patients with obstructive sleep apnea syndrome（OSAS）. The goal of our research was to compare the sites, degree and patterns of upper airway obstruction detected by DISE versus endoscopy in awake children. The benefit of DISE-mediated upper airway surgery in pediatric OSAS was evaluated. Method:This is a retrospective case series of children with OSAS who had adenoid hypertrophy（the area where adenoids block the postnaris ≥2/3） and tonsils ≤2 degrees（Friedman classification method） . All children underwent sleep monitoring by pulse oximeter before and after operation. DISE was performed before adenoidectomy in DISE group. If obstruction of oropharynx caused by tonsils was found, tonsillectomy was performed at the same time with adenoidectomy. The children who did not undergo DISE before operation were enrolled in the control group. Differences in the degrees and patterns of upper airway obstruction in the DISE group under wakefulness and drug induction were analyzed. Result:The study included 126 children in DISE group, and 200 children in control group. In the DISE group, 56 cases（44.4%） had grade 2 tonsils, and 70 cases（55.6%） had grade 1 tonsils. The patterns of obstruction at velum, tongue base and epiglottis were significantly different in DISE compared with awake endoscopy（P<0.05）; the patterns of obstruction at adenoid and oropharynx were the same in both techniques. There were significant differences in endoscopy scores between the lateral wall of oropharynx and the tongue base（P<0.05）. DISE revealed 57 （45.2%） cases had grade 2 obstruction in the oropharyngeal level. Among them, 44 cases （34.9%） had tonsils at 2 degrees and 13 cases （10.3%） had tonsils at 1 degrees.. There was an improvement in respiratory disturbance index（RDI） and oxygen saturation nadir in the DISE and control groups 1 year after surgery（P<0.05）, and the RDI improvement was better in the DISE group compared with controls（P=0.04）. Conclusion:DISE is an effective method to evaluate the sites and severity of upper airway obstruction in children with OSAS, which was conductive to make the upper airway personalized surgical plan for patients.
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