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Updated: Nov 23, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Expert Consensus Statement: Pediatric Drug-Induced Sleep Endoscopy
Cristina M Baldassari1, Derek J Lam2, Stacey L Ishman3
1Eastern Virginia Medical School / Children's Hospital of The King's Daughters, Norfolk, Virginia, USA.
Insights
Expert consensus was reached on 26 statements for pediatric drug-induced sleep endoscopy (DISE) in children, improving care for obstructive sleep apnea. Further research is needed for specific areas like adenotonsillectomy.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Diagnostic Procedures
Background:
- Obstructive sleep apnea (OSA) in children often requires diagnostic evaluation.
- Drug-induced sleep endoscopy (DISE) is a key procedure for assessing upper airway collapse in pediatric OSA.
- Standardization and consensus are needed to optimize pediatric DISE practices.
Purpose of the Study:
- To establish an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE).
- To clarify controversies and identify quality improvement opportunities in pediatric DISE.
- To provide guidance for clinicians managing pediatric OSA.
Main Methods:
- Development of consensus statements by expert group members.
- Systematic literature review to identify best available evidence.
- Delphi survey methodology with multiple iterations to achieve consensus.
Main Results:
- 26 consensus statements achieved across 50 initial topics, covering indications, protocol, and outcomes.
- 11 statements did not reach consensus, highlighting areas for further investigation.
- Key topics included indications, sedation, grading, complications, and surgical outcomes.
Conclusions:
- Expert consensus provides a framework for improving pediatric DISE quality and care.
- The consensus statements can inform clinical policy and protocols.
- Further research, including randomized controlled trials, is recommended for unresolved controversies.
Objective:
To develop an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE) that clarifies controversies and offers opportunities for quality improvement. Pediatric DISE was defined as flexible endoscopy to examine the upper airway of a child with obstructive sleep apnea who is sedated and asleep.
Methods:
Development group members with expertise in pediatric DISE followed established guidelines for developing consensus statements. A search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements regarding DISE in children 0 to 18 years old. Topics with significant practice variation and those that would improve the quality of patient care were prioritized.
Results:
The development group identified 59 candidate consensus statements, based on 50 initial proposed topics, that focused on addressing the following high-yield topics: (1) indications and utility, (2) protocol, (3) optimal sedation, (4) grading and interpretation, (5) complications and safety, and (6) outcomes for DISE-directed surgery. After 2 iterations of the Delphi survey and removal of duplicative statements, 26 statements met the criteria for consensus; 11 statements were designated as no consensus. Several areas, such as the role of DISE at the time of adenotonsillectomy, were identified as needing further research.
Conclusion:
Expert consensus was achieved for 26 statements pertaining to indications, protocol, and outcomes for pediatric DISE. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to pediatric DISE.
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