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Updated: Sep 22, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Sleep Endoscopy and Cine Magnetic Resonance Imaging Evaluation of Children With Persistent Obstructive Sleep Apnea
Carol Li1, Yann-Fuu Kou1, Michael A DeMarcantonio1,2
1Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Drug-induced sleep endoscopy (DISE) and cine MRI offer complementary insights into persistent obstructive sleep apnea in children. DISE excels at evaluating nasal and supraglottic areas, while MRI provides superior soft tissue detail.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Diagnostic Imaging
Background:
- Persistent obstructive sleep apnea (POSA) after adenotonsillectomy requires accurate upper airway assessment.
- Drug-induced sleep endoscopy (DISE) and cine magnetic resonance imaging (MRI) are advanced diagnostic tools for POSA.
- Comparing these modalities is crucial for optimizing diagnostic strategies.
Purpose of the Study:
- To compare the findings of same-day cine MRI and DISE in children with POSA.
- To determine the unique contributions of each technique in evaluating persistent upper airway obstruction.
- To assess the agreement between cine MRI and DISE for specific obstruction sites.
Main Methods:
- Retrospective cohort study of 137 pediatric patients undergoing same-day cine MRI and DISE.
- Chart review for descriptive statistics and Cohen kappa coefficients to assess agreement.
- Analysis focused on obstruction at adenoids, lingual tonsils, and tongue base.
Main Results:
- DISE identified more multilevel obstructions (94.9%) than cine MRI (48.2%).
- Common DISE obstruction sites: tongue base (86.9%), velum (78.7%), epiglottis (74.5%).
- Common cine MRI obstruction sites: hypopharynx (56.3%), tongue base (44.8%). Moderate agreement for adenoids (κ=0.53), poor for lingual tonsils (κ=0.15) and tongue base (κ=0.09).
Conclusions:
- DISE provides better visualization of nasal and supraglottic obstruction, distinguishing partial vs. complete collapse.
- Cine MRI offers superior soft tissue resolution for lymphoid hypertrophy and a global airway view.
- Cine MRI and DISE are complementary tools for evaluating pediatric POSA.
Objective:
To compare findings of same-day cine magnetic resonance imaging (MRI) and drug-induced sleep endoscopy (DISE) and examine how each technique uniquely contributes to the evaluation of persistent obstructive sleep apnea following adenotonsillectomy.
Study Design:
Retrospective cohort study.
Setting:
Quaternary care center.
Methods:
Chart review was performed for consecutive patients who underwent same-day cine MRI and DISE between 2015 and 2020. Descriptive statistics are reported, and Cohen kappa coefficients were calculated to evaluate the agreement between cine MRI and DISE for obstruction at the adenoids, lingual tonsils, and tongue base.
Results:
There were 137 patients, the mean age was 10.4 years (95% CI, 3.2-16.7), and 62.8% were male. The most common sites of obstruction on DISE were the tongue base (86.9%), velum (78.7%), epiglottis (74.5%), inferior turbinate (68.6%), and lingual tonsil (61.3%). The most common sites of obstruction on cine MRI were the hypopharynx (56.3%), tongue base (44.8%), lingual tonsil (38.0%), and macroglossia (37.6%). There was moderate agreement for adenoid hypertrophy (κ = 0.53) and poor agreement for lingual tonsil hypertrophy (κ = 0.15) and tongue base obstruction (κ = 0.09). DISE identified more instances of multilevel obstruction when compared with cine MRI (94.9% vs 48.2%).
Conclusion:
DISE offered a better examination of nasal and supraglottic obstruction and is sensitive to partial vs complete collapse, while cine MRI offered better soft tissue resolution for lymphoid tissue hypertrophy and provided a global view of primary and secondary airway obstruction. Cine MRI and DISE are complementary modalities in the evaluation of children with persistent obstructive sleep apnea.
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