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Updated: Aug 31, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea
Kaci DeJarnette1, Robert M Frederick1, Atia J Harris2
1University of Tennessee Health Science Center College of Medicine, 910 Madison Ave Ste. 1031, Memphis, TN, 38163, USA.
Insights
The VOTE score shows a weak correlation with improved outcomes in pediatric obstructive sleep apnea (OSA). Further research with larger sample sizes is needed to validate the VOTE system for pediatric OSA assessment.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Obstructive Sleep Apnea (OSA) affects 1-4% of U.S. children.
- Drug-Induced Sleep Endoscopy (DISE) and the VOTE classification system are used to identify obstruction levels in OSA.
- The VOTE system is validated in adults, but its utility in pediatric OSA requires investigation.
Purpose of the Study:
- To determine if the VOTE score predicts postoperative outcomes in pediatric OSA patients.
- To assess the correlation between VOTE scores and polysomnography (PSG) parameters post-treatment.
Main Methods:
- Retrospective chart review of 129 pediatric patients (ages 2-17) undergoing DISE.
- Inclusion criteria: DISE, and availability of preoperative and postoperative PSG data.
- 53 patients met the criteria for analysis.
Main Results:
- A weak positive correlation (r=0.35, p=0.01) was found between VOTE score and postoperative Apnea-Hypopnea Index (AHI).
- A significant inverse relationship was observed between postoperative O2 nadir and AHI (r=-0.627, p<0.0001).
- Significant improvements were noted in mean BMI (+1.6), AHI (-23.5), and O2 nadir (+14) postoperatively (p<0.0001).
Conclusions:
- The VOTE score demonstrated a correlation with improved postoperative AHI in pediatric OSA.
- A relationship exists between improved postoperative AHI and O2 nadir.
- Larger studies are recommended to validate the VOTE system for pediatric OSA, or alternative scoring systems may be necessary.
Objectives:
Obstructive Sleep Apnea (OSA) affects 1-4% of the pediatric population in the U.S. Drug-Induced Sleep Endoscopy (DISE) is widely used to localize the level(s) of obstruction. The VOTE classification system is used to grade obstructions found at the velum, oropharynx, base of tongue, and epiglottis and has been validated in adults. This study aims to determine if the VOTE score has any predictive value in pediatric OSA postoperative outcomes.
Methods:
A retrospective chart review of 129 patients from January 7, 2016 to 05/30/2020 was performed. Included patients were between the ages of 2 and 17, undergoing DISE, and if they had preoperative and postoperative polysomnography (PSG) data. Excluded patients did not meet one of the above or had other comorbidities contributing to their sleep apnea. 53 patients were included.
Results:
Pearson's Correlation tests compared intraoperative VOTE score to postoperative BMI, AHI, and O2 nadir and their relationships. We found a weakly positive correlation between the VOTE and postoperative AHI with a coefficient of 0.35 and a p-value of 0.01. We found a relationship between postoperative O2 nadir and AHI, with a coefficient of -0.627 and a p-value <0.0001. Finally, a paired, two-tailed t-test compared the mean change between preoperative and postoperative BMIs (+1.6), oAHIs (-23.5), and O2 nadirs (+14), all with p-value <0.0001.
Conclusion:
We demonstrated a correlation between VOTE and improved postoperative AHI and a relationship between improved postoperative AHI and postoperative O2 nadir. The validity of VOTE may be proven with larger sample size. Alternatively, a different scoring system may be required for pediatric OSA.
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