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Updated: Aug 16, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Drug-induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2-year follow up
Robert M Frederick1, Josiah Brandt1, Anthony Sheyn1
1Department of Otolaryngology, College of Medicine University of Tennessee Health Science Center Memphis Tennessee USA.
Insights
Sleep endoscopy (DISE) effectively improves surgical outcomes for pediatric obstructive sleep apnea (OSA). DISE aided in significantly reducing the mean apnea-hypopnea index in young patients undergoing initial surgery.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Surgical Innovation
Background:
- Obstructive sleep apnea (OSA) is a significant health concern in children.
- Accurate surgical planning is crucial for effective treatment of pediatric OSA.
- Drug-induced sleep endoscopy (DISE) offers detailed airway visualization.
Purpose of the Study:
- To evaluate the effectiveness of DISE in enhancing surgical outcomes for pediatric patients with moderate-to-severe OSA.
- To assess the impact of DISE-guided surgery on the apnea-hypopnea index (AHI).
Main Methods:
- Retrospective review of surgically naive pediatric patients (<18 years) with diagnosed moderate-to-severe OSA.
- Patients underwent DISE at the time of initial sleep surgery.
- Preoperative and postoperative polysomnograms were analyzed to determine surgical success, defined as a decrease in oxygen-related AHI by at least one diagnostic category.
Main Results:
- 106 patients completed the study with available polysomnograms.
- The mean preoperative oxygen-related AHI decreased significantly from 29.7 to 6.6 postoperatively (p < 0.001).
- Surgical success was achieved in 76.4% of patients, with 57.7% achieving an AHI <5.
Conclusions:
- DISE is a valuable tool for guiding initial surgical interventions in pediatric patients with severe OSA.
- Utilizing DISE during initial surgery significantly reduces the mean AHI in surgically naive pediatric patients.
- DISE aids in achieving better surgical outcomes and reducing residual OSA in children.
Objective:
To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA.
Methods:
This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate-severe OSA who underwent DISE at the time of initial sleep surgery. Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1.
Results:
A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI% of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85.
Conclusion:
This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI.
Level Of Evidence:
Level III.
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