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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Clinical Application of Pediatric Sleep Endoscopy: An International Survey
Giannicola Iannella1, Giuseppe Magliulo1, Antonio Greco1
1Department of Organi di Senso, Sapienza University, 00185 Rome, Italy.
Insights
Drug-induced sleep endoscopy (DISE) is a safe and effective tool for diagnosing obstructive sleep apnea (OSA) in children, especially after surgery. However, its clinical application varies significantly across sleep centers internationally.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Diagnostic Procedures
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Drug-induced sleep endoscopy (DISE) aids in identifying airway obstruction.
- Standardization of pediatric DISE protocols is lacking.
Purpose of the Study:
- To survey international experts on the clinical application of pediatric DISE.
- To clarify the use, indications, and protocols for pediatric DISE.
- To assess the perceived role of DISE in managing pediatric OSA.
Main Methods:
- An international survey was developed by pediatric sleep apnea experts.
- The survey targeted sleep apnea specialists and OSA association members.
- 101 experts completed the survey, providing data on pediatric DISE practices.
Main Results:
- 63.4% of experts perform DISE in pediatric OSA patients.
- 81.9% consider DISE a first-line diagnostic step for persistent OSA post-adenotonsillectomy.
- 55.4% disagree with performing DISE during adenotonsillectomy to identify other collapse sites.
Conclusions:
- Pediatric DISE is recognized as safe and effective for identifying obstruction sites in children with residual OSA.
- DISE is valuable for children with craniofacial malformations, small tonsils, laryngomalacia, or Down syndrome.
- Despite its utility, pediatric DISE is not uniformly adopted in sleep centers worldwide.
Objectives:
To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE.
Methods:
A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations.
Results:
A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral.
Conclusion:
Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.
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