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Updated: May 11, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Evaluation of Sleep Stages During Drug-Induced Sleep Endoscopy in Pediatric Patients with Obstructive Sleep Apnea: A
Audrey Abend1, Chase Hintelmann1, Katherine H Dinh1
1Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Insights
This pilot study explored sleep stages in children with obstructive sleep apnea (OSA) during drug-induced sleep endoscopy (DISE). Most children experienced N2 sleep, with no REM sleep observed, providing initial insights into DISE neurophysiology.
Area of Science:
- Pediatric Sleep Medicine
- Neurophysiology
- Sleep Endoscopy
Background:
- Drug-induced sleep endoscopy (DISE) is crucial for evaluating upper airway obstruction in pediatric obstructive sleep apnea (OSA).
- Understanding the neurophysiological changes during DISE-induced sleep is limited.
- This study investigates sleep stages in children undergoing DISE.
Purpose of the Study:
- To demonstrate the safety and feasibility of collecting sleep stage data during DISE in pediatric OSA patients.
- To characterize the sleep architecture of pediatric OSA patients during DISE.
Main Methods:
- Prospective cohort pilot study conducted at an academic medical center.
- Recruited 13 pediatric patients (3-13 years) with OSA, excluding those with craniofacial abnormalities or non-English/Spanish speaking.
- Collected electroencephalogram (EEG), electrooculogram (EOG), and electromyogram (EMG) data during DISE, primarily using dexmedetomidine sedation.
Main Results:
- EEG, EOG, and EMG data were successfully collected and scored.
- Sleep stages observed included N1 (6 subjects), N2 (12 subjects), and N3 (5 subjects).
- The majority of sleep time was spent in N2 sleep; no REM sleep was recorded.
Conclusions:
- This pilot study offers the first insights into sleep stages during DISE in pediatric OSA patients.
- Further research is needed to explore the neurophysiology and anesthetic effects during DISE.
- Findings highlight the potential for detailed sleep analysis during DISE procedures.
Introduction:
Drug-induced sleep endoscopy (DISE) is a valuable tool for the assessment of the upper airway in paediatric obstructive sleep apnoea (OSA). General anaesthesia induces sleep-like conditions during DISE; however, there is limited understanding of the neurophysiological aspects of this sleep. We conducted a prospective cohort pilot study recording electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) data in paediatric OSA patients during DISE.
Objectives:
Demonstrate the safety and feasibility of collecting sleep stages during DISE in paediatric patients with OSA. Characterise sleep stages of paediatric OSA patients undergoing DISE.
Design:
Prospective cohort pilot study.
Setting:
Academic medical centre.
Participants:
Patients between two (2) and 18 years old (inclusive) with a history of OSA and preoperative polysomnography (PSG) were recruited. Patients with known craniofacial abnormalities were excluded. Non-English or non-Spanish speaking subjects were excluded.
Results:
We recruited 13 subjects aged 3 to 13 years old. EEG, EOG, and EMG data was collected during the DISE procedure. Raw data was scored by a board-certified sleep medicine physician. Six subjects experienced N1 sleep, 12 subjects experienced N2 sleep, and 5 subjects experienced N3 sleep. Most subjects spent the majority of their time in N2 sleep. No subjects experienced REM sleep. The primary intravenous sedative agent used was dexmedetomidine.
Conclusion:
This pilot study gives the first insight into sleep stages of paediatric OSA patients undergoing DISE. Additional investigation of the neurophysiology and the effects of different intravenous anaesthetics during the DISE procedure is warranted.
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