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Multiple Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea: Obstruction Patterns and Outcomes.

Daniel R S Habib1,2, Liliana Arida-Moody1,2, Ankita Patro1,3

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The Annals of Otology, Rhinology, and Laryngology
|October 23, 2025
PubMed
Summary

Pediatric obstructive sleep apnea (OSA) often involves multilevel airway obstruction, particularly in obese children. While single surgeries guided by drug-induced sleep endoscopy (DISE) improve outcomes, multiple procedures show diminishing returns.

Keywords:
adenotonsillectomydrug-induced sleep endoscopyobesitypediatric OSA surgical treatmentpediatric obstructive sleep apneaquality of life

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Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Surgical Outcomes Research

Background:

  • Residual obstructive sleep apnea (OSA) after adenotonsillectomy (AT) is common in pediatric patients, especially those with obesity.
  • Drug-induced sleep endoscopy (DISE) is crucial for identifying upper airway obstruction and guiding surgical interventions.
  • A knowledge gap exists regarding the effectiveness of multiple DISE-directed treatments for pediatric OSA.

Purpose of the Study:

  • To evaluate the outcomes of multiple DISE-directed procedures for pediatric OSA.
  • To analyze obstruction patterns and the impact of body mass index (BMI) in these patients.
  • To compare the efficacy of single versus multiple DISE-guided interventions.

Main Methods:

  • Retrospective cohort study of pediatric patients undergoing DISE-directed interventions (2009-2020).
  • Collected data on patient demographics, DISE timing, obstruction patterns, obstructive apnea-hypopnea index (OAHI), and OSA-18 quality-of-life (QOL) scores.
  • Used chi-square and unpaired t-tests to compare outcomes between single and multiple DISE groups, and between high vs. normal BMI groups.

Main Results:

  • 22% of 122 children underwent multiple DISE procedures, with younger age and higher BMI associated with multiple interventions.
  • Common obstructions at second DISE included the epiglottis (74%), adenoid (67%), and inferior turbinates (56%).
  • Single DISE interventions significantly improved OAHI and OSA-18 scores, while multiple procedures showed non-significant improvements.

Conclusions:

  • Pediatric OSA frequently presents with persistent, multilevel obstruction, particularly in younger, high-BMI patients requiring multiple DISE procedures.
  • Anatomy-guided, patient-specific surgical planning is recommended for high-risk pediatric OSA patients.
  • While single DISE-directed interventions offer significant benefits, the utility of repeated procedures requires careful consideration of timing and potential diminishing returns.