Does drug induced sleep endoscopy induce upper airway obstruction?

Drug induced sleep endoscopy (DISE) is employed to assess the source of obstructive sleep apnea syndrome (OSAS). We suspected that the anesthesia for the procedure induces airway obstruction that does not occur during natural sleep. In order to explore this possibility, we looked for airway obstruction during bronchoscopy in children with a broad range of indications. MethodsChildren undergoing bronchoscopy for any indication were included. The pediatric sleep questionnaire (PSQ) for OSAS and the VOTE score were recorded. We analyzed the association between the PSQ results and the VOTE score, focusing on the subgroup of patients with a normal PSQ but with findings suggestive of airway obstruction.

A total of 116 investigations were included in the main analysis. Ninety nine patients had a negative PSQ questionnaire of whom, 75 % had some bronchoscopic evidence of airway obstruction and 21 % had complete airway obstruction. There were 93 children whose primary caregivers did not report snoring. Of these, 73 % had some bronchoscopic evidence of airway obstruction and 16 % had complete airway obstruction. A further 30 children presented for the investigation of snoring of whom 97 % had some bronchoscopic evidence of airway obstruction and 77 % had complete airway obstruction.

This study demonstrated a high percentage of children with no clinical history suggesting OSAS but who had bronchoscopic evidence of obstruction. When performing a bronchoscopy to assess OSAS, clinicians should be aware that the procedure may induce or exaggerate findings that must be taken into account before making therapeutic or surgical decisions.