Does drug induced sleep endoscopy induce upper airway obstruction?

Area of Science:

• Pediatric Pulmonology
• Sleep Medicine
• Otolaryngology

Background:

• Drug-induced sleep endoscopy (DISE) is used to diagnose obstructive sleep apnea syndrome (OSAS).
• Concerns exist that anesthesia during DISE may induce or exacerbate airway obstruction not present during natural sleep.
• This study investigated airway obstruction during bronchoscopy in children with varied indications.

Purpose of the Study:

• To determine the prevalence of airway obstruction during bronchoscopy in children, particularly those without a clinical history suggestive of OSAS.
• To assess the impact of anesthesia on airway findings during pediatric bronchoscopy.
• To correlate pediatric sleep questionnaire (PSQ) results with bronchoscopic findings (VOTE score).

Main Methods:

• Children undergoing bronchoscopy for any indication were included.
• Pediatric Sleep Questionnaire (PSQ) and VOTE scores were recorded.
• Analysis focused on the association between PSQ results and VOTE scores, especially in children with normal PSQ but suggestive obstruction.

Main Results:

• Out of 116 investigations, 99 patients had a negative PSQ; 75% showed some, and 21% complete, bronchoscopic airway obstruction.
• Of 93 children without reported snoring, 73% had some, and 16% complete, obstruction.
• Among 30 children investigated for snoring, 97% had some, and 77% complete, obstruction.

Conclusions:

• A significant percentage of children exhibit bronchoscopic airway obstruction despite lacking a clear clinical history of OSAS.
• Anesthesia during bronchoscopy may induce or amplify airway obstruction findings.
• Clinicians must consider procedure-induced changes when interpreting findings for therapeutic or surgical decisions in pediatric OSAS assessment.