DISE Findings Across Comorbidity Groups and Surgical Status in Pediatric Sleep-Disordered Breathing

Area of Science:

• Pediatric Otolaryngology
• Sleep Medicine
• Respiratory Physiology

Background:

• Obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB) are significant pediatric health concerns.
• Drug-induced sleep endoscopy (DISE) is increasingly utilized for evaluating pediatric OSA/SDB, especially in complex cases.
• Understanding upper airway obstruction patterns is crucial for effective management.

Purpose of the Study:

• To characterize the anatomical obstruction patterns identified by DISE in pediatric patients with OSA/SDB.
• To compare DISE findings between surgically naive children and those who have undergone adenotonsillectomy (T&A).
• To analyze the influence of comorbidities, specifically Down syndrome and overweight/obesity, on DISE findings.

Main Methods:

• A systematic literature search was performed across major databases (PubMed/MEDLINE, Cochrane Library, EMBASE) until September 2024.
• Studies meeting strict inclusion criteria were selected, involving 1415 pediatric patients.
• Data analysis included forest plots generated using R software to synthesize findings.

Main Results:

• Post-T&A patients showed reduced adenoid and lateral wall/tonsillar obstruction but often required revision surgery (56.4%).
• Tongue base obstruction was more frequent in post-T&A children, particularly those with Down syndrome or no comorbidities.
• Multisite obstruction varied, being highest in surgically naive Down syndrome patients and in post-T&A patients without comorbidities.

Conclusions:

• DISE highlights significant variability in airway obstruction patterns in pediatric OSA/SDB.
• These patterns are influenced by surgical status and the presence of comorbidities like Down syndrome and obesity.
• DISE findings underscore the complexity of pediatric OSA/SDB and inform personalized treatment approaches.