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

Drug-induced sleep endoscopy (DISE) has gained popularity for evaluating obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB) in children, particularly those with comorbidities or residual disease after adenotonsillectomy (T&A). This study aimed to characterize DISE findings in pediatric OSA/SDB across surgical status (surgically naive vs. post-T&A) and comorbidities (Down syndrome and overweight/obese children).

A literature search was conducted in Pubmed/MEDLINE, Cochrane Library, and EMBASE.

Terms including "Sleep Apnea Syndromes," "Pediatrics," "Sedation," and "Endoscopy," were used, covering the databases until September 2024. Strict inclusion criteria were applied. Forest plots were generated using R software.

Three hundred and fifty articles were identified, with 16 meeting inclusion criteria, involving 1415 pediatric patients. Across all subgroups, post-T&A children demonstrated less adenoid and lateral wall/tonsillar obstruction; however, revision T&A/adenoidectomy/tonsillectomy remained the most common surgical intervention (56.4%) for residual OSA/SDB. Palatal obstruction was less prevalent in children post-T&A compared to surgically naïve counterparts. Tongue base obstruction was more prevalent in children post-T&A, particularly in those with Down syndrome (naïve: 50%, 95% CI: 25%-75%; post-T&A: 92%, 95% CI: 32%-100%) and in children with no comorbidities (naïve: 24%, 95% CI: 11%-47%; post-T&A: 56%, 95% CI: 15%-91%). Among surgically naïve children, multisite obstruction was greatest in those with Down syndrome (71%, 95% CI: 44%-89%) but was highest in children without comorbidities post-T&A.

DISE demonstrates substantial variability in anatomic obstruction patterns among children with OSA/SDB, underscoring the complexity of the disease, particularly in children with obesity, Down syndrome, or residual disease following T&A.