Differences in upper airway endotype among phenotypically different pediatric OSA patients.

Area of Science:

• Pediatric Sleep Medicine
• Otolaryngology
• Genetics

Background:

• Obstructive sleep apnea (OSA) is a common condition in children.
• Drug-induced sleep endoscopy (DISE) helps identify upper airway (UA) obstruction patterns.
• Understanding UA endotypes in different pediatric phenotypes is crucial for effective treatment.

Purpose of the Study:

• To investigate variations in UA endotypes using DISE among children with OSA across distinct phenotypic groups.
• To compare disease severity and UA obstruction patterns in different pediatric OSA phenotypes.

Main Methods:

• Retrospective cohort study of 18 years or younger with polysomnography-confirmed OSA undergoing DISE.
• Phenotypic groups included: <2 years, typically developing (2-12 years), obesity, Down syndrome, and craniofacial abnormalities.
• DISE findings were analyzed to determine UA endotypes and obstruction levels.

Main Results:

• Adenotonsillar obstruction was prevalent across all phenotypes.
• Multilevel collapse with supraglottic involvement was frequent in children <2 years (63%) and those with Down syndrome (73%).
• Obese children showed isolated adenotonsillar obstruction, while younger and obese children had more severe OSA and hypoxemia.

Conclusions:

• Pediatric OSA exhibits diverse UA endotypes influenced by clinical phenotype.
• Integrating phenotypic information into diagnostic and treatment strategies can optimize surgical planning.
• Addressing phenotypic differences may reduce the likelihood of persistent OSA after intervention.