Related Experiment Video
Updated: Aug 6, 2026
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Precision in Pediatric Obstructive Sleep Apnea: Preventing Unnecessary Surgery Using Drug-Induced Sleep Endoscopy
Sofia Freitas1, Ana S Cruz1, Isabel E Costa2
1Anesthesiology, Unidade Local de Saúde de Braga, Braga, PRT.
Insights
Drug-induced sleep endoscopy (DISE) identified positional epiglottic collapse as the main cause of severe obstructive sleep apnea (OSA) in an obese child, guiding personalized treatment and avoiding unnecessary surgery.
Area of Science:
- Pediatric Pulmonology
- Otolaryngology
- Sleep Medicine
Background:
- Pediatric obstructive sleep apnea (OSA) diagnosis can be challenging, as awake assessments may not reveal the true site of upper airway obstruction.
- Drug-induced sleep endoscopy (DISE) offers a dynamic evaluation under sleep conditions, crucial for identifying obstruction patterns, especially in high-risk children.
- Obesity and neurocognitive impairment are significant factors in severe pediatric OSA.
Abstract:
Pediatric obstructive sleep apnea (OSA) is often multifactorial, and awake airway assessment may fail to accurately identify the sites of upper airway obstruction. Drug-induced sleep endoscopy (DISE) enables dynamic evaluation of the upper airway under sleep-like conditions and may be particularly valuable in children at an increased risk of persistent OSA after adenotonsillectomy. We report the case of a 10-year-old girl with severe OSA, obesity (body mass index: 31.04 kg/m², above the 99th percentile), and neurocognitive impairment, in whom awake assessment suggested adenotonsillar hypertrophy as the presumed primary contributor to obstruction. During sleep-state evaluation, DISE demonstrated isolated positional epiglottic collapse as the dominant dynamic finding, refining the assessment of the obstruction pattern and supporting avoidance of adenotonsillectomy. This case highlights the role of DISE in guiding individualized, anatomy-based management of pediatric OSA and emphasizes the importance of carefully titrated anesthesia to ensure accurate assessment of airway dynamics.
