Drug-Induced Sleep Endoscopy Findings in Children With Obstructive Sleep Apnea With vs Without Obesity or Down Syndrome

Hyzer, Jeffrey; Milczuk, Henry A.; MacArthur, Carol J.; King, Ericka; Quintanilla‐Dieck, Lourdes; Lam, Derek J.

doi:10.1001/jamaoto.2020.4548

Cited by 30 publications

(25 citation statements)

References 33 publications

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“…While it has long been hypothesized that the tongue plays a significant role in airway obstruction in T21 patients, to our knowledge, ours is the first report on this subject in adults. These results are grossly consistent with similar studies in children 4 . A difference in the incidence of a significant base of tongue collapse without significant velum collapse between T21 patients and controls suggests that craniofacial and airway muscle tone factors may play a significant role in the pathogenesis of OSA in T21 patients.…”

Section: Discussionsupporting

confidence: 90%

“…3 Children with T21 and OSA often demonstrate a multi-level pattern of upper airway collapse, namely at the tongue base, oropharynx, and arytenoids, on DISE that significantly differs from obese and nonobese controls. 4 In a case report of three adults with T21 by Li et al, DISE did not show any complete circumferential collapse at the velum in any patients. 5 To our knowledge, however, the patterns of airway collapse on DISE in adults with T21 and OSA have not been compared to those in adults without T21, which, therefore, is the focus of this report.…”

Section: Introductionmentioning

confidence: 82%

“…These results are grossly consistent with similar studies in children. 4 A difference in the incidence of a significant base of tongue collapse without significant velum collapse between T21 patients and controls suggests that craniofacial and airway muscle tone factors may play a significant role in the pathogenesis of OSA in T21 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Drug‐induced sleep endoscopy (DISE) is a useful tool to characterize the anatomic patterns of collapse and can help guide surgical intervention in this setting 3 . Children with T21 and OSA often demonstrate a multi‐level pattern of upper airway collapse, namely at the tongue base, oropharynx, and arytenoids, on DISE that significantly differs from obese and nonobese controls 4 . In a case report of three adults with T21 by Li et al, DISE did not show any complete circumferential collapse at the velum in any patients 5 .…”

Section: Introductionmentioning

confidence: 99%

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Sleep Endoscopy Patterns in Six Adults With Trisomy 21 and Obstructive Sleep Apnea

2021

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Obstructive sleep apnea (OSA) is prevalent amongst individuals with Trisomy 21 (T21). This case series describes the results of drug-induced sleep endoscopy of six adult patients with OSA and T21 and compares the patterns of collapse to those observed in adults without T21. Predominantly hypopharyngeal airway collapse was found in four of the six (66.7%) subjects with T21, a much higher proportion than in the general population. This finding may implicate anatomic differences underlying the increased prevalence of OSA in individuals with T21 and may have treatment implications.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleep Endoscopy Patterns in Six Adults With Trisomy 21 and Obstructive Sleep Apnea

2021

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“…Hyzer et al concluded that the pattern of upper airway collapse as identified through DISE, is different in surgically naïve children with obesity compared to those with DS. These authors recommend DISE in surgically naïve children with DS to guide treatment [11]. Akkina et al also concluded that DISE-directed surgery may be beneficial for children with DS and OSA [12].…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Disorders in Down Syndrome’s Children with and without Lower Airway Anomalies

et al. 2021

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(1) Background: Obstructive sleep apnea (OSA) and lower airway anomalies are both highly prevalent in children with Down syndrome (DS). However, little is known on the interaction between both. We aim to investigate the co-occurrence of OSA (defined as obstructive apnea/hypopnea index (oAHI) ≥ 2/h) and lower airway anomalies in children with DS and explore their impact on OSA severity and treatment outcome. (2) Methods: Retrospective analysis of data from airway endoscopy and polysomnography (PSG) in a cohort of children with DS. (3) Results: Data on both lower airway evaluation and PSG were available for 70 patients with DS. Our study population was relatively young (mean age 3.5 years), not obese and presented with severe OSA (mean oAHI 13.1/h). Airway anomalies were found in 49/70 children (70%), most frequently laryngomalacia, tracheomalacia or a combined airway malformation. In the remaining 21 cases (30%), endoscopy was normal. A comparison between both groups showed a similar distribution of gender, age and BMI z-scores. The prevalence of OSA was not significantly higher in DS patients with airway anomalies (89.6% vs 71.4%, p = 0.078). Additionally, OSA severity or treatment choice (conservative, upper airway surgery or CPAP) were not significantly different. Follow-up data (available for 49/70 patients) showed a significant improvement of OSA in both groups. There is a not significant tendency to more patients with persistent OSA among those with lower airway anomalies (34.3% vs 7.1%, p = 0.075). (4) Conclusions: We found no significant differences in OSA severity, treatment choice or outcome between children with DS with and without lower airway anomalies. Further studies should investigate the role of DISE-directed treatment and compare the outcome of different treatment modalities in larger patient groups.

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Drug-Induced Sleep Endoscopy Differences by Age in Surgically Naive Children With Sleep-Disordered Breathing

Herzig

Hildebrand

Nguyen

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceDrug-induced sleep endoscopy (DISE) is increasingly used to guide treatment decisions in children with sleep-disordered breathing (SDB). Previous reports of DISE findings in children have typically included a broad age range, but it is unclear how these patterns of obstruction vary with age.ObjectiveTo compare patterns of airway obstruction observed during DISE in 3 age groups of surgically naive children with SDB.Design, Setting, and ParticipantsThis cross-sectional analysis of a prospective cohort of surgically naive nonsyndromic children with SDB or obstructive sleep apnea [OSA] at risk for residual disease after adenotonsillectomy (defined as having at least 1 of these criteria: severe OSA, older than 7 years, obesity, or Black race) who were recruited between May 1, 2015, and February 28, 2020, was conducted at a tertiary children’s hospital. Data analysis was conducted from September 2021 to February 2022.ExposuresDISE.Main Outcomes and MeasuresDISE findings were rated at 6 anatomic sites using the Sleep Endoscopy Rating Scale (SERS). The association between age and severity of obstruction at each anatomic site and overall were compared using correlation (Kendall τ) and ordinal logistic regression analysis.ResultsData from 288 children (144 girls [50%]; 20 American Indian/Alaska Native [7%], 4 Asian [1%], 19 Black [7%], 93 Hispanic [33%], 2 Middle Eastern [1%], 6 Native Hawaiian/Pacific Islander [2%], and 203 White [70%] individuals; median [IQR] age, 9.2 [7.0-11.7] years) were stratified by participant age into preschool (age 2-5 years; 27 [9%]), younger school-aged (age 5-10 years; 146 [51%]), and older school-aged (age 10-18 years; 115 [40%]). Among these subgroups, the prevalence of multilevel obstruction was 59%, 51%, and 30%, respectively. Increasing age was inversely correlated with obstruction of the nasal airway (τb, −0.19; 95% CI, −0.29 to −0.09), nasopharynx (τb, −0.20; 95% CI, −0.31 to −0.10), velopharynx (τb, −0.16; 95% CI, −0.26 to −0.06), and overall obstruction (SERS total score: τb, −0.24; 95% CI, −0.33 to −0.14). An adjusted analysis demonstrated an inverse association between age and nasopharyngeal obstruction (odds ratio [OR], 0.84; 95% CI, 0.76 to 0.92), SERS total score (OR, 0.83; 95% CI, 0.76 to 0.90), and the number of sites of complete obstruction (OR, 0.87; 95% CI, 0.87 to 0.95).Conclusions and RelevanceThis cross-sectional analysis of data from a prospective cohort study of surgically naive children with SDB found that preschool-aged children had more frequent multilevel obstruction, more severe overall obstruction, and nasopharyngeal obstruction compared with older children. Understanding the most common sites of obstruction and expected changes with age could inform personalized treatment for children with SDB.

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Drug-Induced Sleep Endoscopy Findings in Children With Obstructive Sleep Apnea With vs Without Obesity or Down Syndrome

Cited by 30 publications

References 33 publications

Sleep Endoscopy Patterns in Six Adults With Trisomy 21 and Obstructive Sleep Apnea

Sleep Endoscopy Patterns in Six Adults With Trisomy 21 and Obstructive Sleep Apnea

Obstructive Sleep Disorders in Down Syndrome’s Children with and without Lower Airway Anomalies

Drug-Induced Sleep Endoscopy Differences by Age in Surgically Naive Children With Sleep-Disordered Breathing

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