Contribution of drug-induced sleep endoscopy to the management of pediatric obstructive sleep apnea/hypopnea syndrome

Blanc, F.; Kennel, Titouan; Merklen, F P; Blanchet, C.; Mondain, M.

doi:10.1016/j.anorl.2019.09.001

Cited by 14 publications

(6 citation statements)

References 32 publications

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“… 45 A recent systematic review of pediatric patients with OSA by Saniasiaya et al 8 reported that DISE findings caused a change in the surgical plan for 30% of the patients. Similarly, Blanc et al 46 reported 31 patients with OSA/hypopnea syndrome and found that DISE caused a change in surgical treatment of obstruction sites in 45% of the patients.…”

Section: The Ability Of Dise To Change Management and Dise-directed Surgical Outcomesmentioning

confidence: 89%

Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Arganbright

Lee

Weatherly

2021

World j. otorhinolaryngol.-head neck surg.

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Section: The Ability Of Dise To Change Management and Dise-directed Surgical Outcomesmentioning

confidence: 89%

Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Arganbright

Lee

Weatherly

2021

World j. otorhinolaryngol.-head neck surg.

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“…DISE enables direct visualization of dynamic airway changes and, therefore, permits delineation of the site of obstruction and subsequent treatment planning [104]. As mentioned, DISE has rapidly gained momentum and the indications and guidelines for the use of this technique will likely emerge in the upcoming years [105][106][107][108][109][110]. At this point, it is routine clinical practice in children with residual OSA after T&A to initially offer PAP therapy and medical therapy, and when patients are either unable, unsuccessful, or unwilling to adopt such options, then use of DISE-directed surgical therapies seems a logical and reasonable step, notwithstanding its limitations [111,112].…”

Section: Drug Induced Sleep Endoscopymentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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“…This is because some families expressed their decision to forego tongue base reductions at the time of initial surgery regardless of DISE findings. DISE has a large effect on surgical planning, with some studies reporting that its utilization changes operative decision making between 30 and 60.8% of the time, depending on the study 29–31 . Reducing the number of operations a child must undergo leads to a decreased risk of adverse effects from anesthesia and a decreased cost for the family and for the facility.…”

Section: Discussionmentioning

confidence: 99%

“…28 Our patients followed this trend in that, DISE has a large effect on surgical planning, with some studies reporting that its utilization changes operative decision making between 30 and 60.8% of the time, depending on the study. [29][30][31] Reducing the number of operations a child must undergo leads to a decreased risk of adverse effects from anesthesia and a decreased cost for the family and for the facility. Although DISE may prolong the single operation, our study found no complications or adverse effects related to DISE, extended anesthesia use, or concurrent procedures.…”

Section: T a B L E 1 Dise Findingsmentioning

confidence: 99%

Drug‐induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2‐year follow up

Frederick

Brandt

Sheyn

2022

Laryngoscope Investig Oto

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Objective: To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA.Methods: This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate-severe OSA who underwent DISE at the time of initial sleep surgery.Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1.Results: A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI % of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85. Conclusion:This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI.

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Contribution of drug-induced sleep endoscopy to the management of pediatric obstructive sleep apnea/hypopnea syndrome

Cited by 14 publications

References 32 publications

Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Drug‐induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2‐year follow up

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