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

Abstract

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.

An update on diagnosis and management of obstructive sleep apnoea in the first 2 years of life

“…In a large retrospective study including more than 413 children under 3 years of age undergoing PSG at a large tertiary care centre, <35% of children below the age of 1 year presented with enlarged tonsils [ 41 ]. H erzig et al [ 42 ] investigated the effect of age on the pattern of upper airway collapse during DISE in surgically naïve nonsyndromic children at risk for persistent OSAS and concluded that the youngest age group (2–5 years) had the highest prevalence of multilevel obstruction (59%). All these data support the notion that dynamic factors such as upper airway muscle hypotonia, laryngomalacia and multilevel upper airway obstruction due to craniofacial malformations or syndromic conditions are more commonly involved at a younger age [ 38 ].…”