Drug‐Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

Abstract

Objective Positional obstructive sleep apnea (POSA)—defined as obstructive sleep apnea twice as severe supine than nonsupine—may offer clues to the underlying pattern of upper airway collapse in children. We compared drug-induced sleep endoscopy (DISE) findings in children with and without POSA. We hypothesized that children with POSA would have significantly higher obstruction at the gravity-dependent palate and tongue base but not at the adenoid, lateral wall, or supraglottis. Study Design Retrospective case series. Setting Tertiary pediatric hospital. Subjects and Methods We included children aged 1 to 12 years with obstructive sleep apnea diagnosed by polysomnography who underwent DISE from July 2014 to February 2019. Scores were dichotomized as ≥50% obstruction (Chan-Parikh 2 or 3) vs <50% obstruction (Chan-Parikh 0 or 1). Results Of 99 children included, 32 (32%) had POSA and 67 (68%) did not. Children with POSA did not differ from children without POSA in age, overall apnea-hypopnea index, sex, race, syndromic diagnoses, obesity, or history of adenotonsillectomy. In logistic regression models, odds of ≥50% obstruction were significantly higher at the tongue base (odds ratio, 2.77; 95% CI, 1.04-7.39) after adjustment for age, sex, obesity, previous adenotonsillectomy, and syndrome. No difference was noted at the adenoid, velum, lateral wall, or supraglottis. Conclusion POSA was associated with higher odds of obstruction on DISE at the tongue base but not at other levels.

Positional Therapy in a Child with Down Syndrome and Obstructive Sleep Apnea: A Case Report

“…3 Improved airway patency, particularly at the base of the tongue/larynx in left lateral position compared to standard supine position has been demonstrated in children during DISE 4 . In another study by Kirkham et al, children with positional OSA had higher odds of obstruction at the tongue base but not at other levels 5 . The airway collapse in the supine position is more significant in patients with DS secondary to hypotonia, mid-facial hypoplasia, and glossoptosis 1 .…”

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

“…In addition, the available evidence showcasing its usefulness and efficiency is insufficient. The majority of literature regarding this subject is constituted by small case series or retrospective studies [17][18][19][20][21][22][23][24][25][26][27][28]. Despite evidence demonstrating that DISE impacts the decisions made regarding surgery in children, it remains unclear how many sleep doctors actually use this procedure and if the results from interventions guided by DISE surpass those from conventional methods.…”

Mechanisms relating to sleeping position to the endotypes of sleep disordered breathing

“…Direct endoscopic examination of the airway has found that moving from lateral to supine position results in increased airway obstruction at the level of the epiglottis, tongue base and soft palate [45]. As with Pcrit measurements, the observed effects of position are larger for sub populations selected on the basis of PSG-diagnosed supine related OSA [45,46 ▪ ]. Recent evidence suggests that site of collapse may be a specific feature of airway obstruction observed when moving from supine to lateral sleeping position, with soft palate epiglottis specific collapse of the airway most prevalent in the supine position [47], and tongue base potentially playing less of a role.…”