Drug-Induced Sleep Endoscopy in Persistent Pediatric Sleep-Disordered Breathing After Adenotonsillectomy

Abstract

Findings from DISE suggest that multiple factors contribute to airway obstruction in persistent SDB after T&A. Further research can address the extent to which directed surgical treatment can improve outcomes in these patients.

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

“…f ) Adenoid regrowth has been demonstrated in 12.2% of non-obese children with OSAS at 1.5 years post-adenotonsillectomy using nasopharyngoscopy (class IV) [255]. Drug-induced sleep endoscopy in children with persistent SDB may demonstrate laryngomalacia, adenoidal tissue regrowth, tongue base obstruction and pharyngeal collapse (class III and IV) [69,[263][264][265]. MRI of the upper airway may reveal residual adenoid tissue in obese children with persistent OSAS following adenotonsillectomy (class IV) [266].…”

An Update on the Management of Pediatric Obstructive Sleep Apnea

“…Typical agents used for DISE in children are propofol, ketamine, or dexmedetomidine. In a recent study examining the feasibility of DISE in children with persistent OSA, the majority of subjects had multilevel obstruction [40]. DISE is increasingly being utilized to direct surgical therapy in children with residual OSA.…”

Surgical management of sleep-disordered breathing in children

“…Performance of sedated endoscopy allows assessment of the site(s) most involved in a patient's obstructive sleep apnea and allows for directed surgical intervention. [19][20][21] Compared with awake endoscopy, it better demonstrates collapse of the tongue base and pharyngeal wall. 22 Adenotonsillectomy Waldeyer ring, comprising the adenoids, palatine tonsils, and lingual tonsil, is a collection of lymphoid tissues surrounding the entrance to the aerodigestive tract.…”