# Drug-Induced Sleep Endoscopy for Targeted Sleep Surgery in Pediatric Patients

## TL;DR

This study shows that drug-induced sleep endoscopy helps guide surgery for children with sleep apnea by identifying where blockages occur, leading to better outcomes.

## Contribution

The study demonstrates how drug-induced sleep endoscopy (DISE) influences surgical decisions in pediatric obstructive sleep apnea beyond standard adenotonsillectomy.

## Key findings

- DISE findings led to surgeries beyond adenotonsillectomy, including lingual tonsillectomy and supraglottoplasty.
- Patients who had adenotonsillectomy showed greater improvement in sleep symptoms than those who did not.
- Significant lateral pharyngeal wall collapse was strongly associated with adenotonsillectomy being performed.

## Abstract

Introduction: This study aims to evaluate the efficacy of drug-induced sleep endoscopy (DISE)-targeted surgery to identify the locations of obstruction and to determine how DISE findings influence whether the standard of care surgery, adenotonsillectomy, is performed.

Methods: This prospective cohort study was done at an academic children's hospital. All patients (n = 42) underwent polysomnography. DISE was performed to evaluate tonsil and adenoid size, Yellon tongue base, lateral pharyngeal wall (LPW) collapse, and signs of laryngomalacia. Surgery was performed based on the most prominent locations of obstruction. Pre-operative and post-operative University of Michigan Pediatric Sleep Questionnaire (UMPSQ) was given to determine the likelihood of residual OSA.

Results: Surgeries included tonsillectomy, adenoidectomy, lingual tonsillectomy, laryngeal cleft repair, supraglottoplasty, and turbinate reduction. Patients had improvement in the UMPSQ score from 13.36 ± 3.67 to 5.68 ± 3.46 (P=0.05). Those who underwent adenotonsillectomy had a greater decrease in UMPSQ scores than those who did not (P=0.03). Patients with significant LPW collapse were more likely to have adenotonsillectomy (P=0.001), while patients with higher Yellon tongue base scores were less likely (P=0.005). There was no statistically significant relationship between OSA severity and whether adenotonsillectomy was performed.

Conclusions: DISE is a valuable tool for evaluating children with multi-level obstruction, and findings change surgical decision-making for children without enlarged tonsils. Adenotonsillectomy resulted in the greatest decrease in OSA symptoms, but was mainly performed on patients with significant LPW collapse.