The impact of sleep endoscopy for obstructive sleep-disordered breathing in children and adolescents

Objective: Studies on the surgical treatment of OSAS in adults have shown an improved outcome after targeted therapy by drug-induced sleep endoscopy (DISE). So far, only a few studies have focused on this method in children. The aim of this study is to evaluate the impact of DISE for children with obstructive sleep-disordered breathing and to determine the influence of DISE on treatment recommendations. Subjects and Methods: The medical records of children (n = 25) who underwent polysomnography and DISE between 05/2012 and 12/2013 were retrospectively reviewed. The subjects were divided into an UARS (upper airway resistance syndrome)/mild OSAS group (AHI < 5; n = 10) and a moderate/severe OSAS group (AHI = 5; n = 15). Results: The oropharynx was the most common site of obstruction. Prevalence of complete obstruction at the oropharynx was significantly higher in moderate or severe OSAS (p = 0.02). The obstruction pattern of the velopharynx was significantly associated with the size of the adenoids (p = 0.02), but tonsil and adenoid size were not related to the severity of OSAS. 71 % of children with grade IV tonsils showed complete obstruction of the oropharynx. After DISE, the initial management plan changed in 5 patients (20 %). Conclusion: DISE is a promising technique to identify sites of obstruction in children with OSAS and to guide treatment decisions. Further studies are needed to predict persistent OSAS based on this tool.