DISE Findings Across Comorbidity Groups and Surgical Status in Pediatric Sleep‐Disordered Breathing
Year: 2025
Type: article
Study design: Systematic Review
Abstract: OBJECTIVE: Drug-induced sleep endoscopy (DISE) has gained popularity for evaluating obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB) in children, particularly those with comorbidities or residual disease after adenotonsillectomy (T&A). This study aimed to characterize DISE findings in pediatric OSA/SDB across surgical status (surgically naive vs. post-T&A) and comorbidities (Down syndrome and overweight/obese children). DATA SOURCES: A literature search was conducted in Pubmed/MEDLINE, Cochrane Library, and EMBASE. REVIEW METHODS: Terms including "Sleep Apnea Syndromes," "Pediatrics," "Sedation," and "Endoscopy," were used, covering the databases until September 2024. Strict inclusion criteria were applied. Forest plots were generated using R software. RESULTS: Three hundred and fifty articles were identified, with 16 meeting inclusion criteria, involving 1415 pediatric patients. Across all subgroups, post-T&A children demonstrated less adenoid and lateral wall/tonsillar obstruction; however, revision T&A/adenoidectomy/tonsillectomy remained the most common surgical intervention (56.4%) for residual OSA/SDB. Palatal obstruction was less prevalent in children post-T&A compared to surgically naïve counterparts. Tongue base obstruction was more prevalent in children post-T&A, particularly in those with Down syndrome (naïve: 50%, 95% CI: 25%-75%; post-T&A: 92%, 95% CI: 32%-100%) and in children with no comorbidities (naïve: 24%, 95% CI: 11%-47%; post-T&A: 56%, 95% CI: 15%-91%). Among surgically naïve children, multisite obstruction was greatest in those with Down syndrome (71%, 95% CI: 44%-89%) but was highest in children without comorbidities post-T&A. CONCLUSIONS: DISE demonstrates substantial variability in anatomic obstruction patterns among children with OSA/SDB, underscoring the complexity of the disease, particularly in children with obesity, Down syndrome, or residual disease following T&A.
Source: The Laryngoscope
DOI: 10.1002/lary.70289
Institutions: Oregon Health & Science University, Portland State University
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,840
Awards: A Personalized Surgical Approach for the Treatment of Children with Obstructive Sleep Apnea and Small Tonsils, Treatment of Obstructive Sleep Apnea with Personalized Surgery in Children with Down Syndrome (TOPS-DS), A Personalized Surgical Approach for the Treatment of Children with Obstructive Sleep Apnea and Small Tonsils
OpenAlex ID: W4417036248