Associate Professor Oregon Health and Science University Portland, Oregon
Introduction: Drug-induced sleep endoscopy (DISE) is increasingly used to guide treatment decisions in children with obstructive sleep apnea (OSA). Previous reports of DISE findings in children have typically included a broad age range, but it is unclear how these patterns of obstruction vary with age. This study compared patterns of airway obstruction observed during DISE in three age groups of surgically naïve children with OSA.
Methods: Cross-sectional analysis of prospective cohort of surgically naïve children with OSA at risk for residual OSA after adenotonsillectomy (AT). Indications for DISE included severe OSA, age older than 7 years, obesity, and African American race. DISE findings were rated at six anatomic levels using the Sleep Endoscopy Rating Scale (SERS). Correlation between age and degree of obstruction were compared at each anatomic site (Kendall’s Tau).
Results: A total of 337 children (164 (49%) girls, 188 (56%) white, median age 9.2 years [IQR 7.0-11.7]). Data were stratified by age into pre-school (2 to 5 years, n=37), young school-aged (5 to 10, n =168), and older school-aged (10 to 18 years, n=133). Nasal obstruction was inversely associated with age (Tau -0.19 [95% CI -0.29, -0.09]) indicating that younger children had greater obstruction at the nasal airway. Nasopharyngeal (Tau -0.22 (95% CI -0.32, -0.11)) and velopharyngeal obstruction (Tau -0.16 (95% CI -0.26, -0.05)) were similarly inversely associated with age. The SERS Total Score (Tau -0.23 (95% CI -0.33, -0.14)) and number of sites with complete obstruction (Tau -0.18 (95% CI -0.28, -0.08)) were also inversely correlated with age. Tonsillar and tongue base obstruction was similar across age groups.
Conclusion: Young children have significantly more sites of complete upper airway obstruction than older children. Understanding the most common sites of obstruction and severity with age could inform personalized surgical approaches beyond the standard AT in children with OSA.