Multiple Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea - Obstruction Patterns and Outcomes

Q: Why is DISE used in children with residual OSA after adenotonsillectomy?

DISE identifies the upper-airway obstruction sites and guides anatomy-directed surgical interventions, often under the same anesthetic. It is especially helpful when symptoms persist after adenotonsillectomy.

Q: What obstruction patterns were commonly seen during second DISE procedures?

The most common obstructions at second DISE involved the epiglottis, adenoid, and inferior turbinates. Multilevel obstruction was also frequently identified.

Q: How did single versus multiple DISE-directed procedures affect outcomes?

Children undergoing single DISE showed significant improvement in OAHI and OSA-18 quality-of-life scores. Improvements were not significant for multiple DISE groups, suggesting diminishing returns with repeated procedures.

Sep 29, 2026

Uploaded by Rhys

Study examines how children with residual obstructive sleep apnea (OSA) respond when undergoing multiple drug-induced sleep endoscopy (DISE)-directed procedures. A single-institution retrospective cohort included pediatric patients treated from 2009–2020. Outcomes include obstruction patterns, OAHI, and OSA-18 quality-of-life scores. Results show frequent multilevel obstruction and shorter DISE intervals in high-BMI children; single DISE improved OAHI and QOL more consistently than multiple DISE.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Methods

Multiple Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea: Obstruction Patterns and Outcomes Annals of Otology, Rhinology & Laryngology 2026, Vol. 135(2) 146–153 © The Author(s) 2025 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/00034894251381169](DOI: 10.1177/00034894251381169)[ ](DOI: 10.1177/00034894251381169)[journals.sagepub.com/home/aor](journals.sagepub.com/home/aor) Daniel R. S. Habib, BA 1,2, Liliana Arida-Moody, BS 1,2, Ankita Patro, MD, MS 1,3, Jeffanie Wu, MD 1,3, Seth Davis, MD 1,3, Shilin Zhao, PhD 1,4, Kalpnaben Patel, CCRP 1, Christopher T. Wootten, MD, MMHC 1,3, and Amy S. Whigham, MD, MS-HPEd 1,3 Abstract Objectives: Residual obstructive sleep apnea (OSA) following adenotonsillectomy (AT) is common in children with obesity. Drug-induced sleep endoscopy (DISE) identifies upper airway obstruction and guides surgery. A gap remains in evaluating multiple DISE-directed treatments. This study evaluates multiple DISE-directed procedure outcomes, obstruction patterns, and BMI in pediatric patients. Methods: This single-institution retrospective cohort study included pediatric patients who underwent DISE-directed interventions from 2009 to 2020. Variables included patient characteristics, DISE timing, obstruction patterns, obstructive apnea-hypopnea index (OAHI), and OSA-18 quality-of-life (QOL). Chi-square tests compared patient demographics and comorbidities between single and multiple DISE groups. Unpaired t-tests compared age, OAHI, and OSA-18 scores between single and multiple DISE groups as well as multiple-DISE outcomes for high versus normal BMI groups. Results: Of 122 children who underwent DISE, 27 (22%) had multiple DISE-directed procedures. Average age at first DISE for single and multiple DISE patients was 7.25 (SD = 3.93) and 4.99 (SD = 3.63) years, respectively (P < .01). Common obstructions at second DISE involved the epiglottis (N = 20, 74%), adenoid (N = 18, 67%), and inferior turbinates (N = 15, 56%). Multilevel obstruction was identified in 96%(N = 26) of second and 80%(N = 4) of third DISEs. Children with high BMI (versus normal BMI) exhibited shorter intervals between DISEs. Patients who underwent single DISE exhibited significant OAHI improvement (mean 8.48 vs 3.91, P < .05), but this was not significant for multiple DISEs. The OSA-18 score improved significantly in patients with single DISE (mean summed score 61.3 vs 44.6, P < .05). Conclusions: Pediatric OSA involves persistent, multilevel obstruction, especially in younger patients with elevated BMI undergoing multiple DISE-directed procedures. These findings support anatomy-guided, patient-specific surgical planning for high-risk groups. While a single DISE-directed intervention can significantly improve OAHI and QOL, repeated procedures may yield diminishing returns, underscoring the need to consider their timing and utility. Early multidisciplinary evaluation and long-term follow-up are essential for managing persistent OSA. Keywords adenotonsillectomy, drug-induced sleep endoscopy, obesity, pediatric obstructive sleep apnea, pediatric OSA surgical treatment, quality of life Introduction Obesity is a well-recognized risk factor for obstructive sleep apnea (OSA), with studies demonstrating that children with higher body mass indices (BMIs) are more likely to experience persistent OSA post-adenotonsillectomy (AT) . 1,2 Children with high BMI often have complex obstructive patterns that require tailored surgical approaches; however, evidence suggests they can still benefit from AT, though potentially less improvement in apnea-hypopnea index (AHI) compared to patients with normal BMI. 1,3-5 1 Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA 2Vanderbilt University School of Medicine, Nashville, TN, USA 3Department of Otolaryngology—Head & Neck

FAQs

Why is DISE used in children with residual OSA after adenotonsillectomy?

DISE identifies the upper-airway obstruction sites and guides anatomy-directed surgical interventions, often under the same anesthetic. It is especially helpful when symptoms persist after adenotonsillectomy.

What obstruction patterns were commonly seen during second DISE procedures?

The most common obstructions at second DISE involved the epiglottis, adenoid, and inferior turbinates. Multilevel obstruction was also frequently identified.

How did single versus multiple DISE-directed procedures affect outcomes?

Children undergoing single DISE showed significant improvement in OAHI and OSA-18 quality-of-life scores. Improvements were not significant for multiple DISE groups, suggesting diminishing returns with repeated procedures.

Sep 29, 2026

Uploaded by Rhys