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Review
. 2017 Nov 2;2(6):423-431.
doi: 10.1002/lio2.118. eCollection 2017 Dec.

An updated review of pediatric drug-induced sleep endoscopy

Lyndy J Wilcox  1 , Mathieu Bergeron  1 , Saranya Reghunathan  2 , Stacey L Ishman  1   3   4
Affiliations
Review

An updated review of pediatric drug-induced sleep endoscopy

Lyndy J Wilcox et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: Drug-induced sleep endoscopy (DISE) involves assessment of the upper airway using a flexible endoscope while patients are in a pharmacologically-induced sleep-like state. The aim of this article is to review the current literature regarding the role of DISE in children with obstructive sleep apnea (OSA). The indications, typical anesthetic protocol, comparison to other diagnostic modalities, scoring systems, and outcomes are discussed.

Methods: A comprehensive review of literature regarding pediatric DISE up through May 2017 was performed.

Results: DISE provides a thorough evaluation of sites of obstruction during sedation. It is typically indicated for children with persistent OSA after tonsillectomy, those with OSA without tonsillar hypertrophy, children with risk factors predisposing then to multiple sites of obstruction, or when sleep-state dependent laryngomalacia is suspected. The dexmedotomidine and ketamine protocol, which replicates non-REM sleep, appears to be safe and is often used for pediatric DISE, although propofol is the most commonly employed agent for DISE in adults. Six different scoring systems (VOTE, SERS, Chan, Bachar, Fishman, Boudewyns) have been used to report pediatric DISE findings, but none is universally accepted.

Conclusions: DISE is a safe and useful technique to assess levels of obstruction in children. There is currently no universally-accepted anesthetic protocol or scoring system for pediatric DISE, but both will be necessary in order to provide a consistent method to report findings, enhance communication among providers and optimize surgical outcomes.

Level of evidence: N/A.

Keywords: DISE; drug‐induced sleep endoscopy; obstructive sleep apnea; pediatric.

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Figures

Figure 1
Figure 1
Images of findings in drug‐induced sleep endoscopy. A) Inferior turbinate hypertrophy. B) Adenoid hypertrophy with horizontally‐oriented palate. C) Normal adenoids with vertically‐oriented palate. D) Lingual tonsillar hypertrophy with partial vallecular effacement. E) Epiglottic retroflexion with complete anterior‐posterior collapse. F) Normal supraglottis and glottis without lingual tonsillar hypertrophy.
See this image and copyright information in PMC

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