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. 2019 Feb 22;14(2):e0212317.
doi: 10.1371/journal.pone.0212317. eCollection 2019.

Drug-induced sleep endoscopy-directed adenotonsillectomy in pediatric obstructive sleep apnea with small tonsils

Jie Chen  1 , Shan He  1
Affiliations

Drug-induced sleep endoscopy-directed adenotonsillectomy in pediatric obstructive sleep apnea with small tonsils

Jie Chen et al. PLoS One. .

Abstract

The study aims to examine drug-induced sleep endoscopy (DISE) in the decision-making process of pediatric obstructive sleep apnea (OSA) patients with small tonsils. This was a retrospective study of children who underwent awake flexible endoscopy, DISE, and adenoidectomy with/without tonsillectomy at the Shanghai Children's Medical Center between 03/2015 and 12/2016. Tonsillectomy was performed for tonsillar obstruction found by DISE. Adenoidectomy was performed for all children. Cardio-pulmonary coupling (CPC) and oximetry were observed before/after surgery. The study included 126 children: 56 (44.4%) with grade 2 tonsils and 70 (55.6%) with grade 1. Mean age was 5.7±3.2 (range, 2.8-10.4) years and mean BMI of 15.7±5.5 kg/m2. Unexpectedly, DISE showed tonsillar obstruction in 57 (45.2%) children, including 44 (78.6%) with grade 2 tonsils and 13 (18.6%) with grade 1. Therefore, DISE-directed tonsillectomy was performed for 57 patients. There was an improvement in respiratory disturbance index (RDI) and oxygen saturation nadir in the DISE (P = 0.0007, P = 0.037) and control (P = 0.001, P = 0.023) groups 6 months after surgery, but RDI improvement was better in the DISE group compared with controls 1 year after surgery (P = 0.042). DISE is a good way to determine the necessity of tonsillectomy in pediatric OSA patients with small tonsils.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
(A) A 6-year-old boy who underwent awake endoscopy. The oropharynx space did not collapse much and expanded during respiration. (B) The same child who underwent DISE. In the oropharynx, the airway was narrowed by the pharyngeal tonsils with medial dynamic displacement, leading to the almost complete obstruction of the airway on inspiration.
Fig 2
Fig 2. Respiratory disturbance index (RDI) before and after surgery in children with OSA who underwent adenoidectomy with/without tonsillectomy, according to DISE influencing or not the surgical management (P<0.05).
Fig 3
Fig 3. Oxygen saturation nadir index before and after surgery in children with OSA who underwent adenoidectomy with/without tonsillectomy, according to DISE influencing or not the surgical management.
See this image and copyright information in PMC

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