Author(s)
Christopher A. Hargunani, MD
Derek J. Lam, MD, MPH
Affiliation(s)
Otolaryngology, Oregon Hlth. and Sci. Univ., Portland, OR.
Abstract:
Introduction: Drug induced sleep endoscopy (DISE) is increasingly used to assess patterns of airway obstruction in children with obstructive sleep apnea (OSA). There is limited data showing good test-retest reliability and changes in DISE findings after surgical treatment in adults, but this has not been demonstrated in pediatric patients. Our aims are: 1) to evaluate the test-retest reliability of DISE in pediatric patients with OSA, and 2) determine whether DISE findings change after sleep surgery.
Methods: This is a retrospective case series of all pediatric patients who underwent multiple DISE procedures. The electronic medical record was reviewed for relevant demographic, comorbidity, and operative report data. DISE findings were scored using the Sleep Endoscopy Rating Scale (SERS). Linearly weighted kappa analysis was used to determine test-retest reliability in a group of patients who had no intervention between DISE procedures (Group 1). Mean changes in SERS score at each anatomic level were compared using t-tests between Group 1 and a second group that did undergo surgical intervention between studies (Group 2).
Results: 20 children were included, 10 in each group. Children in Group 1 were slightly older (mean age 9.9 ± 4.0 vs 7.1 ± 6.1 years, p = 0.24) and had a shorter interval between DISE exams (203 ± 227 vs 512 ± 265 days, p = 0.01). 8/10 patients in Group 1 had comorbidities including obesity, Down syndrome, and achondroplasia. All patients in Group 2 had identified comorbidities. The surgical interventions in Group 2 varied, but 8/10 included adenotonsillectomy as part of the procedure. Aim 1: Reliability was weak at the arytenoids (kappa = 0.17), moderate at the nasal airway and velopharynx (kappa = 0.41 and 0.47 respectively), good at the nasopharynx and base of tongue (kappa = 0.72 and 0.74 respectively), and excellent at the oropharynx (kappa = 0.85). Aim 2: Mean SERS ratings at the nasopharynx and oropharynx were significantly improved (p = 0.04 and 0.03 respectively) in Group 2 compared to Group 1.
Conclusion: DISE has reasonable test-retest reliability in pediatric patients with OSA. This reliability may be strongest in the assessment of the nasopharynx, oropharynx, and base of tongue. Sleep surgery leads to observable changes in DISE scores.