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Original Research—Pediatric Otolaryngology
Airway Obstruction during Drug-Induced
Sleep Endoscopy Correlates with Apnea-
Hypopnea Index and Oxygen Nadir in
Children
Otolaryngology–
Head and Neck Surgery
2016, Vol. 155(4) 676–680
American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2016
Reprints and permission:
sagepub.com/journalsPermissions.navDOI: 10.1177/0194599816653113
http://otojournal.orgJohn P. Dahl, MD, PhD, MBA
1,2
, Craig Miller, MD
3,4
,
Patricia L. Purcell, MD, MPH
3,4
, David A. Zopf, MD, MS
5,6
,
Kaalan Johnson, MD
3,4
, David L. Horn, MD, MS
3,4
,
Maida L. Chen, MD
4,7
, Dylan K. Chan, MD, PhD
8,9
, and
Sanjay R. Parikh, MD
3,4
Sponsorships or competing interests that may be relevant to content are dis-
closed at the end of this article.
Abstract
Objective.
To determine if standardized intraoperative scoring of
anatomic obstruction in children with obstructive sleep apnea
correlates with the apnea-hypopnea index (AHI) and lowest
oxygen saturation on preprocedural polysomnogram (PSG). A
secondary objective was to determine if age, presence of a syn-
drome, or previous adenotonsillectomy affect this correlation.
Study Design
. Case series with chart review.
Setting.
Two tertiary care children’s hospitals.
Subjects.
Patients with a preprocedural PSG who underwent
drug-induced sleep endoscopy (DISE) over a 4-year period.
Methods.
All DISEs were graded in a systematic manner with
the Chan-Parikh (C-P) scoring system. AHI and nadir oxygen
saturations were extracted from preprocedural PSG. Data
were analyzed with a multivariate linear regression model that
controlled for age at time of sleep endoscopy, syndrome diag-
nosis, and previous adenotonsillectomy.
Results.
A total of 127 children underwent PSG prior to DISE:
56 were syndromic, and 21 had a previous adenotonsillectomy.
Mean AHI was 13.6
6
19.6 (
6
SD), and mean oxygen nadir
was 85.4%
6
9.4%. Mean C-P score was 5.9
6
2.7. DISE score
positively correlated with preoperative AHI (
r
= 0.36,
P
\
.0001) and negatively correlated with oxygen nadir (
r
=
2
0.26,
P
= .004). The multivariate linear regression models estimated
that for every 1-point increase in C-P score, there is a 2.6-point
increase in AHI (95% confidence interval: 1.4-3.8,
P
\
.001) and
a 1.1% decrease in the lowest oxygen saturation (95% confi-
dence interval: –1.7 to
2
0.6,
P
\
.001).
Conclusion.
The C-P scoring system for pediatric DISE corre-
lates with both AHI and lowest oxygen saturation on pre-
procedural PSG.
Keywords
obstructive sleep apnea, drug-induced sleep endoscopy,
polysomnogram, sleep-disordered breathing, pediatrics
Received November 30, 2015; revised April 25, 2016; accepted May
13, 2016.
D
rug-induced sleep endoscopy (DISE) is a new diag-
nostic tool in the evaluation of adults and children
with obstructive sleep apnea (OSA).
1-3
Typically, it
is a flexible fiberoptic observation of the upper airway
under general anesthesia while maintaining spontaneous
ventilation.
2-4
DISE has been reported to be a useful tool for
identifying additional sites of obstruction in children and
adults beyond tonsil and adenoid hypertrophy as appreciated
on clinical examination.
1-6
1
Department of Otolaryngology–Head and Neck Surgery, Indiana
University School of Medicine, Indianapolis, Indiana, USA
2
Riley Hospital for Children, Indianapolis, Indiana, USA
3
Department of Otolaryngology–Head and Neck Surgery, University of
Washington School of Medicine, Seattle, Washington, USA
4
Seattle Children’s Hospital, Seattle, Washington, USA
5
Department of Otolaryngology–Head and Neck Surgery, University of
Michigan School of Medicine, Ann Arbor, Michigan, USA
6
C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
7
Department of Pediatrics, Division of Pulmonary and Sleep Medicine,
University of Washington School of Medicine, Seattle, Washington, USA
8
Department of Otolaryngology–Head and Neck Surgery, University of
California–San Francisco, San Francisco, California, USA
9
Benioff Children’s Hospital, San Francisco, California, USA
This article was presented at the 2015 AAO-HNSF Annual Meeting & OTO
EXPO; September 27-30, 2015; Dallas, Texas.
Corresponding Author:
Sanjay R. Parikh, MD, Department of Otolaryngology–Head and Neck
Surgery, University of Washington School of Medicine, Seattle Children’s
Hospital, OA.9.220–Otolaryngology, 4800 Sand Point Way NE, Seattle, WA
98105, USA
Email:
sanjay.parikh@seattlechildrens.orgReprinted by permission of Otolaryngol Head Neck Surg. 2016; 155(4):676-680.
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