Sleep Endoscopy and Anesthetic Considerations in Pediatric Obstructive Sleep Apnea: A Review.

Background ! Obstructive sleep apnea (OSA) may occur as a result of anatomical or functional obstruction at different levels of the upper and lower airway. Functional obstruction happens mostly during REM (rapid-eye movement) and nonREM 1 (N2) sleep stages. ! PSG (polysomnography) provides the data of sleep O2 saturations, hypopneic and apneic events and abnormal respiratory events per hour, however not indicating the specific etiology of the obstruction. ! Drug-induced sleep endoscopy (DISE) has emerged as a method of 3D evaluation of the upper airway during pharmacologicallyinduced sleep. ! Failure to provide an appropriate depth of anesthesia, imitating the natural sleep patterns during REM and N2 stages may lead to inaccurate evaluation of the functional obstruction.