Drug-induced sleep endoscopy for upper airway evaluation in children with obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS To evaluate sites and characteristics of upper airway obstruction, as detected with drug-induced sleep endoscopy (DISE) in children with obstructive sleep apnea (OSA). MATERIAL AND METHODS The medical records of children who underwent DISE were reviewed. Data pertaining to demographics, past medical history, body mass index, tonsil size, adenoid size, polysomnography, and DISE were obtained. RESULTS Eighty-two children had DISE and severity of OSA was mild in four patients, moderate in 17, and severe in 61. DISE revealed obstruction at the level of velum in 67 patients, oropharynx/lateral walls in 72 patients, tongue in 10 patients, and epiglottis in 10 patients. Oropharynx/lateral walls were the most common single site of obstruction. The majority of children had obstruction at multiple sites. Combination of velum and oropharynx/lateral walls was the most common multiple sites of obstruction. Prevalence of complete obstruction at velum and oropharynx/lateral walls in children with severe or moderate OSA were greater than those of children with mild OSA. Complete obstruction at oropharynx/lateral walls was documented in 50% of children with grade I tonsils and 64% of children with grade II tonsils. CONCLUSION The oropharynx/lateral walls are the most common site of obstruction in children with single site obstruction. Combined oropharynx/lateral walls and velum obstruction was the most common sites of obstruction in children with multiple site obstruction. Children with grade I and grade II tonsils may suffer from complete airway obstruction. DISE is a useful tool to identify upper airway obstruction sites in addition to adenotonsillar hypertrophy.