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.
Highlights
Obstructive sleep apnea (OSA) is a common childhood condition which can result in sequelae including growth retardation, poor school performance, enuresis, and behavioral problems [1]
The aim of the present study was to examine the role of drug-induced sleep endoscopy (DISE) in the decisionmaking process of pediatric OSA patients with small tonsils, in order to evaluate the necessity of tonsillectomy in pediatric OSA with small tonsils
Adenotonsillectomy is the first-line treatment for children with OSA, but it is uncertain whether children with small tonsils experience the same benefit as those with tonsil hypertrophy
Summary
Obstructive sleep apnea (OSA) is a common childhood condition which can result in sequelae including growth retardation, poor school performance, enuresis, and behavioral problems [1]. Adenotonsillar hypertrophy is a major contributing factor to the development of OSA in children [2]. Adenotonsillectomy is the most commonly performed procedure for pediatric OSA, resulting in significant improvement or resolution of OSA severity. The gradation of tonsillar enlargement is assessed using the Brodsky tonsil grading scale [2]. According to the size of the tonsils, the tonsillar enlargement is classified into five levels. Tonsils of grades 3 and 4 are considered as tonsillar hypertrophy [3]. Tonsillectomy is commonly performed for children with tonsillar hypertrophy, but not for those whose tonsils are grade 1 or 2 without recurrent chronic tonsillitis.
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