Abstract
BackgroundObstructive sleep apnea frequently persists in children following adenotonsillectomy, which is the first-line treatment recommended for obstructive sleep apnea with adenotonsillar hypertrophy. Drug-induced sleep endoscopy (DISE) is a diagnostic tool increasingly used to assess pediatric obstructive sleep apnea, but its use has not been standardized. The overarching goal of this study was to document the current practice of Canadian otolaryngologists managing this population.MethodsA nation-wide online cross-sectional survey of Canadian otolaryngologist members of the Canadian Society of Otolaryngology – Head and Neck Surgery and the Association d’otorhinolaryngologie et chirurgie cervico-faciale du Québec. The 58-question electronic survey was developed based on a validated survey redaction guide with the aim to assess management and treatment of pediatric obstructive sleep apnea, as well as indications and performance of DISE. Consensus on practice items was defined by a minimum of 75% similar answers.ResultsOne hundred and nine Canadian otolaryngologists completed the survey on management of pediatric obstructive sleep apnea, among which 12 of them completed the questions on DISE. Overall, there was a poor rate of agreement of 55% among the respondents for the 58 questions altogether. There was a consensus to assess pediatric obstructive sleep apnea clinically ± with videos (82.6%), to assess adenotonsillar hypertrophy clinically (93.6%) and with flexible scope in the office (80.7%), as well as for the airway sites examined endoscopically during DISE. However, there was no consensus regarding anesthetic protocol and scoring system. DISE was mostly performed in cases of persistent obstructive sleep apnea after adenotonsillectomy rather than before performing any surgical procedure. There was no difference in the management of obstructive sleep apnea between otolaryngologists who perform DISE and those who do not. The only difference between otolaryngologists who practice in community centers versus in tertiary care centers was the more frequently use of the Brodsky tonsil scale by the latter ones.ConclusionThis Canadian-wide survey highlighted a lack of consensus in the management of pediatric obstructive sleep apnea and DISE. Certain aspects regarding DISE remain unclear, including establishment of its ideal timing in order to eventually avoid unnecessary tonsillectomies.
Highlights
Obstructive sleep apnea frequently persists in children following adenotonsillectomy, which is the first-line treatment recommended for obstructive sleep apnea with adenotonsillar hypertrophy
[1] adenotonsillectomy (T&A) is the first treatment recommended by the American Academy of Pediatrics and the American Academy of Otolaryngology – Head & Neck Surgery for children with Obstructive sleep apnea (OSA) and adenotonsillar hypertrophy [1, 2], the condition persists after surgery in approximately 34% of cases [3]
Drug-induced sleep endoscopy (DISE) procedures were performed on an adult population, this study showed that utilization of an endoscopy setting decreases resource utilization and financial burden, without related complications
Summary
Obstructive sleep apnea frequently persists in children following adenotonsillectomy, which is the first-line treatment recommended for obstructive sleep apnea with adenotonsillar hypertrophy. Drug-induced sleep endoscopy (DISE) is a diagnostic tool increasingly used to assess pediatric obstructive sleep apnea, but its use has not been standardized. [1] adenotonsillectomy (T&A) is the first treatment recommended by the American Academy of Pediatrics and the American Academy of Otolaryngology – Head & Neck Surgery for children with OSA and adenotonsillar hypertrophy [1, 2], the condition persists after surgery in approximately 34% of cases [3]. Cine-MRI (Magnetic Resonance Imaging) and Drug Induced Sleep Endoscopy (DISE) are tools assessing potential sites of airway obstruction. Two different rather old surveys (2004 and 2012) performed in the United States showed that pediatric otolaryngologists rarely use PSG prior to T&A and rely mostly on symptoms and physical exam to guide their management plan. Whereas most of the participants used DISE for residual OSA after T&A, respondents of the only Canadian participating institution (University of Alberta) performed DISE prior to surgery [8]
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