Iannella Giannicola, Magliulo Giuseppe, Greco Antonio, De Virgilio Armando, Maniaci Antonino, Lechien Jerome R, Calvo-Henriquez Christian, Bahgat Ahmed Yassin, Casale Manuele, Lugo Rodolfo, Baptista Peter, Salamanca Fabrizio, D'Ecclesia Aurelio, Perrone Tiziano, Leone Federico, Cannavicci Angelo, Cammaroto Giovanni, Vicini Claudio, Pace Annalisa
Department of Organi di Senso, Sapienza University, 00185 Rome, Italy.
Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy.
Children (Basel). 2024 Jan 12;11(1):94. doi: 10.3390/children11010094.
To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE.
A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations.
A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral.
Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.
通过一项国际调查，研究药物诱导睡眠内镜检查（DISE）在小儿阻塞性睡眠呼吸暂停（OSA）患者中的实际临床应用，并阐明小儿DISE的使用、应用、临床适应证及方案。
最初由5名在小儿睡眠呼吸暂停和药物诱导睡眠内镜检查方面具有专业知识的国际耳鼻喉科医生制定了一项关于小儿DISE的专项调查，随后将其分发给睡眠呼吸暂停领域的专家、不同OSA相关协会的成员。
本研究共纳入101名回答了所有调查问题的参与者。64名睡眠呼吸暂停专家（占受访专家的63.4%）表示他们会对小儿OSA患者进行DISE检查。81.9%的受访者同意将DISE视为腺样体扁桃体切除术后持续性OSA患儿的首要诊断步骤，而55.4%的受访者不同意在计划进行腺样体扁桃体切除术的同时进行DISE检查以确定其他可能的塌陷部位。对于DISE检查时存在残余OSA且仅咽部塌陷的年轻患者，51.8%的专家同意进行腭咽手术。在这种情况下，27.7%的专家不同意，21.4%的专家持中立态度。
国际上认为小儿DISE是一种安全有效的检查方法，可用于识别残余OSA患儿腺样体扁桃体切除术后的阻塞和塌陷部位。这对于患有颅面畸形、扁桃体小、喉软化或唐氏综合征的患者识别实际的塌陷部位也很有用。尽管有这些证据，但我们的调查强调小儿DISE在不同的睡眠中心并未得到应用。
