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Assessment of the obstructive sites of the upper airway by means of drug-induced sleep endoscopy and their correlation with pre- and postoperative OSAS severity.
Obstructive sleep apnea syndrome (OSAS) affects 1 to 4% of the pediatric population. The gold standard treatment is adenotonsillectomy (AT), however, up to 35% of surgical patients remain with residual OSAS. Drug-induced sleep endoscopy (DISE) improves the diagnosis of upper airway collapse (UA) levels, and may influence the treatment outcomes.
To evaluate if obstruction of UA and the score of DISE in children are associated with OSAS severity and with OSA persistence after AT.
In this prospective study, children with indication for adenotonsillectomy (AT), were invited to perform DISE just before surgery. OSA severity and persistence was assessed by full-night polysomnography before and 3-6 months after surgery.
Sixty individuals, 33 male, were evaluated, age ranged between 3.8 and 9.11 years and Z score between -2.06 and 5.67. Regarding the severity of OSAS, they had a mean AHI of 12.3 (2-46.5) preoperatively and 4.5 (0.5-18.2) postoperatively. DISE showed that 17 (28.3%) patients had complete obstruction at the velopharynx level and 32 (53.3%) at the oropharynx level. Fifty-three patients (88%) had some degree of associated vellus and oropharyngeal obstruction. Seven (11.6%) had total obstruction in the base of the tongue. Forty-one patients (68.3%) were considered cured (AHI <5). Of the 19 patients with residual OSAS, 02 had obstruction at the base of the tongue or epiglottis.
DISE can be considered an important test to assess other less usual obstructive sites, such as the base of the tongue and the epiglottis. In this study, no statistically significant relationship was found between obstruction of these sites and residual OSAS.
obstructive sleep apnea; endoscopy; polysomnography; child, drug induced sleep endoscopy
Vanessa Carvalho do Lago, Antonio Carlos Marao, Jefferson Luis de Barros, Karina Araujo dos Santos, Neemias Santos Carneiro, Renato Battistel Santana, Silke Anna Theresa Webber