Drug-Induced Sleep Endoscopy in Infants With Obstructive Sleep Apnea: Current Evidence and Knowledge Gaps.

OBJECTIVE: To map and synthesize the available evidence and evidence gaps on drug-induced sleep endoscopy (DISE) in infants with obstructive sleep apnea (OSA), focusing on reported sites of obstruction, DISE-associated management decisions, postoperative outcomes, safety, and limitations in current reporting. DATA SOURCES: PubMed/MEDLINE/Embase/Google Scholar was searched for studies published in English and French from January 1980 to September 2025. REVIEW METHODS: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligible studies included original reports describing infants under 12 months with OSA who underwent DISE. Two reviewers independently screened titles, abstracts, and full texts, extracted data with a standardized form, and synthesized results descriptively. Extracted variables included available polysomnography (PSG) parameters, DISE methodology, comparator airway evaluations when reported, DISE-directed interventions, postoperative outcomes, and complications. RESULTS: Eight observational studies published between 2013 and 2024 met inclusion criteria, involving 151 infants. DISE often revealed multilevel obstruction, most commonly involving the supraglottis (epiglottis, aryepiglottic folds, arytenoids; including sleep-state laryngomalacia) and retrolingual airway. Contributors from the nasal and adenotonsillar regions were also reported. DISE findings were associated with variable interventions, most frequently supraglottoplasty and adenoidectomy/tonsillectomy, with selected cases requiring mandibular distraction, tongue-lip adhesion, or tracheostomy. When postoperative PSG was available, indices generally improved (mean apnea-hypopnea index [AHI] approximately 10.6 events/h preoperatively and 3 events/h postoperatively). No major DISE-related complications were consistently described. CONCLUSION: In infants with OSA, DISE appears feasible and may identify dynamic, often multilevel obstruction, particularly supraglottic and retrolingual collapse. However, current evidence remains limited by small retrospective series, inconsistent PSG reporting, variable DISE protocols, and limited objective postoperative outcomes. Prospective studies with standardized DISE methods, uniform PSG reporting, defined outcome measures, and comparator airway evaluations are needed. LEVEL OF EVIDENCE: 2.