Drug-induced sleep endoscopy in the identification of obstruction sites causing obstructive sleep apnea-hypopnea syndrome in children.

BACKGROUND: Evidence for drug-induced sleep endoscopy (DISE) versus multilevel surgery guided by clinical examination is sparse in pediatrics. METHODS: A retrospective cohort study included all children undergoing DISE for obstructive sleep apnea (OSA) between September 2021 and April 2025 in a tertiary pediatric center. Clinical examination of obstruction sites was performed in consultation, and treatment was proposed. The data were compared against the intraoperative anatomic data collected during DISE and associated procedures. OBJECTIVE: To assess the surgical contribution of DISE compared to clinical examination in consultation. RESULTS: Files were analyzed for 240 patients, with a mean age of 6.4±4.6 years. 137 (57%) had type 3 OSA, 7 (3%) type 2, and 96 (40%) type 1. DISE led to changes in surgical strategy in 75% of cases, with 803 procedures performed, compared to 597 planned in consultation (P<0.001). Agreement was satisfactory for partial tonsillectomy, but moderate to weak for surgery in other sites, and especially the tongue base and the laryngeal vestibule. Total anatomic score was significantly higher on DISE than in consultation. Median apnea-hypopnea index (AHI) improved significantly after surgery (P<0.001). CONCLUSION: DISE identified more obstruction sites than clinical examination in consultation, in children with OSA.