药物诱导睡眠内窥镜在儿童阻塞性睡眠呼吸暂停诊疗中的应用

doi:10.12372/jcp.2025.24e1292

Abstract

Abstract:

Objective To investigate the application of drug-induced sleep endoscopy (DISE) in pediatric obstructive sleep apnea (OSA). Methods The clinical data of children diagnosed with OSA by polysomnography (PSG) and DISE examination were retrospectively analyzed from June 1, 2023 to June 1, 2024 in the Department of Otorhinolaryngology. The NAVOTEL scoring system was used to score DISE, and the correlation between DISE score and apnea-hypopnea index (AHI) and minimum arterial oxygen saturation (SaO₂) was analyzed. Results DISE tests were performed in 163 children (114 boys and 49 girls), and the median age was 7.0 (5.0-9.0) years. The most common obstructive site was the velopharynx (137 cases, 84.0%), followed by the lateral oropharynx (124 cases, 76.1%), nasal cavity (95 cases, 58.3%), adenoid (92 cases, 56.4%), base of the tongue (52 cases, 31.9%), epiglottis (30 cases, 18.4%), and larynx (3 cases, 1.8%). The most common obstruction site in children of different age groups (≤5 years old, 6~10 years old and 11~18 years old) was velopharynx, accounting for 81.0%, 86.2% and 83.3%, respectively. Spearman rank correlation analysis showed that the total NAVOTEL score of 163 children was significantly positively correlated with AHI (r_s=0.48, P<0.01), and significantly negatively correlated with the lowest SaO₂ (r_s=-0.35, P<0.01). The NAVOTEL score of palatopharyngeal obstruction was positively correlated with AHI (r_s=0.33, P<0.01) and negatively correlated with the lowest SaO₂(r_s=-0.48, P<0.01). Conclusions DISE can be used to evaluate the site and severity of upper airway obstruction in children with OSA, and its score is correlated with AHI and minimum SaO₂, which can cooperate with PSG to improve the diagnosis and treatment level of OSA in children.

Key words: obstructive sleep apnea, drug-induced sleep endoscopy, child

CLC Number:

ZHANG Zhihai, TANG Xinye, YAO Hongbing, WANG Bing, XIAO Ling, YANG Yang. Application of drug-induced sleep endoscopy in pediatric obstructive sleep apnea[J].Journal of Clinical Pediatrics, 2025, 43(11): 830-836.

Figures/Tables 4

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Table 3

References 39

[1]	Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome[J]. Pediatrics, 2012, 130(3): 576-584. doi: 10.1542/peds.2012-1671 pmid: 22926173
[2]	Gulotta G, Iannella G, Vicini C, et al. Risk factors for obstructive sleep apnea syndrome in children: state of the art[J]. Int J Environ Res Public Health, 2019, 16(18): 1-20.
[3]	Mashaqi S, Patel SI, Combs D, et al. The hypoglossal nerve stimulation as a novel therapy for treating obstructive sleep apnea-a literature review[J]. Int J Environ Res Public Health, 2021, 18(4): 1642.
[4]	Dmowska J, Larson SR, Gillespie MB, et al. Effect of drug induced sleep endoscopy on intraoperative decision making in pediatric sleep surgery[J]. Int J Pediatr Otorhinolaryngol, 2020, 130: 109810.
[5]	Williamson A, Coutras SW, Carr MM. Sleep endoscopy findings in children with obstructive sleep apnea and small tonsils[J]. Ann Otol Rhinol Laryngol, 2022, 131(8): 851-858.
[6]	Ghorbani J, Adimi Naghan P, Safavi Naeini A, et al. Can be compared obstructive respiratory events during drug induced sleep endoscopy (DISE) and nocturnal polysomnography[J]. Eur Arch Otorhinolaryngol, 2020, 277(5): 1379-1384. doi: 10.1007/s00405-020-05848-5 pmid: 32086564
[7]	Baldassari CM, Lam DJ, Ishman SL, et al. Expert consensus statement: pediatric drug-induced sleep endoscopy[J]. Otolaryng Head Neck, 2021, 165(4): 578-591.
[8]	Boudewyns A, Saldien V, Van de Heyning P, et al. Drug-induced sedation endoscopy in surgically naïve infants and children with obstructive sleep apnea: impact on treatment decision and outcome[J]. Sleep Breath, 2018, 22(2): 503-510. doi: 10.1007/s11325-017-1581-7 pmid: 29081031
[9]	Adler AC, Chandrakantan A, Musso MF. Continuous positive airway pressure titration during pediatric drug induced sleep endoscopy[J]. Ann Otol Rhinol Laryngol, 2022, 131(10): 1085-1091.
[10]	中国儿童OSA诊断与治疗指南制订工作组, 中华医学会耳鼻咽喉头颈外科学分会小儿学组, 中华医学会儿科学分会呼吸学组, 等. 中国儿童阻塞性睡眠呼吸暂停诊断与治疗指南(2020)[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(8): 729-747.
	Working Group of Chinese Guideline for the Diagnosis and Treatment of Childhood OSA, Subspecialty Group of Pediatrics, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association, Subspecialty Group of Respiratory Diseases, Society of Pediatrics, Chinese Medical Association, et al. Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020)[J]. Zhonghua Erbiyanhou Toujing Waike Zazhi, 2020, 55(8): 729-747.
[11]	李辉, 季成叶, 宗心南, 等. 中国0-18岁儿童、青少年体块指数的生长曲线[J]. 中华儿科杂志, 2009, 47(7): 493-498.
	Li H, Ji CY, Zong XN, et al. Body mass index growth curves for Chinese children and adolescents aged 0 to 18 years[J]. Zhonghua Erke Zazhi, 2009, 47(7): 493-498.
[12]	国家卫生健康委员会. 体重管理指导原则(2024 年版)[M]. 北京: 中国标准出版社, 2024.
	National Health Commission of the People's Republic of China. Guidelines for weight management (2024 Edition)[M]. Beijing: China Standards Press, 2024.
[13]	何权瀛, 陈宝元, 韩芳, 等. 睡眠呼吸病学[M]. 第2版. 北京：人民卫生出版社, 2022.
	He QY, Chen BY, Han F, et al. Sleep and breathing medicine[M]. 2^nd ed. Beijing: People's Medical Publishing House, 2022.
[14]	Padiyara TV, Bansal S, Jain D, et al. Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: a randomized trial[J]. Laryngoscope, 2020, 130(1): 257-262.
[15]	Qarbal J, Le Treut-Gay C, Allali L, et al. Drug-induced sleep endoscopy in children: NAVOTEL scoring system development[J]. Pediatr Pulm, 2023, 58(7): 1889-1895.
[16]	Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification[J]. Eur Arch Otorhinolaryngol, 2011, 268(8): 1233-1236. doi: 10.1007/s00405-011-1633-8 pmid: 21614467
[17]	Fishman G, Zemel M, Derowe A, et al. Fiber-optic sleep endoscopy in children with persistent obstructive sleep apnea: inter-observer correlation and comparison with awake endoscopy[J]. Int J Pediatr Otorhi, 2013, 77(5): 752-755. doi: 10.1016/j.ijporl.2013.02.002 pmid: 23433922
[18]	Chan DK, Liming BJ, Horn DL, et al. A new scoring system for upper airway pediatric sleep endoscopy[J]. JAMA Otolaryngol, 2014, 140(7): 595. doi: 10.1001/jamaoto.2014.612 pmid: 24810174
[19]	Boudewyns A, Verhulst S, Maris M, et al. Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome[J]. Sleep Med, 2014, 15(12): 1526-1531. doi: 10.1016/j.sleep.2014.06.016 pmid: 25311832
[20]	Weaver, Edward, M, et al. Assessment of pediatric obstructive sleep apnea using a drug-induced sleep endoscopy rating scale[J]. Laryngoscope, 2016, 126(6): 1492-1498.
[21]	Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study[J]. Am J Respir Crit Care Med, 2011, 183 (6): 826-827.
[22]	Hyzer JM, Milczuk HA, Macarthur CJ, et al. Drug-induced sleep endoscopy findings in children with obstructive sleep apnea with vs without obesity or Down syndrome[J]. JAMA Otolaryngol Head Neck Surg, 2021, 147(2): 175-181.
[23]	Wang X, Chen YC, Li L, et al. Effects of drug-induced sleep endoscopy in children with conventional obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis[J]. Sleep Breath, 2024, 28(2): 935-944.
[24]	Ma AC, Rosi-Schumacher M, DiNardo LA, et al. A comparison of drug-induced sleep endoscopy findings in infants and toddlers[J]. Otolaryngol Head Neck Surg, 2024, 171(3): 888-893. doi: 10.1002/ohn.810 pmid: 38738918
[25]	Dejarnette K, Frederick RM, Harris AJ, et al. Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea[J]. Int J Pediatr Otorhinolaryngol, 2022, 162: 111256.
[26]	Ghosh S, Kishore S. Understanding correlation of polysomnography parameters with drug induced sleep endoscopy in obstructive sleep apnea[J]. Indian J Otolaryngol, 2023, 76 (1): 30-35.
[27]	Hsu YB, Lan MY, Huang YC, et al. The correlation between drug-induced sleep endoscopy findings and severity of obstructive sleep apnea[J]. Auris Nasus Larynx, 2021, 48(3): 434-440.
[28]	Randerath W, de Lange J, Hedner J, et al. Current and novel treatment options for obstructive sleep apnoea[J]. ERJ Open Res, 2022, 8(2): 00126-2022.
[29]	Piccin O, Caccamo G, Pelligra I, et al. Predictors of response to sleep apnea surgery addressing the lateral pharyngeal wall collapse[J]. Am J Otolaryngol, 2022, 43(2): 103344.
[30]	Nance RM, Fohner AE, McClelland RL, et al. The association of upper airway anatomy with cognitive test performance: the multi-ethnic study of atherosclerosis[J]. BMC Neurol, 2023, 23(1): 394. doi: 10.1186/s12883-023-03443-9 pmid: 37907860
[31]	A Han S, Cha H, Yang SK, et al. Sleep parameter characteristics of patients with OSA who have retropalatal circumferential narrowing and the clinical significance of lateral pharyngeal wall collapse during sleep[J]. Sleep Breath, 2023, 27(6): 2165-2173.
[32]	Kirkham EM. Pediatric drug-induced sleep endoscopy[J]. Otolaryngol Clin North Am, 2022, 55(6): 1165-1180.
[33]	叶惠如, 郝丽娟. 儿童阻塞性睡眠呼吸暂停诊疗进展[J]. 世界睡眠医学杂志, 2023, 10(11): 2753-2758.
	Ye HR, Hao LJ. Progress in diagnosis and treatment of obstructive sleep apnea in children[J]. Shijie Shuimian Yixue Zazhi, 2023, 10(11): 2753-2758.
[34]	Lo Bue A, Salvaggio A, Insalaco G. Obstructive sleep apnea in developmental age. A narrative review[J]. Eur J Pediatr, 2020, 179(3): 357-365. doi: 10.1007/s00431-019-03557-8 pmid: 31940071
[35]	吴云肖, 万真, 孔凡颖, 等. 睡眠呼吸障碍儿童注意缺陷、多动-冲动的特征分析[J]. 中国全科医学, 2022, 25(2): 180-184.
	Wu YX, Wan Z, Kong FY, et al. Characteristics of attention deficit and hyperactivity disorder in children with sleep-disordered breathing[J]. Zhongguo Quanke Yixue, 2022, 25(2): 180-184.
[36]	Raposo D, Menezes M, Rito J, et al. Drug-induced sleep endoscopy in pediatric obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2021, 164(2): 414-421.
[37]	Benedek P, Balakrishnan K, Cunningham MJ, et al. International pediatric otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA)[J]. Int J Pediatr Otorhinolaryngol, 2020, 138: 110276.
[38]	Filipek N, Kirkham E, Chen M, et al. Drug-induced sleep endoscopy directed surgery improves polysomnography measures in overweight and obese children with obstructive sleep apnea[J]. Acta Otolaryngol, 2021, 141(4): 397-402.
[39]	Collu MA, Esteller E, Lipari F, et al. A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: a proposal for indications[J]. Int J Pediatr Otorhinolaryngol, 2018, 108: 113-119.

项目	结果
男[n(%)]	114(69.9)
年龄[M(P₂₅~P₇₅)]/岁	7.0(5.0~9.0)
身高($\bar{x}±s$)/cm	125.3±18.2
体重[M(P₂₅~P₇₅)]/kg	28.0(20.0~37.0)
BMI($\bar{x}±s$)/kg·m^-2	18.1±4.1
肥胖[n(%)]	5(3.1)
偏瘦[n(%)]	88(54.0)
PSG[n(%)]
轻度OSA	95(58.3)
中度OSA	41(25.1)
重度OSA	27(16.6)
AHI[M(P₂₅~P₇₅)]/次·h^-1	8.8(6.9~16.3)
最低SaO₂($\bar{x}±s$)/%	72.9±11.8
BIS值($\bar{x}±s$)	72.0±1.7

阻塞部位	NAVOTEL评分[M(P₂₅~P₇₅)]	评分0[n(%)]	评分1[n(%)]	评分2[n(%)]	总阻塞[n(%)]
鼻腔	1.0(0~1.0)	68(41.7)	94(57.7)	1(0.6)	95(58.3)
腺样体	1.0(0~1.0)	71(43.6)	80(49.1)	12(7.4)	92(56.4)
腭咽	1.0(1.0~2.0)	26(16.0)	79(48.5)	58(35.6)	137(84.0)
咽侧壁	1.0(1.0~2.0)	39(23.9)	68(41.7)	56(34.4)	124(76.1)
舌根	0(0~1.0)	111(68.1)	46(28.2)	6(3.7)	52(31.9)
会厌	0(0~0)	133(81.6)	25(15.3)	5(3.1)	30(18.4)
喉部	0(0~0)	160(98.2)	3(1.8)	0(0)	3(1.8)

年龄	例数	阻塞部位[n(%)]
年龄	例数	鼻腔	腺样体	腭咽	咽侧壁	舌根	会厌	喉部
≤5岁	58	32(55.2)	32(55.2)	47(81.0)	41(70.7)	15(25.9)	14(24.1)	2(3.4)
6~10岁	87	53(60.9)	52(59.8)	75(86.2)	71(81.6)	29(33.3)	16(18.4)	0(0)
11~18岁	18	10(55.6)	8(44.4)	15(83.3)	12(66.7)	8(44.4)	0(0)	1(5.6)

Application of drug-induced sleep endoscopy in pediatric obstructive sleep apnea

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