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Predictors of Factors of Failure of DISE (Drug-Induced Sleep Endoscopy) Directed Adenoidectomy and/or Tonsillectomy in Children with Sleep- Disordered Breathing (SDB)

Waleed R Jabri, Mohamed Kamel and Mostafa M Ali

Background: Sleep-disordered breathing (SDB) is a common pediatric condition. Enlarged tonsils and adenoids are the commonest cause of SDB. However, many patients would have persistent signs and symptoms of SDB after Adenotonsillectomy (AT). Drug-induced sleep endoscopy (DISE) involves assessment of the upper airway using a flexible endoscope while patients are in a pharmacologically-induced sleep-like state. DISE may provide a more individualized surgical plan, predict factors that may cause treatment failure and limit unsuccessful surgeries.

Aim: Using DISE variables to predict the factors associated with persistent SDB in children after adenoidectomy and/or tonsillectomy. Patients and methods: This is a prospective non-randomized cross-sectional study included surgery-naïve patients (2-12 years of age) with adenotonsillar hypertrophy or infection and presented with symptoms of SDB. They have been referred to the Fayoum University Hospital for adenoidectomy and/or tonsillectomy. A pediatric sleep questionnaire (PSQ) for SDB was asked to be completed by the parents before and after the operation. Patients who underwent DISE-directed adenoidectomy and/or tonsillectomy for SDB between were eligible for the study. Other variables such as the history of asthma, Body mass index (BMI), snoring duration, history of allergic rhinitis, tonsil size according to Brodsky score, and adenoid size on X-ray were recorded. Children who had a previous operation for SDB and syndromic children are excluded. Results: One hundred patients have satisfied the inclusion criteria. Based on the postoperative modified PSQ, SDB resolved in 81 patients (81%), whereas 19(19%) had persistent symptoms. After DISE-directed adenoidectomy and/or tonsillectomy, allergic rhinitis (severe form), inferior turbinate hypertrophy, Deviated nasal septum (DNS), tongue base collapse, lateral pharyngeal wall collapse, lingual tonsil hypertrophy, and retroflexed epiglottis were associated with SDB treatment failure. Also, children who are obese and asthmatic were linked to unsuccessful surgery. Conclusions: DISE is a safe and useful technique for exact localization of sites of upper airway obstruction, improving surgical planning, elimination of unnecessary procedures, and improving surgical outcomes.