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Sleep Medicine

DISE Findings in Infants vs Toddlers

Tuesday, October 3, 2023
9:51 AM - 9:57 AM East Coast USA Time
Location: 103A

    Presenting Author(s)

  • Alison C. Ma, BS/MS

    Medical Student
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Buffalo, New York, United States

    • Co-Author(s)

  • Lauren A. DiNardo, BS

    Medical Student
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Buffalo, New York, United States

    • Presenting Author(s)

  • Mattie R. Rosi-Schumacher, MD

    Resident Physician
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Buffalo, NY, United States

    • Senior Author(s)

  • Michele M. Carr, DDS MD PhD

    Professor
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Williamsville, NY, United States

Disclosure(s):
Alison C. Ma, BS/MS: No relevant relationships to disclose.
Lauren A. DiNardo, BS: No relevant relationships to disclose.
Mattie R. Rosi-Schumacher, MD: No relevant relationships to disclose.
Michele M. Carr, DDS MD PhD: No relevant relationships to disclose.
Introduction: Little is known about the mechanism of airway obstruction in infants with obstructive sleep apnea (OSA). In this study, drug-induced sleep endoscopy (DISE) was used to compare patterns of obstruction in infants and toddlers with OSA.

Methods: A retrospective chart review was performed for children aged < 3 years who underwent DISE with propofol titration from 2020 to 2022. DISE recording was done on a validated scorecard at the time of the procedure. Data included age, comorbidities, pre-op and post-op sleep surgery procedures, pre-op and post-op apnea hypopnea index (AHI), total number sites of obstruction, and specific sites of obstruction, including tonsils, adenoid, tongue base, larynx, palate, and nose.

Results: A total of 81 children underwent DISE, 12 infants ( < 1yo) and 69 toddlers (>1 < 3.9yo). 53 (65%) were male and 28 (34%) were female. Mean age of the infant group was 0.84y (95% CI 0.71-0.97y). Mean age of the toddler group was 2.38y (95% CI 2.20-2.55y). Mean number of sites of obstruction was significantly different between infants (N=2.3) and toddlers (N=3.2) (P=.025). Palatal obstruction was more common in infants (N=6, 50%) than toddlers (N=16, 23%)(P=.046). Comorbidities, Z-scores, pre-op and post-op apnea hypopnea index (AHI), and frequency of all other sites of obstruction were not significantly different between the two groups.

The most common sites of obstruction were the epiglottis in 10 (83%) infants and 51 (76%) toddlers (74% of total), aryepiglottic folds in 8 (67%) infants and 51 (79%) toddlers (72% of total), and the tongue base in 9 (82%) infants and 50 (74%) toddlers (72% of total). Adenoid obstruction occurred in 6 (50%) infants and 50 (72%) toddlers (68% of total).

Conclusions: Palatal obstruction occurred in half of this group of infants, but was uncommon in older children, suggesting that this site of obstruction improves with growth. Retrolingual and laryngeal obstruction is common in children age 3 or younger.