Drug-Induced Sleep Endoscopy and Its Recent Clinical Applications in Combination with Other Procedures in Children: A Narrative Review

Zhixian Xiao,1,* Xing Li,2,* Li Zhou,3,* Xiaocui Long,4 Li Tian,3 Weiqi Li2 1Department of Otorhinolaryngology-Head and Neck Surgery, Affiliated Meishan Hospital of Chengdu University of TCM, Meishan, People’s Republic of China; 2Department of Otorhinolaryngology-Head and Neck Surgery, Traditional Chinese Medicine Hospital of Meishan, Meishan, People’s Republic of China; 3Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 4Department of Ophthalmology, Traditional Chinese Medicine Hospital of Meishan, Meishan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Weiqi Li, Department of Otorhinolaryngology-Head and Neck Surgery, Traditional Chinese Medicine Hospital of Meishan, No. 9, North Section of Mindong Avenue, Dongpo District, Meishan, 620010, Sichuan, People’s Republic of China, Tel +8615983311840, Email [email protected] Li Tian, Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39~41, 12 Qiao Road, Jinniu District, Chengdu, 610075, People’s Republic of China, Tel +8618980880129, Email [email protected]: Drug-induced sleep endoscopy (DISE) is a dynamic diagnostic tool that is increasingly used to evaluate upper airway obstruction, especially in pediatric obstructive sleep apnea. Although initially established in adult populations, its pediatric application is expanding. Since 1990, more than 80 studies have explored various aspects of DISE, with a growing subset focusing specifically on its use in children, supported by advancements in sedation protocols. This narrative review summarizes the clinical indications for pediatric DISE, preparation protocols, and validated scoring systems, including the VOTE and Chan classifications. We also highlight the integration of DISE with adjunctive tools such as positive airway pressure titration, long-range optical coherence tomography, and dynamic magnetic resonance imaging for improved diagnostic accuracy and individualized treatment planning. These developments suggest that DISE, when standardized, holds strong potential to refine the management of complex pediatric airway disorders.Keywords: children, drug-induced sleep endoscopy, obstructive sleep apnea, combination strategy