Drug‐Induced Sleep Endoscopy Findings in Obese Adolescents With Sleep Apnea

OBJECTIVE: Data regarding drug-induced sleep endoscopy (DISE) findings in obese adolescents with obstructive sleep apnea (OSA) are lacking; such information could be used to direct and improve management as there is controversy whether adenotonsillectomy (AT) or positive airway pressure is standard therapy for this population. Our primary objective is to describe DISE findings in obese adolescents. STUDY DESIGN: Case-control. SETTING: Tertiary care children's hospital. METHODS: A 10-year retrospective review was conducted of obese adolescents 12 to 21 years old with OSA (apnea-hypopnea index [AHI] ≥ 1) that underwent DISE prior to AT. All DISE procedures were scored utilizing a modified VOTE classification. RESULTS: Forty surgically naïve obese adolescents underwent DISE. Median age of the adolescents was 16 (interquartile range [IQR] 3.0) years. The majority of patients had severe disease with a median AHI of 44 (IQR 46). The most common site of collapse noted on DISE was the oropharynx/lateral oropharyngeal walls, occurring in 93.3% (n = 36) of obese adolescents. Complete tongue base obstruction was infrequent, occurring in only 12.8% (n = 5) of obese patients. While the majority (n = 31, 80%) of obese patients had multilevel obstruction, median AHI was not associated with multilevel collapse (diff 19.2, 95% CI [-44.1, 5.7], P = .13). CONCLUSION: The most common site of collapse found on DISE in surgically naïve obese adolescents is the oropharynx. Multilevel upper airway obstruction is common among obese adolescents with OSA. Future research is needed to assess if DISE-directed multilevel sleep surgery improves outcomes in this challenging-to-treat population.