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Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 155(4):676-680.

Original Research—Pediatric Otolaryngology

Otolaryngology– Head and Neck Surgery 2016, Vol. 155(4) 676–680 American Academy of Otolaryngology—Head and Neck

Airway Obstruction during Drug-Induced Sleep Endoscopy Correlates with Apnea- Hypopnea Index and Oxygen Nadir in Children John P. Dahl, MD, PhD, MBA 1,2 , Craig Miller, MD 3,4 , Patricia L. Purcell, MD, MPH 3,4 , David A. Zopf, MD, MS 5,6 , Kaalan Johnson, MD 3,4 , David L. Horn, MD, MS 3,4 , Maida L. Chen, MD 4,7 , Dylan K. Chan, MD, PhD 8,9 , and Sanjay R. Parikh, MD 3,4

Surgery Foundation 2016 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599816653113 http://otojournal.org

Keywords obstructive sleep apnea, drug-induced sleep endoscopy, polysomnogram, sleep-disordered breathing, pediatrics Received November 30, 2015; revised April 25, 2016; accepted May 13, 2016. D rug-induced sleep endoscopy (DISE) is a new diag- nostic tool in the evaluation of adults and children with obstructive sleep apnea (OSA). 1-3 Typically, it is a flexible fiberoptic observation of the upper airway under general anesthesia while maintaining spontaneous ventilation. 2-4 DISE has been reported to be a useful tool for identifying additional sites of obstruction in children and adults beyond tonsil and adenoid hypertrophy as appreciated on clinical examination. 1-6 1 Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA 2 Riley Hospital for Children, Indianapolis, Indiana, USA 3 Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA 4 Seattle Children’s Hospital, Seattle, Washington, USA 5 Department of Otolaryngology–Head and Neck Surgery, University of

Sponsorships or competing interests that may be relevant to content are dis- closed at the end of this article.

Abstract Objective. To determine if standardized intraoperative scoring of anatomic obstruction in children with obstructive sleep apnea correlates with the apnea-hypopnea index (AHI) and lowest oxygen saturation on preprocedural polysomnogram (PSG). A secondary objective was to determine if age, presence of a syn- drome, or previous adenotonsillectomy affect this correlation.

Study Design . Case series with chart review.

Setting. Two tertiary care children’s hospitals.

Subjects. Patients with a preprocedural PSG who underwent drug-induced sleep endoscopy (DISE) over a 4-year period. Methods. All DISEs were graded in a systematic manner with the Chan-Parikh (C-P) scoring system. AHI and nadir oxygen saturations were extracted from preprocedural PSG. Data were analyzed with a multivariate linear regression model that controlled for age at time of sleep endoscopy, syndrome diag- nosis, and previous adenotonsillectomy. Results. A total of 127 children underwent PSG prior to DISE: 56 were syndromic, and 21 had a previous adenotonsillectomy. Mean AHI was 13.6 6 19.6 ( 6 SD), and mean oxygen nadir was 85.4% 6 9.4%. Mean C-P score was 5.9 6 2.7. DISE score positively correlated with preoperative AHI ( r = 0.36, P \ .0001) and negatively correlated with oxygen nadir ( r = 2 0.26, P = .004). The multivariate linear regression models estimated that for every 1-point increase in C-P score, there is a 2.6-point increase in AHI (95% confidence interval: 1.4-3.8, P \ .001) and a 1.1% decrease in the lowest oxygen saturation (95% confi- dence interval: –1.7 to 2 0.6, P \ .001). Conclusion. The C-P scoring system for pediatric DISE corre- lates with both AHI and lowest oxygen saturation on pre- procedural PSG.

Michigan School of Medicine, Ann Arbor, Michigan, USA 6 C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA

7 Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA 8 Department of Otolaryngology–Head and Neck Surgery, University of

California–San Francisco, San Francisco, California, USA 9 Benioff Children’s Hospital, San Francisco, California, USA

This article was presented at the 2015 AAO-HNSF Annual Meeting & OTO EXPO; September 27-30, 2015; Dallas, Texas. Corresponding Author: Sanjay R. Parikh, MD, Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle Children’s Hospital, OA.9.220–Otolaryngology, 4800 Sand Point Way NE, Seattle, WA 98105, USA Email: sanjay.parikh@seattlechildrens.org

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