Coutras SW, et al. - Researchers aimed to describe the patterns of obstruction in persistent pediatric obstructive sleep apnea (OSA) and their relationship with patient weight. In persistent pediatric OSA, they observed multiple sites of obstruction. Slightly different findings were observed in children with higher BMIs, suggesting that attention to adenoid regrowth and lingual tonsil hypertrophy is important.

Methods

• Researchers reviewed all pediatric DISE procedures performed at a tertiary care hospital between October 2010 and October 2015.
• Patients underwent Polysomnography after adenotonsillectomy that confirmed persistent obstructive sleep apnea (OSA).
• Age, gender, co-morbidities, and AHI were the included variables.
• In this study, DISE findings focused on inferior turbinates, adenoid, tongue base, epiglottis, aryepiglottic (AE) folds, arytenoids, lingual tonsil and their contributions to obstruction.

Results

• Inclusion of 34 patients was performed; mean age was 7.85 (2–16) years, mean BMI was 23.15 (13.6–44.8) and mean AHI was 6.34 (1.5–25.2) events per hour.
• In 97% patients, obstruction occurred at the level of the epiglottis; with retropositioning by tongue base (73.6%) or lingual tonsil enlargement (70.5%).
• Obstruction occurred at the inferior turbinates, the adenoid and the palate in 76.5%, 64.7% and 58.8%, respectively.
• Researchers less frequently identified shortened AE folds (15%).
• Ninety-seven percent of patients showed multiple sites of partial or complete obstruction.
• In this study, overweight or obese patients showed a mean of 3 sites of complete obstruction and 4.69 sites of partial or complete obstruction as compared to 2.33 and 4.52 in underweight or normal weight children.
• Compared to normal/underweight children, overweight or obese children were more likely to have obstruction at the lingual tonsil or adenoid.