Assessment of upper airway obstruction sites by means of sonoendoscopy and its correlation with OSAS severity before and after surgery

Abstract

Obstructive sleep apnea syndrome (OSAS) affects 1 to 4% of the pediatric population and its gold standard treatment is adenotonsillectomy (TA). It is known that 10 to 35% of patients undergoing TA remain with residual OSAS. Drug-induced sleep endoscopy (DISE) can assist in the diagnosis of upper airway collapse (VAS) sites, which may improve this statistic. Objectives: To correlate the sites of upper airway obstruction evaluated by DISE in children with OSAS in the pre and postoperative period of TA.

Methods: Prospective study that evaluated children with OSAS, confirmed by polysomnography, and indication for TA. The participants were submitted to DISE immediately before surgery and the results of OSAS severity and obstruction sites were compared before and after the surgery.

Results: A total of 60 individuals were evaluated, 33 male, aged between 3.8 and 9.11 years, with Z score from -2.06 to 5.67. The mean apnea and hypopnea index (AHI) was 12.3 (2-46.5) in the preoperative period and 4.5 (0.5-18.2) in the post-operative period. DISE showed that 17(28.3%) participants had complete obstruction at the velopharynx level and 32(53.3%) at the oropharynx level. Fifty-three participants (88%) had some degree of obstruction at velo and oropharynx. Seven (11.6%) had total obstruction on the base of the tongue. Forty-one participants (68.3%) were considered cured (AHI <5). From the 19 participants with residual OSAS, 2 had obstruction at the base of the tongue or epiglottis.

Conclusions: DISE can be considered a useful instrument to assess other obstructive sites, less common, such as the base of the tongue and epiglottis.