Visualizing natural sleep state during nasolaryngoscopy in infants: A feasibility study

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY
Vanessa Helou , Nicholas Oberlies , Amber D. Shaffer , Rachel Whelan , Sanjay R. Patel , Noel Jabbour
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Abstract

Introduction

Otolaryngology consultation for infant airway obstruction is common, with nasolaryngoscopy being the primary diagnostic tool. However, traditional awake nasolaryngoscopy is often limited by infant crying and brief examinations. A more detailed drug-induced sleep endoscopy requires anesthesia and operating room resources. This study explores Time-Induced Sleep Endoscopy (TISE) as a relatively brief, non-invasive alternative for evaluating sleep-related airway dynamics in infants.

Methods

This prospective study enrolled infants under three months of age at UPMC Children's Hospital of Pittsburgh. Hospitalized infants requiring bedside flexible nasolaryngoscopy for airway evaluation were eligible. A flexible nasolaryngoscope was inserted nasally and left in place until the infant fell asleep with a 5-min cut-off. Endoscopic videos were scored for airway obstruction while awake and asleep by two pediatric otolaryngologists using the Sleep Endoscopy Rating Scale. Demographics and time to sleep were recorded. Logistic regression examined factors associated with successful TISE. Inter-rater reliability was assessed using Cohen's Kappa.

Results

Among 19 infants (median post-menstrual age at evaluation: 40.3 weeks, range: 37.1–51.5), TISE was successful in 11 (57.9 %), with an average time to sleep of 3.1 min. Infants younger than three weeks were eight times more likely to fall asleep compared to older infants (OR = 8.00, 95 % CI: 1.00–63.96, p=.048). Compared to awake endoscopy, TISE revealed higher frequency of airway obstruction, particularly for hypopharyngeal obstruction (100 % compared to 18 %, p=.004). Inter-rater reliability was moderate for awake endoscopy (κ = 0.55) and fair for TISE (κ = 0.38).

Conclusion

TISE can allow for visualization of sleep-related airway obstruction in some infants. Further validation is needed for broader use.
婴儿鼻咽镜检查时自然睡眠状态的可视化:可行性研究
婴儿气道阻塞的耳鼻喉科会诊是常见的,鼻咽喉镜检查是主要的诊断工具。然而,传统的清醒鼻咽镜检查往往受到婴儿哭声和简短检查的限制。更详细的药物诱发睡眠内窥镜检查需要麻醉和手术室资源。本研究探讨了时间诱导睡眠内窥镜(TISE)作为评估婴儿睡眠相关气道动力学的一种相对简短、无创的替代方法。方法本前瞻性研究纳入匹兹堡UPMC儿童医院3个月以下的婴儿。需要床边柔性鼻咽镜检查气道评估的住院婴儿符合条件。将一个可弯曲的鼻咽镜从鼻腔插入,并保持在原位,直到婴儿入睡,间隔5分钟。两名儿科耳鼻喉科医生使用睡眠内窥镜评分量表对清醒和睡眠时的内窥镜视频进行气道阻塞评分。统计数据和睡眠时间被记录下来。Logistic回归分析了与成功的TISE相关的因素。评估者间信度采用Cohen's Kappa。结果19例婴儿(评估时月经后年龄中位数为40.3周,范围为37.1-51.5)中,有11例(57.9%)成功,平均睡眠时间为3.1 min。小于3周的婴儿入睡的可能性是较大婴儿的8倍(OR = 8.00, 95% CI: 1.00-63.96, p= 0.048)。与清醒内镜相比,TISE显示气道阻塞的频率更高,特别是下咽阻塞(100%比18%,p= 0.004)。清醒内窥镜的评分间信度为中等(κ = 0.55), TISE的评分间信度为中等(κ = 0.38)。结论:该方法可对部分婴幼儿睡眠相关气道阻塞进行可视化检查。为了更广泛的应用,需要进一步的验证。
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来源期刊
CiteScore
3.20
自引率
6.70%
发文量
276
审稿时长
62 days
期刊介绍: The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.
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