Evaluation of Sleep Stages During Drug-Induced Sleep Endoscopy in Pediatric Patients with Obstructive Sleep Apnea: A Pilot Study

Introduction

Drug-induced sleep endoscopy (DISE) is a valuable tool for the assessment of the upper airway in paediatric obstructive sleep apnoea (OSA). General anaesthesia induces sleep-like conditions during DISE; however, there is limited understanding of the neurophysiological aspects of this sleep. We conducted a prospective cohort pilot study recording electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) data in paediatric OSA patients during DISE.

Objectives

Demonstrate the safety and feasibility of collecting sleep stages during DISE in paediatric patients with OSA. Characterise sleep stages of paediatric OSA patients undergoing DISE.

Design

Prospective cohort pilot study.

Setting

Academic medical centre.

Participants

Patients between two (2) and 18 years old (inclusive) with a history of OSA and preoperative polysomnography (PSG) were recruited. Patients with known craniofacial abnormalities were excluded. Non-English or non-Spanish speaking subjects were excluded.

Results

We recruited 13 subjects aged 3 to 13 years old. EEG, EOG, and EMG data was collected during the DISE procedure. Raw data was scored by a board-certified sleep medicine physician. Six subjects experienced N1 sleep, 12 subjects experienced N2 sleep, and 5 subjects experienced N3 sleep. Most subjects spent the majority of their time in N2 sleep. No subjects experienced REM sleep. The primary intravenous sedative agent used was dexmedetomidine.

Conclusion

This pilot study gives the first insight into sleep stages of paediatric OSA patients undergoing DISE. Additional investigation of the neurophysiology and the effects of different intravenous anaesthetics during the DISE procedure is warranted.