Patterns of Pharyngeal Obstruction and Collapse in Obese and Nonobese Children on Drug-Induced Sleep Endoscopy

Objective(1) Compare proportions of collapse, obstruction, or mixed instances on drug-induced sleep endoscopy findings of obese and nonobese children with obstructive sleep disordered breathing. (2) Determine the frequency of collapse in general between both groups. Study DesignRetrospective case-control study. SettingTertiary pediatric center. MethodsObese (body mass index >95 percentile) children presenting with obstructive sleep disordered breathing (>33 on the pediatric sleep questionnaire) were identified from a prospectively kept surgical database. Only those who had undergone drug-induced sleep endoscopy were eligible. Age and sex pair-matched nonobese children were identified. Only nonsyndromic, neurologically normal, surgically naive patients were included. The frequency of obstructive, collapse, and mixed pharyngeal patterns was documented in both groups. A comparison of proportions was then undertaken (chi(2) test). ResultsOver a 5-year period, 73 consecutive children with obesity were identified (40 males; mean of 8.5 +/- 3.0 years, 2.8-13.1). They were matched with 73 nonobese children (8.4 +/- 3.0 years, 2.6-14.1). The obese group exhibited significantly more pharyngeal collapses (62:47) (p = .0021 odds ratio [OR] 3.358, 95% confidence interval [CI] 1.52-7.42). The proportion of pharyngeal findings on drug-induced sleep endoscopy was significantly different (p = .000129) between the 2 groups; obese (61 mixed: 3 obstruction: 9 collapse) and nonobese (48 mixed: 22 obstruction: 4 collapse). ConclusionThe predominance of hypopharyngeal collapse in children with obesity may explain the likelihood of failure of surgery directed at obstructive findings. This may also strengthen the case for drug-induced sleep endoscopy in this group at the initial surgery to guide it rather than after the failure of adenotonsillectomy.

Automated summary

This retrospective case-control study compared the proportions of collapse, obstruction, or mixed instances on drug-induced sleep endoscopy findings between obese and nonobese children with obstructive sleep disordered breathing. The results showed that obese children exhibited significantly more pharyngeal collapses than nonobese children. This finding suggests that the predominance of hypopharyngeal collapse in obese children may contribute to the failure of surgery directed at obstructive findings.