Sleep endoscopy findings in children in supine versus left lateral position.

Objective: To describe how drug-induced sleep endoscopy (DISE) findings in children with obstructive sleep apnea (OSA) change with lateral positioning.

Methods: Children undergoing DISE for OSA in 2018-19 at a tertiary care children's hospital were positioned first supine and then in left lateral (LL) and findings were compared.

Results: 63 children were included, 30 (47.6%) female and 33 (52.4%) male, mean age 4.64 years, and a mean Z-score 0.70. Mean pre-op Apnea Hypopnea Index (AHI) was 6.41 and REM AHI was 15.04. In supine position, 20 had obstruction at the palate (31.7%), 39 (61.9%) had obstruction at each of the base of tongue and the larynx, 17 (27.0%) had obstruction at the tonsils. In LL position, 11 (17.5%) were obstructed at the palate, 21 (33.3%) at the tonsils, 8 (12.7%) at the base of tongue and 7 (11.1%) at the larynx. Larynx and base of tongue were most likely to improve in LL position, as 54% of patients obstructed in supine position were open in LL position. Overall 38 (60.3%) patients improved on LL, 18 (28.6%) had no change, and 7 (11.1%) worsened. 30 (47.6%) patients improved in 1 site while 12 (19.0%) improved in more than 1 site. 16 (25.4%) patients worsened in 1 site and 9 (56.3%) of these had improvement in another site.

Conclusions: A significant number of patients improved airway patency, particularly at the base of tongue/larynx, during DISE when placed in LL position as compared to standard supine positioning.