{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:57:48Z","timestamp":1789390668814,"version":"build-2803163510"},"reference-count":43,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Otol Rhinol Laryngol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Residual obstructive sleep apnea (OSA) following adenotonsillectomy (AT) is common in children with obesity. Drug-induced sleep endoscopy (DISE) identifies upper airway obstruction and guides surgery. A gap remains in evaluating multiple DISE-directed treatments. This study evaluates multiple DISE-directed procedure outcomes, obstruction patterns, and BMI in pediatric patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This single-institution retrospective cohort study included pediatric patients who underwent DISE-directed interventions from 2009 to 2020. Variables included patient characteristics, DISE timing, obstruction patterns, obstructive apnea-hypopnea index (OAHI), and OSA-18 quality-of-life (QOL). Chi-square tests compared patient demographics and comorbidities between single and multiple DISE groups. Unpaired\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -tests compared age, OAHI, and OSA-18 scores between single and multiple DISE groups as well as multiple-DISE outcomes for high versus normal BMI groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 122 children who underwent DISE, 27 (22%) had multiple DISE-directed procedures. Average age at first DISE for single and multiple DISE patients was 7.25 (SD\u2009=\u20093.93) and 4.99 (SD\u2009=\u20093.63) years, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.01). Common obstructions at second DISE involved the epiglottis (N\u2009=\u200920, 74%), adenoid (N\u2009=\u200918, 67%), and inferior turbinates (N\u2009=\u200915, 56%). Multilevel obstruction was identified in 96% (N\u2009=\u200926) of second and 80% (N\u2009=\u20094) of third DISEs. Children with high BMI (versus normal BMI) exhibited shorter intervals between DISEs. Patients who underwent single DISE exhibited significant OAHI improvement (mean 8.48 vs 3.91,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.05), but this was not significant for multiple DISEs. The OSA-18 score improved significantly in patients with single DISE (mean summed score 61.3 vs 44.6,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Pediatric OSA involves persistent, multilevel obstruction, especially in younger patients with elevated BMI undergoing multiple DISE-directed procedures. These findings support anatomy-guided, patient-specific surgical planning for high-risk groups. While a single DISE-directed intervention can significantly improve OAHI and QOL, repeated procedures may yield diminishing returns, underscoring the need to consider their timing and utility. Early multidisciplinary evaluation and long-term follow-up are essential for managing persistent OSA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00034894251381169","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T08:06:19Z","timestamp":1761206779000},"page":"146-153","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Multiple Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea: Obstruction Patterns and Outcomes"],"prefix":"10.1177","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0504-9076","authenticated-orcid":false,"given":"Daniel R. S.","family":"Habib","sequence":"first","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Vanderbilt University School of Medicine, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0379-5957","authenticated-orcid":false,"given":"Liliana","family":"Arida-Moody","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Vanderbilt University School of Medicine, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-9071","authenticated-orcid":false,"given":"Ankita","family":"Patro","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffanie","family":"Wu","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5627-0670","authenticated-orcid":false,"given":"Seth","family":"Davis","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalpnaben","family":"Patel","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher T.","family":"Wootten","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids (SOCKs), Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Department of Otolaryngology\u2014Head &amp; 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