{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:16:46Z","timestamp":1788239806747,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Drug-induced sleep endoscopy (DISE) enables dynamic, real-time visualization of the level, severity, and configuration of upper airway collapse during pharmacologically induced sleep, providing anatomical information that polysomnography cannot. It is increasingly used to guide individualized surgical planning in obstructive sleep apnea (OSA), particularly in children with persistent OSA after adenotonsillectomy or at elevated risk of surgical failure. However, the absence of a universally accepted pediatric-specific classification system and standardized protocol continues to limit comparability across studies and the development of evidence-based treatment algorithms. This review evaluates the role of DISE in pediatric OSA, focusing on airway assessment, classification systems, anesthesia protocols, and its impact on surgical decision-making. Methods: A PubMed literature review (2013\u20132025) identified 42 pediatric-specific studies, including cohort studies, systematic reviews, and meta-analyses. Data were extracted regarding indications, classification scales, anesthetic techniques, safety, and surgical outcomes. Results: DISE provides dynamic visualization of multilevel obstructions often missed during awake examinations. While adult-derived systems such as VOTE are used, pediatric-specific tools (e.g., Chan\u2013Parikh, NAVOTEL, PedDISE-8, IPSES) offer more age-appropriate assessments. Anesthetic choice is a key factor; dexmedetomidine, alone or with ketamine, best approximates non-rapid eye movement (NREM) sleep while maintaining airway tone and stability. DISE findings altered surgical plans in 30\u201360% of patients, facilitating targeted procedures such as supraglottoplasty, lingual tonsillectomy, and epiglottopexy. Conclusions: DISE is a valuable diagnostic and decision-support tool for complex pediatric OSA. Clinical utility depends on standardized assessment and anesthesia. Further multicenter studies are required to validate classification systems and determine long-term impacts on quality of life.<\/jats:p>","DOI":"10.3390\/jcm15176630","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:47:13Z","timestamp":1787849233000},"page":"6630","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea: Clinical Applications, Classification Systems, and Anesthetic Considerations"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3274-2343","authenticated-orcid":false,"given":"Patryk Oskar","family":"Manycz","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Wroclaw Medical University, Pasteura 1, 50-369 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Morawska-Kochman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Wroclaw Medical University, Pasteura 1, 50-369 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1747-2250","authenticated-orcid":false,"given":"Jakub","family":"Zieli\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Wroclaw Medical University, Pasteura 1, 50-369 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/j.1365-2273.1991.tb01050.x","article-title":"Sleep nasendoscopy: A technique of assessment in snoring and obstructive sleep apnoea","volume":"16","author":"Croft","year":"1991","journal-title":"Clin. Otolaryngol. Allied Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.sleep.2022.12.015","article-title":"Automatic scoring of drug-induced sleep endoscopy for obstructive sleep apnea using deep learning","volume":"102","author":"Hanif","year":"2023","journal-title":"Sleep Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s11325-017-1521-6","article-title":"Drug-induced sedation endoscopy (DISE) classification systems: A systematic review and meta-analysis","volume":"21","author":"Dijemeni","year":"2017","journal-title":"Sleep Breath."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s11325-023-02945-7","article-title":"Effects of drug-induced sleep endoscopy in children with conventional obstructive sleep apnea-hypopnea syndrome: A systematic review and meta-analysis","volume":"28","author":"Wang","year":"2024","journal-title":"Sleep Breath."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s40463-021-00539-5","article-title":"Management of obstructive sleep apnea in children: A Canada-wide survey","volume":"50","author":"Cousineau","year":"2021","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"110440","DOI":"10.1016\/j.ijporl.2020.110440","article-title":"Anesthetic management of children undergoing drug-induced sleep endoscopy: A retrospective review","volume":"139","author":"Liu","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1177\/0194599820947666","article-title":"Drug-induced sleep endoscopy in pediatric obstructive sleep apnea","volume":"164","author":"Raposo","year":"2021","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1016\/j.otc.2022.07.004","article-title":"Pediatric drug-induced sleep endoscopy","volume":"55","author":"Kirkham","year":"2022","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1002\/ohn.810","article-title":"A comparison of drug-induced sleep endoscopy findings in infants and toddlers","volume":"171","author":"Ma","year":"2024","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Blokland, R., Friedland, Y., Kalra, A., Withers, A., and Vijayasekaran, S. (2025). Outcomes of DISE-directed surgery for obstructive sleep apnoea in children. Children, 12.","DOI":"10.20944\/preprints202507.0518.v1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1177\/0194599820985000","article-title":"Expert consensus statement: Pediatric drug-induced sleep endoscopy","volume":"165","author":"Baldassari","year":"2021","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/coa.14008","article-title":"Is drug-induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta-analysis","volume":"48","author":"Lisan","year":"2023","journal-title":"Clin. Otolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s12070-023-04052-1","article-title":"Understanding correlation of polysomnography parameters with drug induced sleep endoscopy in obstructive sleep apnea","volume":"76","author":"Ghosh","year":"2024","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/coa.14283","article-title":"Drug induced sleep endoscopy-directed tongue surgery to treat persistent pediatric obstructive sleep apnea: A systematic review and meta-analysis","volume":"50","author":"Sims","year":"2025","journal-title":"Clin. Otolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103992","DOI":"10.1016\/j.amjoto.2023.103992","article-title":"Does DISE increase the success rate of surgery for obstructive sleep apnea in children? A systematic review of DISE directed treatment of children with OSAS","volume":"44","author":"Sigaard","year":"2023","journal-title":"Am. J. Otolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Mas\u00e1rov\u00e1, M., Matou\u0161ek, P., Jor, O., Nov\u00e1k, V., Vrtkov\u00e1, A., Kubec, V., Zelen\u00edk, K., Kom\u00ednek, P., and Form\u00e1nek, M. (2022). Sleep endoscopy with positive airway pressure: A method for better compliance and individualized treatment of patients with obstructive sleep apnea. Life, 12.","DOI":"10.3390\/life12122108"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hady, K.K., and Okorie, C.U.A. (2021). Positive airway pressure therapy for pediatric obstructive sleep apnea. Children, 8.","DOI":"10.3390\/children8110979"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.wjorl.2021.05.002","article-title":"Pediatric drug-induced sleep endoscopy: An updated review of the literature","volume":"7","author":"Arganbright","year":"2021","journal-title":"World J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1177\/00034894251318158","article-title":"Reliability and validity of a pediatric drug-induced sleep endoscopy grading system (PedDISE-8)","volume":"134","author":"Jaffal","year":"2025","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"110289","DOI":"10.1016\/j.ijporl.2020.110289","article-title":"Drug-induced sleep endoscopy findings in surgically-na\u00efve obese vs non-obese children","volume":"138","author":"Lookabaugh","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_21","first-page":"e10765","article-title":"Pediatric drug-induced sleep endoscopy: Technique and scoring system","volume":"12","author":"Williamson","year":"2020","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"111284","DOI":"10.1016\/j.ijporl.2022.111284","article-title":"Reliability of a pediatric sleep endoscopy scoring system","volume":"162","author":"Williamson","year":"2022","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1159\/000518660","article-title":"Beyond VOTE: The new frontier of drug-induced sleep endoscopy","volume":"84","author":"Dedhia","year":"2022","journal-title":"ORL J. Otorhinolaryngol. Relat. Spec."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Iannella, G., Magliulo, G., Greco, A., De Virgilio, A., Maniaci, A., Lechien, J.R., Calvo-Henriquez, C., Bahgat, A.Y., Casale, M., and Lugo, R. (2024). Clinical application of pediatric sleep endoscopy: An international survey. Children, 11.","DOI":"10.3390\/children11010094"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1002\/ppul.26408","article-title":"Drug-induced sleep endoscopy in children: NAVOTEL scoring system development","volume":"58","author":"Qarbal","year":"2023","journal-title":"Pediatr. Pulmonol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"111627","DOI":"10.1016\/j.ijporl.2023.111627","article-title":"International Pediatric Otolaryngology Group (IPOG) consensus on scoring of pediatric drug induced sleep endoscopy (DISE)","volume":"171","author":"Parikh","year":"2023","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"111900","DOI":"10.1016\/j.ijporl.2024.111900","article-title":"Long-range optical coherence tomography of pediatric airway during drug induced sleep endoscopy: A preliminary report","volume":"178","author":"Goshtasbi","year":"2024","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1177\/00034894211055527","article-title":"Continuous positive airway pressure titration during pediatric drug induced sleep endoscopy","volume":"131","author":"Adler","year":"2022","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1002\/lio2.918","article-title":"Drug-induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2-year follow-up","volume":"7","author":"Frederick","year":"2022","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/ohn.947","article-title":"Lingual tonsillectomy as part of a DISE-directed multilevel upper airway surgery to treat complex pediatric OSA: A safe and appropriate procedure","volume":"172","author":"Trandafir","year":"2025","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1177\/01945998221097659","article-title":"Sleep endoscopy and cine magnetic resonance imaging evaluation of children with persistent obstructive sleep apnea","volume":"168","author":"Li","year":"2023","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5664\/jcsm.10816","article-title":"Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea","volume":"20","author":"Williamson","year":"2024","journal-title":"J. Clin. Sleep Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"110482","DOI":"10.1016\/j.ijporl.2020.110482","article-title":"Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: A systematic review","volume":"139","author":"Saniasiaya","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/lary.23832","article-title":"Drug-induced sleep endoscopy for upper airway evaluation in children with obstructive sleep apnea","volume":"123","author":"Ulualp","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2771","DOI":"10.1002\/lary.27759","article-title":"Polysomnography outcomes in children with small tonsils undergoing drug-induced sleep endoscopy-directed surgery","volume":"129","author":"Miller","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1177\/00034894211045645","article-title":"Sleep endoscopy findings in children with obstructive sleep apnea and small tonsils","volume":"131","author":"Williamson","year":"2022","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1055\/s-0043-1768207","article-title":"The effect of tonsillectomy and adenoidectomy on upper airway obstruction patterns in children with obstructive sleep apnea","volume":"27","author":"Mothersole","year":"2023","journal-title":"Int. Arch. Otorhinolaryngol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"110351","DOI":"10.1016\/j.ijporl.2020.110351","article-title":"Outcomes of OSA in surgically na\u00efve young children with and without DISE identified laryngomalacia","volume":"138","author":"Love","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s12070-022-03245-4","article-title":"Severe pediatric sleep apnea: Drug-induced sleep endoscopy based surgery","volume":"75","author":"Mendes","year":"2023","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"De Lausnay, M., Verhulst, S., Van Hoorenbeeck, K., and Boudewyns, A. (2021). Obstructive sleep disorders in Down syndrome\u2019s children with and without lower airway anomalies. Children, 8.","DOI":"10.3390\/children8080693"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"111256","DOI":"10.1016\/j.ijporl.2022.111256","article-title":"Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea","volume":"162","author":"DeJarnette","year":"2022","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1007\/s00405-017-4481-3","article-title":"Drug-induced sedation endoscopy in children <2 years with obstructive sleep apnea syndrome: Upper airway findings and treatment outcomes","volume":"274","author":"Boudewyns","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40463-022-00562-0","article-title":"Pediatric sleep outcomes after endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy","volume":"51","author":"Maksimoski","year":"2022","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1080\/00016489.2018.1504169","article-title":"Does drug induced sleep endoscopy-directed surgery improve polysomnography measures in children with Down syndrome and obstructive sleep apnea?","volume":"138","author":"Akkina","year":"2018","journal-title":"Acta Otolaryngol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1001\/jamaoto.2014.612","article-title":"A new scoring system for upper airway pediatric sleep endoscopy","volume":"140","author":"Chan","year":"2014","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1002\/lary.25842","article-title":"Assessment of pediatric obstructive sleep apnea using a drug-induced sleep endoscopy rating scale","volume":"126","author":"Lam","year":"2016","journal-title":"Laryngoscope"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"111748","DOI":"10.1016\/j.ijporl.2023.111748","article-title":"Development and validation of the international pediatric sleep endoscopy scale (IPSES)","volume":"174","author":"Lam","year":"2023","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1177\/01945998211036645","article-title":"The quest for a DISE protocol","volume":"167","author":"Mooney","year":"2022","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s11325-020-02179-x","article-title":"Propofol versus dexmedetomidine during drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea","volume":"25","author":"Kirkham","year":"2021","journal-title":"Sleep Breath."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.sleep.2020.12.028","article-title":"Effect of body weight on upper airway findings and treatment outcome in children with obstructive sleep apnea","volume":"79","author":"Verhulst","year":"2021","journal-title":"Sleep Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/s00405-011-1633-8","article-title":"Drug-induced sleep endoscopy: The VOTE classification","volume":"268","author":"Kezirian","year":"2011","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Chen, Y.T., Sun, C.K., Wu, K.Y., Chang, Y.J., Chiang, M.H., Chen, I.W., Liao, S.W., and Hung, K.C. (2021). The use of propofol versus dexmedetomidine for patients receiving drug-induced sleep endoscopy: A meta-analysis of randomized controlled trials. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081585"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6630\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:25:38Z","timestamp":1788236738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6630"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":52,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176630"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176630","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]}}}