药物诱导睡眠内镜在儿童阻塞性睡眠呼吸暂停中的应用：临床应用、分类系统与麻醉考量

文献信息

中文摘要

背景/目的： 药物诱导睡眠内镜（DISE）能够在药物诱导睡眠期间对上气道塌陷的层面、严重程度和构型进行动态、实时可视化，提供多导睡眠监测无法获得的气道解剖信息。它越来越多地用于指导阻塞性睡眠呼吸暂停（OSA）的个体化手术规划，尤其是在腺样体扁桃体切除术后持续存在OSA或手术失败风险较高的儿童中。然而，缺乏普遍接受的儿童特异性分类系统和标准化方案，仍限制研究间的可比性以及循证治疗算法的制定。本综述评估DISE在儿童OSA中的作用，重点关注气道评估、分类系统、麻醉方案及其对手术决策的影响。方法：通过PubMed文献综述（2013—2025年）识别出42项儿童特异性研究，包括队列研究、系统综述和荟萃分析。提取了关于适应证、分类量表、麻醉技术、安全性和手术结局的数据。结果：DISE可动态显示清醒检查中常被遗漏的多层面阻塞。尽管使用源自成人的VOTE等系统，但儿童特异性工具（如Chan-Parikh、NAVOTEL、PedDISE-8、IPSES）提供了更适合年龄的评估。麻醉选择是关键因素；右美托咪定单独或与氯胺酮联合使用，最能接近非快速眼动（NREM）睡眠，同时维持气道张力和稳定性。DISE发现改变了30%—60%患者的手术计划，促进了声门上成形术、舌扁桃体切除术和会厌固定术等针对性手术。结论：DISE是复杂儿童OSA有价值的诊断和决策支持工具。其临床效用取决于标准化评估和麻醉。需要进一步的多中心研究来验证分类系统并确定其对生活质量的长期影响。

英文摘要

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 (2013-2025) 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-Parikh, 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 30-60% 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.