Child sleeping peacefully, visualized sleep endoscopy

DISE: The Sleep Endoscopy Revolution for Kids – Is It Right for Your Child?

Samir D’Costa in Health & Wellness December 2025 • 5 min read.

"Drug-Induced Sleep Endoscopy (DISE) is changing how doctors understand and treat sleep apnea in children. But when is it truly needed?"

Obstructive Sleep Apnea Syndrome (OSAS) is a common issue in kids, impacting anywhere from 0.69% to 4.7% of the general pediatric population. If left unaddressed, OSAS can trigger a cascade of problems, from hindering growth and development to increasing the risk of cardiovascular issues, neurocognitive disorders, and behavioral challenges. Recognizing and treating OSAS early is crucial, but how do doctors know the best course of action for each child?

Traditionally, diagnosing OSAS involves a thorough look at a child's medical history, a physical exam, and an overnight polysomnography (PSG) – the gold standard sleep study. Treatment often starts with tonsillectomy and adenoidectomy (T&A). However, the picture isn't always clear-cut. In some children with OSAS, enlarged tonsils and adenoids aren't the main problem, and T&A alone may not resolve their sleep issues. This is where Drug-Induced Sleep Endoscopy (DISE) enters the scene.

DISE offers a real-time, three-dimensional view of a child's airway during simulated sleep. By observing exactly where and how the airway collapses, doctors can gain valuable insights beyond what traditional methods reveal. But is DISE necessary for every child with suspected sleep apnea? A new study published in the International Journal of Pediatric Otorhinolaryngology investigates when DISE provides the most significant benefit in guiding treatment decisions.

DISE: Not a One-Size-Fits-All Solution for Pediatric Sleep Apnea

Child sleeping peacefully, visualized sleep endoscopy

The study, led by Maria Antonietta Collu and colleagues, explored the impact of DISE on 150 children diagnosed with OSAS. The researchers categorized these children into three subgroups, based on their clinical presentation and polysomnography results:

Conventional OSAS: Children with classic OSAS symptoms, enlarged tonsils, and AHI (Apnea-Hypopnea Index) scores between 0 and 10, and had no previous surgery.
Disproportional OSAS: These children presented with severe AHI scores (above 10) despite no prior surgery. Some had AHI scores over 3 with smaller tonsils.
Persistent OSAS: Those who continued to have sleep apnea symptoms (AHI ≥3) despite having undergone adenotonsillar surgery.

The study revealed that DISE's impact varied significantly across these groups. While DISE rarely altered the treatment plan for children with conventional OSAS (only 4.5% saw a change), it proved far more influential in the other two subgroups. In the disproportional OSAS group, DISE led to a change in surgical plans for 17.5% of patients. The most striking impact was observed in the persistent OSAS group, where DISE changed the surgical approach in a remarkable 72.7% of cases.

DISE: A Targeted Approach to Better Sleep for Children

The researchers concluded that DISE is a valuable and safe procedure for children experiencing OSAS, but it's most beneficial when applied strategically. For children with classic OSAS and enlarged tonsils/adenoids, DISE may not be necessary, as T&A often remains the first-line treatment. However, in cases where the OSAS picture is less typical – either with disproportional findings or persistence after surgery – DISE can be a game-changer.

By identifying specific airway obstructions beyond the tonsils and adenoids, DISE can guide surgeons towards more targeted interventions, such as tongue base reduction, turbinate surgery, or pharyngoplasty. This personalized approach has the potential to improve outcomes and reduce the need for additional surgeries.

For parents concerned about their child's sleep apnea, this research offers valuable insights. While DISE isn't a routine procedure for all children with OSAS, it can be a powerful tool in complex cases. Discuss the potential benefits of DISE with your child's doctor, especially if they have persistent symptoms despite prior treatments or if their initial diagnosis doesn't quite fit the typical OSAS profile. Together, you can determine the best path towards a restful night's sleep for your child.

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Everything You Need To Know

What exactly is Drug-Induced Sleep Endoscopy (DISE), and what does it do?

Drug-Induced Sleep Endoscopy (DISE) is a medical procedure that allows doctors to examine a child's airway while they are in a state of simulated sleep. This is achieved through the use of medication to induce a sleep-like state, during which a small camera is inserted to visualize the upper airway. The primary goal of DISE is to identify the specific areas in the airway that are collapsing and causing breathing obstruction during sleep. This real-time, three-dimensional view provides insights that are often not obtainable through traditional methods. In the context of pediatric sleep apnea, DISE aids in pinpointing the exact cause of airway obstruction, which is critical for guiding treatment decisions.

What is Obstructive Sleep Apnea Syndrome (OSAS), and why is it a problem for children?

Obstructive Sleep Apnea Syndrome (OSAS) is a condition in children where breathing repeatedly stops and starts during sleep due to a blockage in the upper airway. This can happen because of enlarged tonsils or adenoids, but there can be other factors. OSAS is a significant concern because it can lead to a variety of health problems, including issues with growth and development, cardiovascular problems, neurocognitive disorders, and behavioral challenges. Recognizing and addressing OSAS early is crucial to prevent these complications.

What does the Apnea-Hypopnea Index (AHI) measure, and how is it relevant?

The Apnea-Hypopnea Index (AHI) is a metric used in polysomnography (PSG) to measure the severity of sleep apnea. It represents the number of apneas (complete cessation of breathing) and hypopneas (partial reduction in breathing) per hour of sleep. An AHI score above a certain threshold indicates the presence of sleep apnea. The study referenced categorized children into three subgroups based on their AHI scores and clinical presentation: Conventional OSAS (AHI scores between 0 and 10), Disproportional OSAS (severe AHI scores above 10), and Persistent OSAS (AHI ≥3 after surgery). This highlights the importance of the AHI in determining the severity of the condition and the impact of DISE on different patient groups.

What is the role of tonsillectomy and adenoidectomy (T&A) in treating sleep apnea?

Tonsillectomy and adenoidectomy (T&A) is a surgical procedure involving the removal of the tonsils and adenoids, often performed to treat OSAS. This is a common first-line treatment because enlarged tonsils and adenoids are a frequent cause of airway obstruction in children with sleep apnea. However, the effectiveness of T&A can vary. When T&A doesn't fully resolve the sleep issues, further investigation using Drug-Induced Sleep Endoscopy (DISE) can provide additional information to guide the next steps in treatment. The study shows the varying impact of DISE across patient groups, with the most influence being observed in the Persistent OSAS group, where the surgical approach was changed in a significant percentage of cases after DISE.

In what situations is Drug-Induced Sleep Endoscopy (DISE) most helpful for children?

Drug-Induced Sleep Endoscopy (DISE) is most beneficial in certain scenarios. It proves to be a valuable diagnostic tool for children who present with 'Disproportional OSAS' (severe AHI scores despite no prior surgery) and 'Persistent OSAS' (sleep apnea symptoms continuing even after adenotonsillar surgery). For children with conventional OSAS, where enlarged tonsils and adenoids are the primary issue, DISE might not be needed since T&A is often successful. In the other two groups, DISE provides critical insights into the specific sites of airway obstruction, which enables doctors to tailor treatment plans. The study emphasizes the importance of using DISE strategically, depending on the child's specific condition and response to initial treatments.