The Utility of Diagnostic Laryngoscopy and Bronchoscopy in Pediatric Obstructive Sleep Apnea

Introduction: Direct laryngoscopy and bronchoscopy (DLB) is traditionally performed to evaluate airway obstruction in children with obstructive sleep apnea (OSA), particularly when severe. However, prior studies are limited by sample size, age, and report few subsequent surgical interventions. We aim to evaluate the role for DLB in the management of pediatric patients with OSA .

Methods: We performed a retrospective cohort study at the University of Maryland Medical Center. All DLBs indicated for OSA and performed by three pediatric otolaryngologists from January 1, 2019, to December 21, 2023 were evaluated. The following patient demographics were collected: age, race, ethnicity, birth history, biological sex, co-morbidities, insurance status. We also documented intraoperative findings, interventions, changes to management, and polysomnogram data.

Results: One-hundred twenty-seven DLBs performed for OSA were included. Eighty (62.9%) patients were male. The mean age was 3.77 years (95% CI, 39.13 to 51.33). Sixty-six (52%) patients were younger than three years. Sixty-six (52%) patients identified as Black and twelve (9.4%) as Latino. There were forty-nine (38.6%) positive findings identified on DLB and two (1.6%) of these patients underwent an intervention. Children older than three years were more likely than younger children to have negative findings on DLB (p=0.017). Patients with DLB-findings were not significantly associated with having a DLB-influenced intervention (p=0.072). Latino patients were more likely to have airway abnormalities than White and Black patients (p=.0294, p=.0496). Children with airway abnormalities had similar apnea hypoxia indices or O2 nadir scores as patients without DLB findings. Adenoid hypertrophy was significantly higher in Black and Latino children compared to White children (p < 0.0002, p=.0057).

Conclusions: This is a large and notably diverse pediatric cohort study on the utility of DLB in OSA. Although several positive findings were identified on DLB, few required an intervention. This suggests that DLB may add little value in the evaluation of pediatric OSA.