@article {MarisP4277, author = {Mieke Maris and Stijn Verhulst and Marek Wojciechowski and Vera Saldien and Paul Van de Heyning and An Boudewyns}, title = {Upper airway evaluation by drug-induced sleep endoscopy (DISE) in children with Down syndrome and obstructive sleep apnoea}, volume = {42}, number = {Suppl 57}, elocation-id = {P4277}, year = {2013}, publisher = {European Respiratory Society}, abstract = {Introduction: The statement that upper airway obstruction during sleep in children with Down Syndrome (DS) is caused by a large tongue falling backwards, has recently been challenged. Imaging studies have shown that DS is characterised by a narrow upper airway and relative macroglossia.Aim: To investigate the pattern of upper airway obstruction in children with DS and obstructive sleep apnoea (OSA).Methods: Fifteen DS children with OSA, age 4.0 {\textpm} 3.9 years, BMI 17.5 {\textpm} 4.1 kg/m2 and OAHI 17.5 {\textpm} 18.4/hr, without previous upper airway surgery underwent an upper airway endoscopy during drug-induced sleep (DISE). The upper airway was examined under spontaneous breathing and the site (s) of upper airway obstruction or hypotonia were documented.Results: Significant obstruction at the level of adenoids and/or tonsils was found in 13 out of 15 patients. The remaining 2 patients showed upper airway hypotonia. Partial obstruction at the level of the tongue base was documented in 1 patient with concomittant adenotonsillar obstruction. Obstruction at the level of the epiglottis was found in 6 subjects.Conclusions: Upper airway evaluation with drug-induced sleep endoscopy in surgically naive Down syndrome children with OSA showed that adenotonsillar hypertrophy is the major cause of upper airway obstruction. Obstruction at the level of the epiglottis was more commonly observed than in otherwise healthy children with OSA and illustrates that DS children may have multilevel upper airway collapse.Only 1 out of 15 patients had a tongue base obstruction supporting the concept of {\textquotedblleft} relative macroglossia{\textquotedblright}.}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/42/Suppl_57/P4277}, eprint = {https://erj.ersjournals.com/content/42/Suppl_57/P4277.full.pdf}, journal = {European Respiratory Journal} }