Precision in Pediatric Obstructive Sleep Apnea: Preventing Unnecessary Surgery Using Drug-Induced Sleep Endoscopy.

Pediatric obstructive sleep apnea (OSA) is often multifactorial, and awake airway assessment may fail to accurately identify the sites of upper airway obstruction. Drug-induced sleep endoscopy (DISE) enables dynamic evaluation of the upper airway under sleep-like conditions and may be particularly valuable in children at an increased risk of persistent OSA after adenotonsillectomy. We report the case of a 10-year-old girl with severe OSA, obesity (body mass index: 31.04 kg/m², above the 99th percentile), and neurocognitive impairment, in whom awake assessment suggested adenotonsillar hypertrophy as the presumed primary contributor to obstruction. During sleep-state evaluation, DISE demonstrated isolated positional epiglottic collapse as the dominant dynamic finding, refining the assessment of the obstruction pattern and supporting avoidance of adenotonsillectomy. This case highlights the role of DISE in guiding individualized, anatomy-based management of pediatric OSA and emphasizes the importance of carefully titrated anesthesia to ensure accurate assessment of airway dynamics.