(1308) Comorbidity-Associated Variation in Polysomnographic Features Among Children Undergoing Drug-Induced Sleep Endoscopy

Introduction: Children referred for drug-induced sleep endoscopy (DISE) often represent a clinically complex subset of pediatric obstructive sleep apnea. Characterizing how polysomnographic severity varies across demographic and comorbidity profiles in this population may inform risk stratification and clinical decision-making.

Methods: We conducted a retrospective cohort study of children aged 2-18 years who underwent diagnostic polysomnography prior to DISE at a tertiary pediatric institution between January 2015 and July 2025. Polysomnographic metrics, demographic characteristics, and comorbid conditions were extracted, with continuous and categorical variables compared using the Mann-Whitney U test and chi-square or Fisher’s exact tests, respectively. Selected variables were dichotomized for analysis; obesity was defined by a documented diagnosis in the medical record. Postoperative polysomnographic outcomes following DISE-directed surgery were not included and will be incorporated upon completion of data collection.

Results: A total of 213 children were included. Median age was 8 years (interquartile range [IQR], 4-13), 61.0% were male, and median apnea-hypopnea index (AHI) was 12.5 events/hour (IQR, 6.7-27.1). AHI did not differ significantly by sex (p=0.86) or race/ethnicity (p=0.07). Children with obesity demonstrated higher AHI compared with non-obese children (median 18.0 versus 10.7, p=0.002), and children with Trisomy 21 also had higher AHI than those without Trisomy 21 (median 18.6 vs. 12.1, p=0.025). No differences were observed by neuromuscular disorder (p=0.71) or craniofacial abnormality status (p=0.91). Children with Trisomy 21 additionally had lower minimum oxygen saturation and greater time with oxygen saturation below 92% (p=0.036), with no significant difference in REM AHI (p>0.05).

Conclusions: Among children undergoing DISE, polysomnographic disease severity varied by obesity and Trisomy 21, with higher AHI and greater oxygen desaturation burden observed in these groups. Recognition of these differences may aid clinical risk stratification and surgical planning.