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All Journal Community Medicine and Education Journal Scientific Journal of Pediatrics
Sarah Istiqomah
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Humanities Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Nursing Public Health

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Predictive Value of Drug-Induced Sleep Endoscopy (DISE) in Pediatric Obstructive Sleep Apnea: A Multicenter Cohort Study in Indonesia Sarah Istiqomah; Annisa Annisa; Dessy Agustina; Abhimanyu Putra; Zainal Abidin Hasan; Johan Wirahadi Putro; Venny Melinda; Nabila Saraswati; Made Swastika
Scientific Journal of Pediatrics Vol. 3 No. 1 (2025): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v2i2.174

Abstract

Introduction: Obstructive sleep apnea (OSA) is a significant pediatric health concern in Indonesia, but diagnostic and treatment pathways are often resource-constrained. Drug-induced sleep endoscopy (DISE) offers a dynamic assessment of upper airway obstruction, but its predictive value for treatment outcomes in Indonesian children remains unclear. This study aimed to evaluate the predictive value of DISE findings for polysomnography (PSG)-determined OSA severity and surgical outcomes in a multicenter cohort of Indonesian children. Methods: A prospective, multicenter cohort study was conducted at three tertiary hospitals in Indonesia. Children aged 2-18 years with suspected OSA underwent DISE and overnight PSG. DISE findings were classified using the VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification system. The primary outcome was the correlation between DISE findings and the apnea-hypopnea index (AHI) on PSG. Secondary outcomes included the prediction of surgical success (defined as a postoperative AHI < 5 and >50% reduction from baseline) after adenotonsillectomy (T&A). Statistical analyses included Spearman's rank correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression. Results: 250 children (mean age 8.2 ± 3.5 years, 60% male) were included. A significant positive correlation was found between the total VOTE score and AHI (ρ = 0.62, p < 0.001). Tongue base obstruction (VOTE-T) showed the strongest correlation with AHI (ρ = 0.58, p < 0.001). The area under the ROC curve (AUC) for the total VOTE score predicting severe OSA (AHI ≥ 10) was 0.85 (95% CI, 0.79-0.91). In the subgroup of 180 children who underwent T&A, a higher total VOTE score (particularly VOTE-T and VOTE-E scores) was significantly associated with a lower likelihood of surgical success (OR 0.45, 95% CI 0.28-0.72, p = 0.001). Conclusion: DISE, using the VOTE classification, demonstrates good predictive value for OSA severity and surgical outcomes in Indonesian children. Tongue base and epiglottic obstruction are particularly important predictors. DISE can be a valuable tool for guiding treatment decisions in resource-limited settings.
Impact of Integrated Care Models on Chronic Disease Management Outcomes in Underserved Communities: A Mixed-Methods Study in Surabaya, Indonesia Sarah Istiqomah; Iting Shofwati; Theresia Putri Sinaga; Lin Chia
Community Medicine and Education Journal Vol. 6 No. 1 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i1.695

Abstract

Integrated care models (ICMs) are increasingly promoted as a strategy to improve chronic disease management, but evidence of their effectiveness in resource-constrained settings like Surabaya, Indonesia, is limited. This study aimed to evaluate the impact of an ICM on chronic disease management outcomes in underserved communities in Surabaya. A mixed-methods study design was employed, combining a quantitative quasi-experimental component with qualitative data collection. The quantitative component compared pre- and post-intervention data on key clinical indicators (blood pressure control, HbA1c levels, medication adherence) and healthcare utilization (hospital admissions, emergency room visits) for patients with hypertension, diabetes, and cardiovascular disease enrolled in an ICM program (n= 250) versus a control group receiving standard care (n= 250). Data was analyzed using descriptive statistics, t-tests, and chi-square tests. The qualitative component involved semi-structured interviews with patients (n=30) and healthcare providers (n=15) participating in the ICM to explore their experiences and perceptions of the program's impact. Thematic analysis was used to analyze the qualitative data. The quantitative analysis revealed statistically significant improvements in several clinical indicators for the ICM group compared to the control group. Data showed a mean reduction in systolic blood pressure of 8 mmHg (p<0.001) and a decrease in HbA1c levels of 0.7% (p<0.01) in the ICM group. Hospital admissions related to chronic disease complications were also lower in the ICM group (p<0.05). Qualitative findings highlighted improved patient self-management, enhanced provider coordination, and increased patient satisfaction with the ICM. Barriers to implementation included resource constraints, logistical challenges, and the need for ongoing provider training. In conclusion, this study provides evidence that ICMs can improve chronic disease management outcomes in underserved communities in Surabaya, Indonesia. The findings support the scaling up of ICMs in similar settings, with careful consideration of resource allocation, provider training, and community engagement.
Co-Authors Abhimanyu Putra Annisa Annisa Dessy Agustina Iting Shofwati Johan Wirahadi Putro Lin Chia Made Swastika Nabila Saraswati Theresia Putri Sinaga Venny Melinda Zainal Abidin Hasan