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Updated: Feb 9, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Trends in management of obstructive sleep apnea in pediatric patients with Down syndrome
Jennifer Best1, Sean Mutchnick2, Jonathan Ida3
1Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Insights
Residual obstructive sleep apnea (OSA) is common in children with Down syndrome after adenotonsillectomy (T&A). Further surgeries and drug-induced sleep endoscopy (DISE) can effectively manage persistent OSA.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Genetics
Background:
- Obstructive sleep apnea (OSA) is prevalent in children with Down syndrome (DS).
- Adenotonsillectomy (T&A) is a common treatment for sleep-disordered breathing (SDB) in this population.
- Residual OSA after T&A presents a significant management challenge in pediatric DS patients.
Purpose of the Study:
- To analyze trends in surgical and medical management of OSA in pediatric patients with Down syndrome.
- To describe an algorithmic approach for managing persistent OSA in children with DS post-T&A.
Main Methods:
- Retrospective case series of pediatric patients with DS undergoing polysomnography (PSG) after T&A.
- Data collected from a tertiary care medical center between January 2008 and June 2016.
- Analysis included pre- and post-T&A apnea-hypopnea index (AHI) and subsequent interventions.
Main Results:
- 35.4% of patients required at least one additional surgical procedure post-T&A.
- Revision adenoidectomies and lingual tonsillectomies were common additional surgeries.
- Drug-induced sleep endoscopy (DISE) was utilized in 23.1% of cases to guide surgical decisions.
Conclusions:
- Residual OSA is frequent in children with Down syndrome following T&A.
- Additional surgical interventions, guided by DISE, can successfully reduce AHI in persistent OSA.
- DISE is integral to the management algorithm for post-T&A OSA in pediatric DS patients.
Introduction:
Residual obstructive sleep apnea (OSA) after adenotonsillectomy (T&A) is a common problem in children with Down Syndrome (DS). Our objective was to describe trends in surgical and medical management of OSA in pediatric patients with DS, and to present an algorithmic approach to managing these children.
Methods:
Retrospective case series of children with DS seen at a tertiary care medical center between 1/2008-6/2016 who underwent polysomnography (PSG) after having a T&A performed for sleep disordered breathing (SDB).
Results:
Sixty-five patients met inclusion criteria. The mean age at T&A was 4.8 years and 52.0% were male. The mean apnea-hypopnea index (AHI) was 23.2 events/hour for patients who had pre-T&A PSGs. The mean AHI was 10.7 events/hour after T&A. Twenty-three patients (35.4%) underwent at least one additional surgical procedure after T&A; 5 (7.7%) patients had ≥ two additional procedures. The most common additional surgical procedures were revision adenoidectomies (n = 8) and lingual tonsillectomies (n = 13). Fifteen (23.1%) patients underwent at least one drug-induced sleep endoscopy (DISE) to help direct selection of surgical site/s.
Conclusions:
Residual OSA is common after T&A in children with Down syndrome and can be managed by additional surgical interventions in many instances with successful reduction of the AHI. DISE has become part of a standard algorithm for managing persistent OSA in children with Down syndrome after T&A.
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