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Drug Induced Sleep Endoscopy-Directed Tongue Surgery to Treat Persistent Pediatric Obstructive Sleep Apnea: A
R Kenneth Sims1, Alexander Leeds1, Grace Johnson1
1Department of Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Drug-induced sleep endoscopy (DISE)-directed tongue surgery effectively treats persistent obstructive sleep apnea (OSA) in children post-adenotonsillectomy. This approach significantly reduces apnea-hypopnea index (AHI) and improves lowest oxygen saturation (LSAT).
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Surgical Outcomes Research
Background:
- Obstructive sleep apnea (OSA) in children often persists or recurs after adenotonsillectomy.
- Tongue surgery, guided by drug-induced sleep endoscopy (DISE), is an option for persistent pediatric OSA.
- Evaluating the efficacy of DISE-directed tongue surgery is crucial for treatment planning.
Purpose of the Study:
- To systematically review literature on DISE-directed tongue surgery outcomes in children with persistent OSA after adenotonsillectomy.
- To conduct a meta-analysis of polysomnographic (PSG) data from relevant studies.
- To assess the effectiveness of this surgical approach in improving OSA parameters.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Inclusion of studies evaluating DISE-directed tongue surgery in pediatric OSA patients.
- Analysis of primary outcomes: post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT), and secondary outcome: surgical response rate.
Main Results:
- Seven studies (283 patients) were included in the systematic review.
- The overall surgical response rate was 70.0% ± 17.0%.
- Meta-analysis of six studies (270 patients) showed a significant decrease in AHI (mean difference -5.13 events/h, p < 0.00001) and an improvement in LSAT (mean difference 2.71%, p < 0.0001).
Conclusions:
- DISE-directed tongue surgery demonstrates effectiveness in reducing AHI by approximately 50% and improving LSAT by nearly 3% in children with persistent OSA.
- The collective evidence supports the efficacy of DISE-directed tongue surgery, with a 70% positive response rate.
- Limitations include heterogeneity in reported outcomes and potential confounding factors, necessitating further research.
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