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Multi-level surgery for obstructive sleep apnoea in syndromic and non-syndromic paediatric patients - A systematic

Ryan Seng Hong Wong1, Tanya Xin Yu Tan1, Omkar Mahadevan1

  • 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Sleep Medicine
|February 14, 2026
PubMed

Insights

Multi-level airway surgery effectively treats paediatric obstructive sleep apnoea (OSA) in non-syndromic and syndromic children. This surgical approach offers significant improvements in the Apnoea-Hypopnea Index (AHI) and oxygen saturation, especially in Down syndrome cases.

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Sleep Medicine

Background:

  • Obstructive sleep apnoea (OSA) is a significant health concern in children.
  • Multilevel surgery is established for adult OSA but less so for pediatric cases.
  • Efficacy of multilevel airway surgery in pediatric OSA, including syndromic and non-syndromic populations, requires further evaluation.

Purpose of the Study:

  • To evaluate the efficacy of multilevel airway surgery in treating pediatric obstructive sleep apnoea.
  • To assess surgical outcomes in both non-syndromic and syndromic pediatric populations.
  • To determine improvements in key sleep parameters post-surgery.

Main Methods:

  • Systematic review and meta-analysis of PubMed, Embase, and Cochrane Library databases.
  • Inclusion of observational and randomized studies on pediatric multilevel sleep surgeries.
  • Pooled analysis of post-operative Apnoea-Hypopnea Index (AHI) and SpO2 Sleep Nadir.

Main Results:

  • Analysis of 17 studies involving 338 children (228 non-syndromic, 80 with Down syndrome, 30 with other syndromes).
  • Significant AHI improvement (-10.13) and SpO2 nadir increase (4.39) in non-syndromic children; 66.4% AHI normalization.
  • Marked AHI improvement (-14.58) and SpO2 nadir increase (+3.75) in children with Down syndrome, with zero heterogeneity.

Conclusions:

  • Multilevel airway surgery is a valuable addition to adenotonsillectomy for pediatric OSA, particularly for refractory and selected syndromic cases.
  • The study highlights the effectiveness of this surgical approach in improving sleep parameters.
  • Further research is needed to identify specific syndromic subgroups that would benefit most from individualized treatment strategies.
Abstract

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