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Updated: Feb 17, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Pediatric Drug-Induced Sleep Endoscopy Directed Surgery Outcomes With Trisomy 21 Subgroup Comparison: A Meta-Analysis
Alexa F Ibrahim1, Sofia Khan1, Cindy Hoang-Tran2
1Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA.
Insights
Drug-induced sleep endoscopy-directed surgery (DISEDS) significantly improves pediatric obstructive sleep apnea (OSA) outcomes. Benefits are more pronounced in children with Trisomy 21 (T21), supporting its use for guiding surgery.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Surgical Outcomes Research
Background:
- Pediatric obstructive sleep apnea (OSA) is a common condition affecting children's health and development.
- Surgical intervention is a primary treatment modality for pediatric OSA.
- Drug-induced sleep endoscopy (DISE) aids in identifying specific airway obstructions to guide surgical planning.
Purpose of the Study:
- To evaluate the effectiveness of drug-induced sleep endoscopy-directed surgery (DISEDS) in improving polysomnographic outcomes in pediatric obstructive sleep apnea (OSA).
- To compare the impact of DISEDS in children with Trisomy 21 (T21) compared to the general pediatric OSA population.
Main Methods:
- Systematic literature search of PubMed, Scopus, and CINAHL databases (up to January 1, 2025) following PRISMA guidelines.
- Meta-analysis of 41 studies (n=3404) including pre- and postoperative apnea-hypopnea index (AHI), obstructive AHI (oAHI), or oxygen nadir in patients ≤21 years undergoing DISEDS.
- Subgroup analysis for patients with Trisomy 21 (T21); risk of bias and publication bias were assessed.
Main Results:
- DISEDS significantly improved AHI (MD: 9.63) and oAHI (MD: 11.46), and oxygen nadir (MD: -4.37; P < .00001).
- Improvements in OSA severity and oxygenation were more pronounced in the T21 subgroup, particularly for AHI (MD: 14.78).
- Minimal publication bias was detected across the included studies.
Conclusions:
- DISEDS demonstrates significant efficacy in improving polysomnographic outcomes and oxygenation in pediatric OSA patients.
- Children with Trisomy 21 (T21) experience greater benefits from DISEDS, highlighting its importance in this specific population.
- These findings advocate for the earlier integration of DISE to tailor anatomy-based surgical approaches for pediatric OSA.
Objective:
To evaluate the effectiveness of drug-induced sleep endoscopy-directed surgery (DISEDS) in improving polysomnographic outcomes in pediatric obstructive sleep apnea (OSA), and to compare its impact in children with Trisomy 21 (T21) pediatric population.
Data Sources:
PubMed, Scopus, and CINAHL databases were systematically searched from inception through January 1, 2025, in accordance with PRISMA guidelines.
Review Methods:
Studies were included if they reported pre- and postoperative apnea-hypopnea index (AHI), obstructive AHI (oAHI), or oxygen nadir in patients ≤21 years undergoing DISEDS. Meta-analyses were performed using random-effects models to calculate mean differences with 95% confidence intervals (CIs). Subgroup analyses were conducted for patients with T21. Risk of bias was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Publication bias was evaluated using funnel plots and Egger's test.
Results:
Forty-one studies (n = 3404; 320 with T21) met inclusion criteria. DISEDS was associated with significant improvements in AHI (mean difference [MD]: 9.63; 95% CI: 7.54-11.73), oAHI (MD: 11.46; 95% CI: 9.13-13.80), and oxygen nadir (MD: -4.37; 95% CI: -5.36 to -3.39; all P < .00001). Improvements were more pronounced in the T21 subgroup, particularly for AHI (MD: 14.78; 95% CI: 9.99-19.56). Publication bias was minimal.
Conclusion:
DISEDS significantly improves OSA severity and oxygenation in pediatric patients, with greater benefits observed in children with T21. These findings support earlier DISE use to guide individualized, anatomy-based surgery in pediatric OSA.
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