Beyond adenotonsillectomy: outcomes of sleep endoscopy-directed treatments in pediatric obstructive sleep apnea.
OBJECTIVE
In this study we determine the subjective and objective outcomes of pediatric patients with refractory OSA undergoing drug-induced sleep endoscopy (DISE)-directed surgical treatment.


METHODS
31 consecutive children with OSA following TA underwent DISE. 26 completed DISE-directed operative management of the level(s) of ongoing upper airway obstruction. Pre- and postoperative OSA were assessed through a detailed history (of nighttime symptoms (NS) and daytime symptoms (DS)), physical examination, and polysomnography.


RESULTS
Age ranged 5-18 years (mean 9.7 ± 3.4). Fourteen of 26 had trisomy 21 (51%). Operations were performed in the following frequencies: lingual tonsillectomy (LT) (22), midline posterior glossectomy (MPG) (16), revision adenoidectomy (11), inferior turbinate submucosal resection (7), uvulopalatoplasty (2), and supraglottoplasty (2). Overall, 92% reported subjective improvement. NS improved from 5.8 ± 2.9 preoperatively to 2.1 ± 2.5 postoperatively (p<0.05), while DS improved from 2.1 ± 1.3 preoperatively to 0.6 ± 1.1 postoperatively (p<0.05). Seventeen patients completed preoperative polysomnography, while only 11 of them also completed postoperative polysomnography. Mean OAHI fell from 7.0 (±5.8) events/hr to 3.6 (±1.8) events/hr (t-test, p=0.09).


CONCLUSIONS
Individualized, multilevel, DISE-directed operative therapy was associated with substantial improvement in subjective measures of sleep.
Department of Otolaryngology, Division of Pediatric Otolaryngology, Vanderbilt University, Nashville, TN, United States. Electronic address: christopher.t.wootten@vanderbilt.edu.
Christopher T
CT
Wootten
Department of Otolaryngology, Division of Pediatric Otolaryngology, Vanderbilt University, Nashville, TN, United States.
Sivakumar
S
Chinnadurai
Department of Otolaryngology, Division of Pediatric Otolaryngology, Vanderbilt University, Nashville, TN, United States.
Steven L
SL
Goudy
D000233:Adenoidectomy; D000293:Adolescent; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications; D004724:Endoscopy; D005260:Female; D005927:Glossectomy / Q000379:methods; D006801:Humans; D008297:Male; D019647:Oral Surgical Procedures; D010160:Palate, Soft / Q000601:surgery; D017286:Polysomnography; D015742:Propofol / Q000008:administration & dosage; D012008:Recurrence; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy; D014420:Turbinates / Q000601:surgery; D014609:Uvula / Q000601:surgery
D018686:Anesthetics, Intravenous; D015742:Propofol
Apnea; MRI; Obstructive sleep apnea; Pediatric sleep; Sleep endoscopy; Tonsillectomy