title: Surgical outcomes and sleep endoscopy for children with sleep-disordered breathing and hypotonia.
abstract: OBJECTIVE
  To study the efficacy of surgical management for obstructive sleep apnea (OSA) syndrome in children with hypotonia, and to identify common anatomic sites of airway obstruction.
  
  
  METHODS
  Retrospective chart review of polysomnographic parameters and quality of life instrument scores for seventy eight children with hypotonia who underwent surgical intervention for sleep-disordered breathing at two tertiary children's hospitals, and analysis of drug-induced sleep endoscopy data using a previously validated scoring system.
  
  
  RESULTS
  Children undergoing surgical intervention had baseline severe OSA with a statistically significant improvement in apnea-hypopnea index from 23.6 to 11.1 after surgery, but persistent severe OSA. OSA-18 sleep-related quality of life measurement and overall quality of life score showed statistically and clinically significant improvements, from 72.0 to 43.4 and from 5.3 to 7.6 respectively. Sleep endoscopy showed an average obstructive score of 7.2/15 (n = 39), with multi-level obstruction in 49% of children. Greater than 50% obstruction was observed at the tongue base in 64% of patients, velum in 46%, lateral pharyngeal wall in 38%, supraglottis in 38%, and adenoid in 23%.
  
  
  CONCLUSIONS
  OSA syndrome is challenging to treat in hypotonic children. Severe residual OSA is common after surgical intervention, but improvement in quality of life is clinically and statistically significant. The tongue base is the most common site of persistent airway obstruction. Drug-induced sleep endoscopy can identify sites of airway obstruction and may aid in surgical planning for high-risk patients.
authors.affiliation: University of California, San Francisco, Pediatric Otolaryngology, 550 16th Street, San Francisco, CA 94158, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Park
authors.affiliation: University of California, San Francisco, Pediatric Otolaryngology, 550 16th Street, San Francisco, CA 94158, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Chan
authors.affiliation: Seattle Children's Hospital, Pediatric Otolaryngology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Parikh
authors.affiliation: University of California, San Francisco, Pediatric Otolaryngology, 550 16th Street, San Francisco, CA 94158, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Meyer
authors.affiliation: University of California, San Francisco, Pediatric Otolaryngology, 550 16th Street, San Francisco, CA 94158, USA. Electronic address: kristina.rosbe@ucsf.edu.
authors.forename: K W
authors.initials: KW
authors.lastname: Rosbe
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging; D000402:Airway Obstruction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D006801:Humans; D007830:Larynx / Q000000981:diagnostic imaging; D009123:Muscle Hypotonia / Q000150:complications*; D010614:Pharynx / Q000000981:diagnostic imaging; D017286:Polysomnography; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000601:surgery*; D014059:Tongue / Q000000981:diagnostic imaging
keywords: Drug-induced sleep endoscopy (DISE); Hypotonia; Obstructive sleep apnea; Pediatric; Sleep-disordered breathing; Surgical outcomes