Beyond adenotonsillectomy: Outcomes of sleep endoscopy-directed treatments in pediatric obstructive sleep apnea

Objectives: In this study we determine the subjective and objective outcomes of pediatric patients with refractory USA undergoing drug-induced sleep endoscopy (DISE)-directed surgical treatment. Methods: 31 consecutive children with USA following TA underwent DISE. 26 completed DISE-directed operative management of the level(s) of ongoing upper airway obstruction. Pre- and postoperative USA 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. (C) 2014 Elsevier Ireland Ltd. All rights reserved.