Evolving Therapies to Treat Retroglossal and Base-of-Tongue Obstruction in Pediatric Obstructive Sleep Apnea

Objective: To describe our experience treating retro-glossal and base-of-tongue collapse in children and young adults with obstructive sleep apnea using combined genioglossus advancement (Repose THS; MedtronicENT, Jacksonville, Florida) and radiofrequency ablation of the tongue base. Design: Retrospective institutional review board approved analysis of 31 operations. Setting: Tertiary pediatric medical center. Patients: Thirty-one patients with a mean age of 11.5 years (age range, 3.1-23.0 years). Interventions: Combined genioglossus advancement and radiofrequency ablation. Main Outcome Measures: Preoperative and postoperative polysomnographic data were evaluated for each patient. Success of surgery was determined using the criteria of a postoperative apnea-hypopnea index of 5 or fewer events per hour, without evidence of hypoxemia (oxygen saturation as measured by pulse oximetry), and without prolonged hypercarbia (end-tidal carbon dioxide). Results: Thirty-one patients who underwent genioglossus advancement were analyzed. Nineteen (61%) had Down syndrome. The overall success rate was 61% (19 of 31) (58% [12 of 19] success among patients with Down syndrome and 66% [7 of 12] success among patients without Down syndrome). Overall, the mean apnea-hypopnea index improved from 14.1 to 6.4 events per hour (P<.001); the mean nadir oxygen saturation as measured by pulse oximetry during apnea improved from 87.4% to 90.9% (P=.07). Conclusions: Pediatric obstructive sleep apnea refractory to adenotonsillectomy that is due to retroglossal and base-of-tongue collapse remains difficult to treat. However, most patients in this analysis benefited from combined genioglossus advancement and radiofrequency ablation.