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

Wootten CT, Chinnadurai S, Goudy SL
Int J Pediatr Otorhinolaryngol. 2014 78 (7): 1158-62

PMID: 24845267 · DOI:10.1016/j.ijporl.2014.04.041

OBJECTIVES - 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.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

MeSH Terms (20)

Adenoidectomy Adolescent Anesthetics, Intravenous Child Child, Preschool Down Syndrome Endoscopy Female Glossectomy Humans Male Oral Surgical Procedures Palate, Soft Polysomnography Propofol Recurrence Sleep Apnea, Obstructive Tonsillectomy Turbinates Uvula

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