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Severe Pediatric Sleep Apnea: Drug-Induced Sleep Endoscopy Based Surgery

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Although adenotonsillectomy is the recommended treatment of obstructive sleep apnea (OSA) in children, some patients with preoperative severe OSA (Apnea–hypopnea index/AHI > 10) remain symptomatic after surgery and may need further workup. This study aims to: (1) analyse preoperative factors and its relation with surgical failure/persistent OSA (AHI > 5 after adenotonsillectomy) in severe pediatric OSA; (2) determine the levels of airway collapse during DISE (drug induced sleep endoscopy) in cases of surgical failure; (3) evaluate the efficacy of targeted surgery based on DISE findings. This retrospective study was conducted between August and September 2020. Across 9 years (from 2011 to 2020), all children diagnosed with severe OSA in our Hospital underwent adenotonsillectomy and repeated type 1 polysomnography (PSG) 3 months after surgery. Cases of surgical failure underwent DISE for planning eventual directed surgery. Chi-square test was used to assess the relationship between persistent OSA and preoperative patients’ characteristics. 80 cases of severe pediatric OSA were diagnosed (68.8% males; mean age: 4.3 years—standard deviation: 2.49; mean AHI: 16.3—standard deviation 7.14) in the aforementioned period. We found a significant association between surgical failure (11.3% of cases; mean AHI: 6.9—SD 0.91) and obesity (p = 0.002; confidence level of 95%). Neither preoperative AHI nor other PSG parameters were associated with surgical failure. In cases of surgical failure, epiglottis collapse was present in every DISEs and adenoid tissue was present in 66% of children. All cases of surgical failure had directed surgery and surgical cure (AHI ≤ 5) was obtained in 100% of cases. This study suggests that obesity is the strongest predictor of surgical failure in children with severe OSA who undergo adenotonsillectomy. Epiglottis collapse and presence of adenoid tissue are the most common findings in postoperative DISEs of children with persistent OSA after primary surgery. DISE based surgery seems a safe and effective tool to manage persistent OSA after adenotonsillectomy.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Hospital Prof Doutor Fernando Fonseca, IC19, 2720-276, Amadora, Lisbon, Portugal

    Nuno Mendes, Joselina Antunes, Ana Guimarães, Cristina Adónis & Filipe Freire

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  1. Nuno Mendes
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  2. Joselina Antunes
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  3. Ana Guimarães
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  4. Cristina Adónis
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  5. Filipe Freire
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Correspondence to Nuno Mendes.

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The authors of this article declare no conflict of interest.

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The authors declare that all the parents of the participants in this study were informed (by letter and orally) about the study design and eventual publication of results. All of them signed the informed consent letter. Participants' privacy and data are fully protected. Neither the authors nor the journal have access to the participants' personal data. This work was approved by ethical commission of our Hospital.

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Mendes, N., Antunes, J., Guimarães, A. et al. Severe Pediatric Sleep Apnea: Drug-Induced Sleep Endoscopy Based Surgery. Indian J Otolaryngol Head Neck Surg 75, 54–59 (2023). https://doi.org/10.1007/s12070-022-03245-4

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  • DOI: https://doi.org/10.1007/s12070-022-03245-4

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