Drug Induced Sleep Endoscopy-Directed Tongue Surgery to Treat Persistent
Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis
Abstract
Objective: To systematically review the literature for articles
evaluating outcomes of drug-induced sleep endoscopy (DISE) directed
tongue surgery in children with prior adenotonsillectomy and persistent
or recurrent obstructive sleep apnea (OSA), and to perform a
meta-analysis on the polysomnographic (PSG) data. Design:
Systematic review and metanalysis in accordance with the Preferred
Reporting Items for Systematic Review and Meta-Analysis (PRISMA)
statement guidelines. Outcome Measures: Primary, post-operative
apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT);
Secondary, surgical response rate. Results: Seven studies (283
patients) met criteria and reported PSG outcome data for the systematic
review. The mean ± standard deviation surgical response rate was 70.0 ±
17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients)
reported specific pre- and post-operative PSG data included in our
meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1
to 4.2 ± 6.9 events/hr (p < 0.04) with a mean difference (MD)
of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (P<0.00001).
LSAT improved from 87.8 ± 5.7 to 90.1 ± 5.1% (p < 0.02) with
a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (P<0.0001).
Conclusion: Existing literature demonstrates DISE-directed
tongue surgery in children with persistent OSA can reduce AHI by
approximately 50%, improve LSAT by nearly 3%, and have an overall
positive response to surgery rate of 70%. There is collective evidence
that DISE-directed tongue surgery is effective, but there is
heterogeneity in reported outcomes influenced by confounding factors.
Key Words: Drug Induced Sleep Endoscopy; Pediatric Sleep Apnea;
Tongue Surgery