Rationale
Pediatric obstructive sleep apnea (OSA) is a condition of upper airway resistance obstructing air flow and oxygen delivery into the lungs during sleep. It is characterized by prolonged partial or complete upper airway obstruction that disrupts normal ventilation during sleep and interferes with normal sleep patterns.1 OSA impacts upwards of 1.2-5.7% of the pediatric population with higher prevalence among children with morbid obesity, Down syndrome, craniofacial abnormalities, cerebral palsy, and hypotonia.2,3
Adenotonsillectomy is the first-line recommendation by the American Academy of Otolaryngology for treatment of pediatric OSA.4 Despite its success, the persistence of OSA remains an issue for about 25-40% patients following surgery for a multitude of reasons including obesity, medical comorbidities, and other sites of airway obstruction.2,5,6 Drug Induced Sleep Endoscopy (DISE) has become an indispensable tool to provide anatomic targets for the surgical management of persistent OSA. In patients with persistent or recurrent OSA, DISE directed surgeries have demonstrated statistically significant improvement in both lowest saturation of oxygen (LSAT) and apnea-hypopnea index (AHI).7 Indeed the 2023 Expert Consensus statement by Ishman et al. recommends DISE for recurrent or persistent pediatric OSA after adenotonsillectomy.2
Among the anatomic subsites evaluated with DISE, lingual tonsil hypertrophy/tongue base have consistently been one of the most frequent sites of obstruction making it a very common surgical target.7 Given the increasing trend toward performing DISE and the expected concomitant rise is surgical management of the tongue, it is imperative that we better understand the effectiveness of this intervention.