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.