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Polysomnography outcomes of sleep endoscopy–directed intervention in surgically naïve children at risk for persistent obstructive sleep apnea

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Abstract

Purpose

Drug-induced sleep endoscopy (DISE) is useful in children with obstructive sleep apnea (OSA) that persists after adenotonsillectomy (AT), but its utility in surgically naïve children is unclear. We report polysomnography outcomes of surgically naïve children who underwent DISE-directed intervention because they were considered high risk for persistent OSA after adenotonsillectomy.

Methods

This study is a case series of 62 surgically naïve children with OSA who were considered high risk for persistence after AT and underwent DISE-directed intervention with pre- and postoperative polysomnography between 2012 and 2016. Analysis was performed with the paired t test.

Results

Children were on average 5.9 (± 5.5, 0.2–18.6) years old at the time of surgery, 68% male, 18% obese, and 60% white. Thirty-eight percent had a syndromic diagnosis: 19% trisomy 21, 11% hypotonic neuromuscular disorder, and 8% craniofacial condition. The remaining 62% were non-syndromic but underwent DISE because they had at least one risk factor for OSA persistence after AT (age > 7 years, black race, 1+ tonsils, obesity, and/or severe OSA). Forty-two percent underwent AT, while 58% underwent treatment other than AT, including 18% who had multilevel surgery. Children improved significantly in 4 out of 5 polysomnography parameters tested, including obstructive apnea-hypopnea index (oAHI; 22.2 to 7.2, p < 0.01) and oxygen nadir (82 to 87, p < 0.01). Thirty-eight (61%) had a postoperative oAHI < 5; 16 (21%) had a postoperative oAHI < 2.

Conclusion

DISE resulted in intervention other than AT in 58% of surgically naïve children at high risk for persistent OSA after AT. DISE-directed intervention resulted in significant mean improvement in postoperative OSA.

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Authors and Affiliations

  1. Department of Otolaryngology: Head and Neck Surgery, The University of Michigan, Ann Arbor, MI, USA

    Erin Kirkham

  2. Mott Children’s Hospital, University of Michigan Medical Center, 1540 E. Hospital Dr. CW 5-702, SPC 4241, Ann Arbor, MI, 48109, USA

    Erin Kirkham

  3. Department of Otolaryngology: Head and Neck Surgery, The University of Washington School of Medicine, Seattle, WA, USA

    Cheng-Cheng Ma, Natalia Filipek, David L. Horn, Kaalan Johnson & Sanjay R. Parikh

  4. Seattle Children’s Hospital, Seattle, WA, USA

    David L. Horn, Kaalan Johnson, Maida L. Chen & Sanjay R. Parikh

  5. Department of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, WA, USA

    Maida L. Chen

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  1. Erin Kirkham
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Correspondence to Erin Kirkham.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kirkham, E., Ma, CC., Filipek, N. et al. Polysomnography outcomes of sleep endoscopy–directed intervention in surgically naïve children at risk for persistent obstructive sleep apnea. Sleep Breath 24, 1143–1150 (2020). https://doi.org/10.1007/s11325-019-02006-y

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