Polysomnography outcomes in children with small tonsils undergoing drug-induced sleep endoscopy-directed surgery

Craig Miller; Erin Kirkham; Cheng-Cheng Ma; Natalia Filipek; David L Horn; Kaalan Johnson; Maida L Chen; Sanjay R Parikh

doi:10.1002/lary.27759

Polysomnography outcomes in children with small tonsils undergoing drug-induced sleep endoscopy-directed surgery

Laryngoscope. 2019 Dec;129(12):2771-2774. doi: 10.1002/lary.27759. Epub 2018 Dec 21.

Authors

Craig Miller^{1

2

3

4}, Erin Kirkham^{1

2

3

4}, Cheng-Cheng Ma^{3

4}, Natalia Filipek^{3

4}, David L Horn^{1

2

3

4}, Kaalan Johnson^{1

2

3

4}, Maida L Chen^{3

4}, Sanjay R Parikh^{1

2

3

4}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Seattle, Washington.
² Department of Pediatrics Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington.
³ Seattle Children's Hospital, Seattle, Washington.
⁴ Department of Pediatrics, Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, U.S.A.

PMID: 30575040
DOI: 10.1002/lary.27759

Abstract

Objectives/hypothesis: The optimal surgical treatment to improve sleep apnea in children with small tonsils is not known. Drug-induced sleep endoscopy (DISE) may be useful in selecting effective surgical procedures for this patient population. This study compared polysomnography (PSG) measures before and after DISE-directed surgery in children with small tonsils. We hypothesize that DISE-directed surgery improves PSG measures in children with small tonsils. We also aimed to identify the most common surgery performed in this population.

Study design: Retrospective chart review.

Methods: A retrospective review was performed of subjects who underwent DISE at a single pediatric tertiary care center over a 6-year period. Inclusion criteria were 1+ tonsils and PSG performed before and after DISE-directed surgery. Exclusion criteria were previous tonsillectomy and tonsils score 2+ or greater. Pre- and postoperative PSG parameters were compared using paired t tests.

Results: Average age was 7 ± 4 years old at the time of surgery. The most common DISE-directed intervention was supraglottoplasty (n = 23). DISE-directed surgery significantly improved mean apnea-hypopnea index (AHI) from 14.4 to 8.0 (P = .02). Although improvements were seen in mean obstructive AHI (12.5 to 5.5), O₂ nadir (87.0 to 88.3), and ODI (10.6 to 5.8), these measures did not reach statistical significance.

Conclusions: DISE-directed surgery significantly improves AHI in children with small tonsils. The most common intervention performed on these children was supraglottoplasty. Interestingly, adenotonsillectomy was rarely performed in this cohort. Additionally, supraglottic collapse, prompting supraglottoplasty, is difficult to accurately assess in an awake child, supporting use of a DISE-directed approach in this patient population.

Level of evidence: 4 Laryngoscope, 129:2771-2774, 2019.

Keywords: Obstructive sleep apnea; drug induced sleep endoscopy; pediatrics; polysomnography; sleep disordered breathing.

MeSH terms

Anesthetics, Intravenous / administration & dosage
Child
Endoscopy / methods*
Female
Follow-Up Studies
Humans
Male
Palatine Tonsil / surgery*
Polysomnography / methods*
Retrospective Studies
Sleep / physiology*
Sleep Apnea Syndromes / diagnosis
Sleep Apnea Syndromes / physiopathology
Sleep Apnea Syndromes / surgery*
Tonsillectomy / methods*
Treatment Outcome

Substances

Anesthetics, Intravenous