Outcome Of Drug-Induced Sleep Endoscopy-Directed Surgery For Persistent Obstructive Sleep Apnea After Adenotonsillar Surgery

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): E. Esteller, J.C. Villatoro, A. Agüero, E. Matiñó, R. Lopez, Aristimuño A, Nuñez V, M.A. Díaz-Herrera

Abstract

PURPOSE

Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment.

METHODS

Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12±3 months.

RESULTS

All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1±4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895±1.11 vs 6.143±4.88; p<0.05) and, in 85% (n=17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12±3 months (15%; n= 3) compared to before surgery (75%; n=15) (p<0.005).

CONCLUSION

DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.

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