Outcome of drug-induced sleep endoscopy-directed surgery for persistent obstructive sleep apnea after adenotonsillar surgery

Esteller, Eduard Carbonell i; Villatoro, Juan Carlos; Agüero, Adriana; Matiñó, Eusebi; López, Roser; Aristimuño, A.; Núñez, V; Díaz-Herrera, Miguel Ángel

doi:10.1016/j.ijporl.2019.02.004

Cited by 19 publications

(11 citation statements)

References 42 publications

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“…This is easily explained by the fact that in this group of patients, we analyzed only the surgical failures, a selected population that already had persistent OSA after TA. Equivalent adenoid regrowth rates to what we found were reported by studies with similar study designs 28–30 . Almost half of the patients also showed significant obstruction at the level of the tongue base or the supraglottis, more than what we saw in the surgically naïve group.…”

Section: Discussionsupporting

confidence: 78%

“…Equivalent adenoid regrowth rates to what we found were reported by studies with similar study designs. 28-30 Almost half of the patients also showed significant obstruction at the level of the tongue base or the supraglottis, more than what we saw in the surgically naïve group. These data are in accordance with previous studies that demonstrated an increased prevalence of tongue base and supraglottic obstruction in children with persistent OSA after TA.…”

Section: Discussionmentioning

confidence: 49%

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Drug‐Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea

Raposo

Menezes

Rito

et al. 2020

Otolaryngol.--head neck surg.

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Objective To describe drug-induced sleep endoscopy (DISE) findings in children with obstructive sleep apnea and to differentiate them between surgically naïve children and children who had adenotonsillectomy performed. Study Design Retrospective case series with chart review. Setting Secondary care hospital. Subjects and Methods A cohort of 56 children with the diagnosis of obstructive sleep apnea was submitted to DISE and subsequent upper airway surgery: 23 were surgically naïve, and 33 had persistent obstructive sleep apnea after adenotonsillectomy. Comparisons between groups were calculated with chi-square test and Student’s t test. Simple linear regression was used to model polysomnographic indices. Results In surgically naïve children, the most common sites of obstruction were the adenoids (78.2%) and the lateral pharyngeal walls/tonsils (82.6%). In children with persistent obstructive sleep apnea after adenotonsillectomy, the most common sites of obstruction were the adenoids (54.5%), followed by the supraglottis (48.5%) and the tongue base (45.5%). No correlation was found between obstructive apnea-hypopnea index and DISE findings. Simple linear regression revealed that the degree of obstruction at the tongue base (β = −0.73; 95% CI, −1.22 to −0.25; P = .004) and the presence of multilevel obstruction (β = −1.75; 95% CI, −3.20 to −0.30; P = .02) predicted saturation nadir in children with persistent obstructive sleep apnea after adenotonsillectomy. Conclusion DISE findings differed between surgically naïve children and children with persistent obstructive sleep apnea after adenotonsillectomy. Increased obstruction at the level of the tongue base and the presence of multilevel obstruction predicted a lower saturation nadir in children with persistent obstructive sleep apnea after adenotonsillectomy.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 49%

Drug‐Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea

Raposo

Menezes

Rito

et al. 2020

Otolaryngol.--head neck surg.

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“…The study found that DISE-directed surgery had better results for children with a lower AHI at baseline. 48 Esteller et al 49 showed that DISE-directed surgery led to significant improvement of OAHI in 20 otherwise healthy patients with prior AT. For surgically naïve patients, DISE-directed surgery has also been shown to decrease OAHI.…”

Section: The Ability Of Dise To Change Management and Dise-directed Surgical Outcomesmentioning

confidence: 99%

Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Arganbright

Lee

Weatherly

2021

World j. otorhinolaryngol.-head neck surg.

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“…DISE enables direct visualization of dynamic airway changes and, therefore, permits delineation of the site of obstruction and subsequent treatment planning [104]. As mentioned, DISE has rapidly gained momentum and the indications and guidelines for the use of this technique will likely emerge in the upcoming years [105][106][107][108][109][110]. At this point, it is routine clinical practice in children with residual OSA after T&A to initially offer PAP therapy and medical therapy, and when patients are either unable, unsuccessful, or unwilling to adopt such options, then use of DISE-directed surgical therapies seems a logical and reasonable step, notwithstanding its limitations [111,112].…”

Section: Drug Induced Sleep Endoscopymentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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Outcome of drug-induced sleep endoscopy-directed surgery for persistent obstructive sleep apnea after adenotonsillar surgery

Cited by 19 publications

References 42 publications

Drug‐Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea

Drug‐Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea

Pediatric drug‐induced sleep endoscopy: An updated review of the literature

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

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