Does drug induced sleep endoscopy-directed surgery improve polysomnography measures in children with Down Syndrome and obstructive sleep apnea?

• Published in: Acta oto-laryngologica Vol. 138; no. 11; pp. 1009 - 1013
• Main Authors: Akkina, Sarah R., Ma, Cheng C., Kirkham, Erin M., Horn, David L., Chen, Maida L., Parikh, Sanjay R.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.11.2018
• Subjects: DISE; Down syndrome; drug-induced sleep endoscopy; obstructive sleep apnea; polysomnography; Trisomy 21; Trisomy 21; obstructive sleep apnea; drug-induced sleep endoscopy; Down syndrome; polysomnography; DISE
• ISSN: 0001-6489; 1651-2251
• DOI: 10.1080/00016489.2018.1504169

Background: Children with Down Syndrome (DS) and obstructive sleep apnea (OSA) are difficult to treat, as first line therapies may not lead to significant improvement. Drug-induced sleep endoscopy (DISE) directed surgery may be particularly beneficial for these patients. Objective: To assess change in polysomnography (PSG) measures of patients with DS who underwent DISE-directed surgery. Methods: Retrospective chart review was performed on patients with DS who underwent DISE-directed surgery and had pre- and post-surgery PSG. Patients were analyzed in groups defined by previous adenotonsillectomy. Two-sided t-tests with equal variances were used to assess statistical significance. Results: Of 24 patients reviewed, 14 were surgically naïve and 10 had undergone prior adenotonsillectomy. The primary outcome was change in PSG parameters including apnea hypopnea index, obstructive apnea hypopnea index, oxygen nadir, oxygen desaturation index, and mean carbon dioxide level. While improvement was seen in all PSG parameters, only improvement in oxygen nadir in children who had undergone prior adenotonsillectomy was statistically significant (88.5% to 90.9%, p = .04). Conclusions and Significance: DISE-directed surgery may be beneficial for children with DS and OSA, with improvement in the means of main PSG measures observed. A larger, prospective study is warranted to further explore DISE utility.