Drug Induced Sleep Endoscopy-Directed Tongue Surgery to Treat Persistent Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2025-01-27 DOI:10.1111/coa.14283

R. Kenneth Sims IV, Alexander Leeds, Grace Johnson, Anna Davide, Macario Camacho

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引用次数: 0

Abstract

Objective

To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data.

Design

Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines.

Outcome Measures

Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate.

Results

Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0% ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/h (p < 0.04) with a mean difference (MD) of −5.13 [95% CI -7.13, −3.13], Z-score 5.02 (p < 0.00001). LSAT improved from 87.8 ± 5.7 to 90.1% ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (p < 0.0001).

Conclusion

Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective; limitations include heterogeneity in reported outcomes influenced by confounding factors.

查看原文本刊更多论文

药物诱导睡眠内镜引导舌部手术治疗顽固性儿童阻塞性睡眠呼吸暂停：一项系统综述和荟萃分析。

目的：系统回顾药物诱导睡眠内镜（DISE）指导舌部手术治疗既往腺扁桃体切除术和持续性或复发性阻塞性睡眠呼吸暂停（OSA）患儿的文献，并对多导睡眠图（PSG）数据进行荟萃分析。设计：根据系统评价和荟萃分析（PRISMA）声明指南的首选报告项目进行系统评价和荟萃分析。预后指标：原发性、术后呼吸暂停低通气指数（AHI）和最低血氧饱和度（LSAT）；其次，手术反应率。结果：7项研究（283例患者）符合标准，并报告了系统评价的PSG结局数据。平均±标准差手术有效率为70.0%±17.0% [95% CI 67.6, 71.6]。7项研究中的6项（270例患者）报告了特定的术前和术后PSG数据，纳入我们的荟萃分析。术前和术后AHI从9.5±12.1事件/小时下降到4.2±6.9事件/小时(p)。结论：现有文献表明，持续性OSA患儿的dis定向舌部手术可使AHI降低约50%，LSAT提高近3%，手术总体阳性反应率为70%。有集体证据表明，疾病指导下的舌部手术是有效的；局限性包括受混杂因素影响的报告结果的异质性。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.