Drug-induced sleep endoscopy directed surgery improves polysomnography measures in overweight and obese children with obstructive sleep apnea

Abstract

Background

Obstructive sleep apnea affects approximately 1–4% of all children, with increased prevalence amongst overweight and obese children.

Objective

To assess the effects of drug-induced sleep endoscopy (DISE)-directed surgery on polysomnography parameters in obese and overweight children.

Material/Methods

A retrospective case-series was performed on obese and overweight pediatric patients who underwent clinically indicated DISE-directed surgery. Forty children met the inclusion criteria, including: body mass index ≥85%, DISE-study, and pre- and post-DISE polysomnography. Patients were divided into surgically naïve (n = 23) and prior adenotonsillectomy (n = 17) groups. Demographic and clinical characteristics were examined with chi-square and Wilcoxon rank-sum test. Polysomnography parameters were compared with Wilcoxon signed rank test.

Results

Of 40 children with mean BMI 94% and mean age 8 ± 6 years old, 17 (43%) underwent a previous adenotonsillectomy. Overall, significant improvements were observed in the apnea-hypopnea index (AHI; 25.0 to 9.9 events/hour, p < .01) and oxygen nadir (82.7% to 88.5%, p < .01). A similar pattern was observed among the surgically naïve (AHI: 35.9 to 12.7 events/hour, p = .04; oxygen nadir: 79.7% to 86.4%, p = .2) and post-adenotonsillectomy groups (AHI: 10.4 to 6.2 events/hour, p = .02; oxygen nadir: 86.7% to 91.2%, p < .01).

Conclusions/Significance

Polysomnography parameters significantly improved following DISE-directed interventions in obese and overweight children with obstructive sleep apnea.

Chinese abstract

背景：阻塞性睡眠呼吸暂停影响约1-4％的儿童, 超重和肥胖儿童的患病率更高。

目的：评估药物诱导的睡眠内窥镜（DISE）手术对肥胖和超重儿童多导睡眠图参数的影响。

材料/方法：对临床上接受过DISE手术的肥胖和超重的儿科患者进行回顾性病例系列研究。 40名儿童符合入选标准, 包括：体重指数≥85％, DISE研究以及DISE前后的多导睡眠监测。患者分为单纯手术组（n¼23）和既往腺扁桃体切除术组（n¼17）。

人口特征和临床​​特征用卡方检验和Wilcoxon秩和检验来检测。将多导睡眠图参数与Wilcoxon秩检验进行比较。

结果：在平均BMI为94％, 平均年龄为8±6岁的40名儿童中, 有17名（43％）接受过腺扁桃体切除术。总体而言, 观察到呼吸暂停-呼吸不足指数的明显改善（AHI; 25.0至9.9次/小时, p <0.01）和氧最低点的明显改善（82.7％至88.5％, p <0.01）。在单纯手术中观察到了类似的模式（AHI：35.9至12.7次/小时, p¼.04；氧最低点：79.7％至86.4％, p¼.2）和腺扁桃体切除术后组（AHI：10.4至6.2次/小时, p¼.02；氧最低点：86.7％至91.2％, p <.01）。

结论/意义：患阻塞性睡眠呼吸暂停的肥胖和超重儿童在接受DISE手术后, 多导睡眠图参数明显改善。

Keywords:

• Sleep
• endoscopy
• apnea
• obesity
• children

Disclosure statement

No potential conflict of interest was reported by the author(s).