Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: A systematic review

INTRODUCTION: Paediatrics obstructive sleep apnoea have been discussed to a great degree over the recent years and remains a conundrum till date. The advent of instrumentation has aided upper airway evaluation in determining the site and degree of upper airway collapse for targeted and effective surgical planning. The literature was reviewed to determine the outcome of Drug Induced Sleep Endoscopy (DISE) directed surgery in children with obstructive sleep apnoea.

MATERIAL AND METHODS: A literature search was conducted for the period from January 2000 to December 2019 by using a number of medical literature data bases including Scopus, PubMed and Embase. The following search words were used either individually or in combination: drug-induced sleep endoscopy, sleep endoscopy directed surgery, paediatrics sleep apnoea. The search was conducted over a month period (December 2019). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed when possible.

RESULTS: Seven clinical research articles were selected based on our objective and selection criteria. Seven studies were of level III evidence: retrospective, case-control and prospective series. Altogether, there were 996 patients with male predominance; 61%. Over 10% of patients (133 patients) were found to have comorbidities or were syndromic. The mean age of patient was 6 years and majority (87.6%) of our patients were found to be surgically naïve, that is, no previous surgical procedures were performed for OSA. Surgical decision was changed in 295 patients (30%) following DISE. Post intervention outcomes were objectively revealed in 4 studies. Most of our patients underwent a multilevel surgery based on DISE (86%). Complications were documented in 3 studies.

CONCLUSIONS: Analysis of the results indicated that DISE directed surgery was an effective, safe therapeutic approach to treating paediatrics obstructive sleep apnoea. DISE directed surgery has shown to have changed surgical management in most studies.