Outcomes of DISE-Directed Surgery for Obstructive Sleep Apnoea in Children with Comorbidities

Background: Obstructive sleep apnoea (OSA) affects 1–4% of children and may cause significant health issues if left untreated. While adenotonsillectomy is the primary intervention, up to 33% of children experience residual OSA. Drug-induced sleep endoscopy (DISE) enables identification of the site of anatomical obstruction, thus facilitating targeted surgical interventions. The approach of the institution at which this research was conducted is to only perform DISE in selected patients including those who fail adenotonsillectomy or when adenotonsillectomy is not expected to be successful. Methods: This retrospective case series reviewed 24 children who underwent DISE at Perth Children's Hospital between 2018 and 2021. Of these, 19 underwent DISE-directed surgeries for OSA. Polysomnography (PSG) parameters pre- and post-surgery were compared. Results: Overall, there were no significant improvements in PSG parameters in the group post-surgery. However, improvements were found with sub-group analyses in younger children, those with severe pre-operative OSA and non-obese children. No significant improvement was observed in children with Trisomy 21. Revision adenoidectomy was the most frequently performed surgery and tongue-base reduction achieved the highest success rate (80%) based on improvement of PSG parameters. Conclusion: DISE-directed surgery offers a promising approach for managing residual paediatric OSA. Outcomes were most favourable in younger patients, those with severe OSA and non-obese patients. Further research with larger cohorts is warranted to refine surgical strategies.