DISE-Directed Surgery Outcomes for Pediatric Trisomy 21 Patients: A Systematic Review and Meta-Analysis

Introduction: Drug-Induced Sleep Endoscopy (DISE) is increasingly used in pediatric obstructive sleep apnea (OSA). A previous meta-analysis reported a mean reduction in AHI of 4.28 after adenotonsillectomy (AT) without DISE. Does DISE-directed surgery (DISEDS) in children result in improvement of polysomnographic parameters and is it as impactful in children with Trisomy 21 (T21)?

Methods: A meta-analysis following PRISMA guidelines was conducted, searching PubMed, Scopus, and CINAHL from inception to 1/1/2025. Eligible studies assessed DISEDS that reported apnea-hypopnea index (AHI) or obstructive AHI (oAHI) outcomes in pediatric patients, including both surgically naive and those with residual OSA after AT.

Results: 29 studies were included, including 1340 patients with a mean age of 9.6 years (range: 4.2-14.3; (95% CI: 8.9-10.3). A total of 24 surgical interventions were performed, either alone or in combination, with AT (n=571), lingual tonsillectomy (n=567), and supraglottoplasty (n=328) the most common. The mean preoperative AHI, oAHI, and lowest oxygen saturation (LSAT) for all pediatric patients were 11.8 (95% CI: 11.6-12.0), 12.0 (95% CI: 11.0-13.1), and 85.9 (95% CI: 85.6-86.3), respectively. The mean preoperative AHI, oAHI, and LSAT for T21 patients were 21.5 (95% CI: 20.6-22.3), 23.6 (95% CI: 21.3-26.0), and 85.3 (95% CI: 84.9-85.8), respectively. The mean preoperative AHI and oAHI were significantly higher in T21 patients compared to all pediatric patients (p <.001). The mean change after DISEDS for all pediatric patients were AHI: -6.3 (95% CI: -6.0- -6.6; p<.001), oAHI: -7.3 (95% CI -6.1- -8.4; p<.001), and LSAT: 3.8 (95% CI 4.3-3.4; p<.001). The mean difference for children with T21 were AHI: -14.6 (95% CI -13.2- -16.0; p<.001), oAHI: -14.9 (95% CI -12.2- -17.7; p<.001), LSAT: 4.3 (95% CI 5.0-3.6; p<.001).

Conclusions: DISEDS significantly improves AHI, oAHI, and LSAT in children with OSA, more than AT alone, with greater benefits in those with T21. These findings highlight the importance of utilizing DISEDS, especially in the T21 population.