OD10 Advanced Sleep Surgery: What the pediatrician should know

Summary

Tonsil surgery with or without adenoidectomy is the recognized first line treatment for pediatric obstructive sleep apnea (OSA) based on multiple guidelines across different countries. But it is also well recognized that at least 20-30% of children will have persistent OSA after adenotonsillectomy (AT). Children with comorbidities such obesity, Down syndrome, severe baseline OSA, craniofacial anomalies, and neuromuscular disease are at particular risk for persistent OSA. However, the reasons for failure, and the optimal management of children with persistent OSA after AT remains a significant clinical challenge without clear guidelines.

In an effort to help guide decision-making in the treatment of OSA in children, pediatric drug-induced sleep endoscopy (DISE) has become increasingly popular in recent years. DISE offers direct visualization of the upper airway and characterization of the dynamic patterns of obstruction that occur during sleep. Despite its increasing popularity, there remains significant variation and controversy regarding the appropriate indications, sedation regimen, endoscopy protocol, and interpretation of findings. In addition, though evidence is improving, it remains unclear whether DISE offers improved outcomes compared to other approaches.

Specific topics to be discussed include a review of the outcomes of AT for OSA, screening and detection of post-AT OSA, DISE in children, and outcomes of DISE-directed surgery for persistent post-AT OSA in children. In addition, case discussions will illustrate common clinical scenarios and treatment strategies.

Learning Objectives

Upon completion of this CME activity, participants should be able to:

• Discuss short- and long-term outcomes of adenotonsillectomy and risk factors for persistent OSA
• Recognize the indications, practice variations, and areas of controversy in pediatric DISE
• Recognize the advanced surgical techniques for management of persistent pediatric OSA
• Summarize the latest evidence for the outcomes of DISE-directed surgical intervention

Target Audience

Pediatricians and pediatric sleep medicine providers

Chair

Derek Lam (United States)

Outcomes of adenotonsillectomy for pediatric OSA

Ron Mitchell (United States)

Screening for post-adenotonsillectomy OSA

Kate Chan (Hong Kong)

DISE overview: Indications and variations in practice

An Boudewyns (Belgium)

Role of polysomnography in selecting DISE candidates

Norm Friedman (United States)

DISE-directed sleep surgery: Nose to palate

Derek Lam (United States)

DISE-directed sleep surgery: Tongue base and larynx

Erin Kirkham (United States)