Effects Of Drug-induced Sleep Endoscopy In Children With Obstructive Sleep Apnea-hypopnea Syndrome:clinical Study And Meta-analysis

Objective:Obstructive sleep apnea hypopnea syndrome（OSAHS）is a common disease in children.If left untreated,it may have a profound impact on the health of children.Adenotonsillectomy（T&A）,as a first-line treatment for OSAHS in children,aims to reduce its effect.However,most studies have shown that 20%of children still have persistent sleep apnea after tonsillectomy.Drug-induced sleep endoscopy（DISE）is a new technique to evaluate the location and degree of upper airway obstruction,which has attracted more and more attention in recent years.It can provide targeted and effective treatment plans for children.Up to now,there are few related studies on children’s DISE in China,which hinders the progress of the diagnosis and treatment of children’s OSAHS in our country.This study intends to observe the upper airway obstruction of moderate and severe children with OSAHS by using DISE,guide the treatment plan of children with OSAHS,analyze the short-term effect after operation,and then explore the role of DISE in moderate and severe children with OSAHS.In addition,it is still controversial whether children with conventional OSAHS（no history of upper airway surgery,no craniofacial deformities,no syndrome）are ideal for DISE in children.Therefore,this study intends to conduct meta analysis and systematic evaluation of the change rate of the treatment mode of routine OSAHS children under DISE and the obstruction sites found in DISE,so as to explore the role of DISE in the treatment of routine OSAHS children.Methods:Part I:Children with moderate to severe OSAHS who were diagnosed by PSG at Shenzhen Children’s Hospital from October 2020 to June 2022 but were untreated and met the inclusion and exclusion criteria were selected for DISE examination.Routine physical examination,PSQ questionnaire and PSG were performed before treatment.Children were divided into conventional OSAHS and persistent OSAHS according to the presence or absence of previous history of upper airway surgery.The Chan-Parikh scoring system was used to assess the level of upper airway obstruction and its degree of obstruction,and individualized treatment was performed according to the results to investigate the guiding significance of DISE in the treatment of OSAHS in children.Combined with PSQ questionnaire and PSG results 3 months after treatment,the short-term efficacy was analyzed.Part II:We searched CNKI,WF,VIP,Pub Med,EMBASE,Cochrane Library and Web of Science by computer combined with hand to find relevant case studies on DISE to guide the treatment of children with OSAHS from database establishment to January 2023.Articles were screened and required data were extracted in strict accordance with the inclusion and exclusion criteria,and meta-analysis was performed using Stata16.0 software.Results:Part I:A total of 51 children with moderate to severe OSAHS were included in this study,including 37 children with conventional OSAHS and 14 children with postoperative persistent OSAHS.DISE changed the conventional surgical methods in 45.1%of children with moderate to severe OSAHS,including 40.5%of children with conventional OSAHS and 57.1%of children with persistent OSAHS after surgery,affirming the role of DISE in the treatment of children with OSAHS.The PSQ questionnaire score,OAHI,and lowest Sa O₂ were significantly improved during postoperative follow-up compared with before.Part II:Four case studies with a total of761 subjects were included,and none of the children had a history of upper airway surgery,craniofacial deformity,or syndrome.The quality evaluation results showed that the methodological quality of the included studies was not high and all were non-randomized case studies.Meta-analysis showed that in children with conventional OSAHS,the nasopharyngeal（adenoid）obstruction rate was 93%,the soft palate obstruction rate was35%,the oropharyngeal（tonsillar）obstruction rate was 76%,the tongue base obstruction rate was 32%,the supraglottic obstruction rate was 31%,and the multiplanar obstruction rate was 60%in DISE examination.DISE changed the conventional surgical methods in45%（95%CI:29%-60%）of the children with conventional OSAHS and provided personalized treatment options for the children,and the postoperative symptoms and sleep-related parameters were significantly improved compared with before,greatly improving the success rate of surgery and avoiding unnecessary surgery.Conclusion:Part I:For children with moderate to severe OSAHS undergoing upper airway surgery,DISE is a safe and reliable auxiliary examination method that can assess upper airway obstruction during sedative sleep and find the site of obstruction missed in physical examination,which helps to provide targeted and effective treatment plan for children,and its treatment results are good.Part II:DISE changed the routine surgical approach in 45%of children with conventional OSAHS without a history of upper airway surgery,craniofacial malformations,or syndromes.Conventional OSAHS should be an ideal examination population for DISE,but relevant high-quality RCT studies should be further conducted in future studies to investigate the role of DISE in the treatment of children with conventional OSAHS.