DISEDS improves polysomnographic outcomes in pediatric OSA, with greater effect in Trisomy 21
This meta-analysis of 41 observational studies evaluated the effectiveness of drug-induced sleep endoscopy-directed surgery (DISEDS) in 3,404 pediatric patients (≤21 years) with obstructive sleep apnea, including a subgroup of 320 patients with Trisomy 21. The analysis compared postoperative polysomnographic outcomes to preoperative status, without a concurrent control group.
DISEDS was associated with significant improvements in key polysomnographic parameters. The mean difference in apnea-hypopnea index (AHI) was 9.63 (95% CI: 7.54-11.73, P < .00001), in obstructive AHI (oAHI) was 11.46 (95% CI: 9.13-13.80, P < .00001), and in oxygen nadir was -4.37 (95% CI: -5.36 to -3.39, P < .00001). In the Trisomy 21 subgroup, the AHI improvement was more pronounced with a mean difference of 14.78 (95% CI: 9.99-19.56).
Safety and tolerability outcomes were not reported in the meta-analysis. The authors assessed risk of bias using JBI and ROBINS-I tools and found minimal publication bias, but the inherent limitations of observational data remain. The analysis reports associations, not causation, and does not address clinical outcomes beyond polysomnographic measures or long-term results.
For practice, these findings support the concept of using DISE to guide individualized, anatomy-based surgical planning in pediatric OSA, particularly in patients with Trisomy 21 who showed greater AHI improvement. However, clinicians should interpret these results cautiously given the observational nature of the evidence and lack of safety data.
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