Sigaard Rasmus Krarup, Bertelsen Jannik Buus, Ovesen Therese
Department of Otorhinolaryngology, Head and Neck Surgery, Goedstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark.
Department of Otorhinolaryngology, Head and Neck Surgery, Goedstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark.
Am J Otolaryngol. 2023 Nov-Dec;44(6):103992. doi: 10.1016/j.amjoto.2023.103992. Epub 2023 Jul 10.
A systematic review of the evidence on the success of Drug-Induced Sleep Endoscopy (DISE) directed surgery in children with obstructive sleep apnea (OSA) defined as cure rate.
The PRISMA guidelines were followed and three databases (PubMed, Embase and Cochrane Library) were searched for studies on DISE directed surgery in children.
Pre- and post-surgical change in polysomnography (PSG); change in surgical target; side effects.
Study quality was assessed using the modified Delphi technique quality appraisal tool for case series. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias.
A total of 1805 studies were found. The most important reasons for exclusion were as follows: none-DISE studies, reports on adults, conflation of results on syndromic and healthy patients, no relevant outcome measurements. Five studies with a total of 376 patients (range: 26-126) were included. The surgeons changed the planned strategy in 50.4 % of patients according to the DISE findings. Comparison of pre- and post-surgical sleep monitoring revealed an average decrease in apnea-hypopnea index (AHI) of 11.1 and a treatment success (AHI < 5) and cure (AHI < 2) of 78 % and 53 %, respectively. The quality of the included studies was moderate especially due to small populations, designs without randomization or control groups, lack of analysis of drop outs, short follow-up, and considerable level of bias.
DISE directed surgery has been shown to change the surgical approach when treating children with OSA. If this can be transferred into a better outcome compared to standard surgical treatment is unknown, due to the current poor level of evidence. To decide whether or not DISE should be included in the treatment of children with OSA, we suggest further data, preferably an RCT, to increase the level of evidence.
对药物诱导睡眠内镜检查（DISE）指导下的手术治疗儿童阻塞性睡眠呼吸暂停（OSA）的成功率相关证据进行系统评价，以治愈率作为衡量指标。
遵循PRISMA指南，检索了三个数据库（PubMed、Embase和Cochrane图书馆）中关于DISE指导下儿童手术的研究。
多导睡眠图（PSG）术前和术后的变化；手术靶点的变化；副作用。
采用改良的德尔菲技术病例系列质量评估工具评估研究质量。使用Cochrane协作网的偏倚风险评估工具评估偏倚风险。
共检索到1805项研究。排除的最重要原因如下：非DISE研究、成人报告、综合征患者和健康患者结果混淆、无相关结局测量。纳入了5项研究，共376例患者（范围：26 - 126例）。根据DISE结果，外科医生在50.4%的患者中改变了计划策略。术前和术后睡眠监测结果比较显示，呼吸暂停低通气指数（AHI）平均下降11.1，治疗成功率（AHI < 5）和治愈率（AHI < 2）分别为78%和53%。纳入研究的质量中等，尤其是由于样本量小、设计无随机分组或对照组、缺乏失访分析、随访时间短以及偏倚程度较高。
已表明DISE指导下的手术在治疗儿童OSA时会改变手术方式。与标准手术治疗相比，这是否能转化为更好的治疗效果尚不清楚，因为目前证据水平较低。为了决定DISE是否应纳入儿童OSA的治疗，我们建议进一步收集数据，最好是进行随机对照试验（RCT），以提高证据水平。
