Pediatric Drug-Induced Sleep Endoscopy Directed Surgery Outcomes With Trisomy 21 Subgroup Comparison: A Meta-Analysis.

Abstract

To evaluate the effectiveness of drug-induced sleep endoscopy-directed surgery (DISEDS) in improving polysomnographic outcomes in pediatric obstructive sleep apnea (OSA), and to compare its impact in children with Trisomy 21 (T21) pediatric population. PubMed, Scopus, and CINAHL databases were systematically searched from inception through January 1, 2025, in accordance with PRISMA guidelines. Studies were included if they reported pre- and postoperative apnea-hypopnea index (AHI), obstructive AHI (oAHI), or oxygen nadir in patients ≤21 years undergoing DISEDS. Meta-analyses were performed using random-effects models to calculate mean differences with 95% confidence intervals (CIs). Subgroup analyses were conducted for patients with T21. Risk of bias was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Publication bias was evaluated using funnel plots and Egger's test. Forty-one studies (n = 3404; 320 with T21) met inclusion criteria. DISEDS was associated with significant improvements in AHI (mean difference [MD]: 9.63; 95% CI: 7.54-11.73), oAHI (MD: 11.46; 95% CI: 9.13-13.80), and oxygen nadir (MD: -4.37; 95% CI: -5.36 to -3.39; all P < .00001). Improvements were more pronounced in the T21 subgroup, particularly for AHI (MD: 14.78; 95% CI: 9.99-19.56). Publication bias was minimal. DISEDS significantly improves OSA severity and oxygenation in pediatric patients, with greater benefits observed in children with T21. These findings support earlier DISE use to guide individualized, anatomy-based surgery in pediatric OSA.