Drug-induced sleep endoscopy compared with systematic adenotonsillectomy in the management of obstructive sleep apnoea in children: a systematic review and meta-analysis protocol

INTRODUCTION: Obstructive sleep apnoea affects up to 6% of children worldwide. Although current guidelines recommend systematic tonsillectomy and adenoidectomy, many children do not benefit from these interventions. Drug-induced sleep endoscopy (DISE) allows the dynamic evaluation of patients’ airways to identify the specific anatomic sites of obstruction. This intervention can potentially guide subsequent invasive procedures to optimise outcomes and minimise the number of children exposed to unnecessary operations. METHODS AND ANALYSIS: We will identify randomised controlled trials and controlled observational studies comparing DISE-directed interventions to systematic tonsillectomy and adenoidectomy in paediatric populations. We will search MEDLINE, EMBASE, CINAHL, CENTRAL as well as clinical trial registries and conference proceedings (initial electronic search date 9 October 2018). Screening, data extraction and risk of bias assessments will be performed in duplicate by independent reviewers. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence and present our results. ETHICS AND DISSEMINATION: Ethics approval is not required for this systematic review of published data. This review will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will present our findings at otorhinolaryngology conferences and publish a report in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018085370.