# Optimization of Surgical Treatment for Pediatric Obstructive Sleep Apnea

> **NIH NIH K23** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $194,400

## Abstract

PROJECT SUMMARY/ABSTRACT
Obstructive sleep apnea (OSA) affects 1-4% of children, can lead to cognitive, behavioral, and cardiovascular
morbidity, and is associated with a 226% increase in healthcare utilization. Guidelines recommend
adenotonsillectomy (AT) as first-line treatment for pediatric OSA and nearly half a million are performed in U.S.
children annually. However, AT is a one-size-fits-all procedure for a condition with pathophysiology that can
differ dramatically between individuals based on differences in upper airway anatomy and dynamics. These
differences likely account for the high rate of persistent post-AT OSA. Drug-induced sleep endoscopy (DISE)
is a flexible fiber-optic assessment of the upper airway performed under sedation that has potential to direct
individualized surgical treatment and improve outcomes in children with OSA. While early series have
demonstrated good outcomes after DISE-assisted surgery, there is currently no well-controlled, prospective
data to support the use of DISE in children. Prospective research on pediatric DISE has been fundamentally
hindered by the lack of a standardized sedation protocol for the procedure. Choice of sedative may be
important as anesthetic drugs impact upper airway patency to various degrees. Fundamental questions about
how DISE findings should be interpreted and applied cannot be answered without first understanding which
anesthetic facilitates the most useful assessment of upper airway obstruction. The goal of this project is to
determine which anesthetic should be used for DISE. We will perform a randomized controlled trial comparing
the two anesthetic drugs most commonly used to sedate children for the procedure: dexmedetomidine (DEX)
and propofol. The central hypothesis of this proposal is that PROP exaggerates dynamic obstruction
compared to DEX, and thus DISE under DEX provides a more useful and predictive measurement of upper
airway obstruction during sleep. To test this, we will 1) compare mean DISE obstruction scores under sedation
with PROP versus DEX and 2) test the predictive value of obstruction seen on DISE but left untreated by AT
on post-AT outcomes (improvement in symptoms, behavior, quality-of-life, and polysomnography measures)
and need for further treatment for persistent post-AT OSA. To accomplish these aims, Dr. Kirkham will receive
mentorship, focused didactic coursework and training in pediatric sleep medicine and on the design and
implementation of randomized controlled trials. Dr. Kirkham’s long-term goal is to become a leading
independent clinical investigator and expert in the surgical treatment of pediatric OSA. An NHLBI K23 award
will provide Dr. Kirkham with the protected time and needed training to achieve her career goals and improve
outcomes for children with sleep apnea.

## Key facts

- **NIH application ID:** 10478086
- **Project number:** 5K23HL153897-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Erin Marie Kirkham
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $194,400
- **Award type:** 5
- **Project period:** 2021-09-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10478086

## Citation

> US National Institutes of Health, RePORTER application 10478086, Optimization of Surgical Treatment for Pediatric Obstructive Sleep Apnea (5K23HL153897-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10478086. Licensed CC0.

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