# A Personalized Surgical Approach for the Treatment of Children with Obstructive Sleep Apnea and Small Tonsils

> **NIH NIH R61** · OREGON HEALTH & SCIENCE UNIVERSITY · 2024 · $324,317

## Abstract

Project Summary
Obstructive sleep apnea (OSA) is common in children with an estimated prevalence of 1-6%. Untreated
pediatric OSA is associated with hypertension, autonomic dysfunction, attention deficit/hyperactivity disorder,
neurocognitive deficits, and poor quality of life. Adenotonsillar hypertrophy is the primary risk factor for pediatric
OSA, and adenotonsillectomy (AT) is the recommended first-line treatment. However, it is unclear whether
children with small tonsils will benefit from AT. Clinic assessments of tonsil size do not consistently correlate
with OSA severity or response to AT, resulting in confusion about how best to treat OSA in children with small
tonsils. Drug-induced sleep endoscopy (DISE) enables direct observation of the sites and patterns of
obstruction during sedated sleep. DISE increasingly helps guide surgical decision-making in adult OSA, and
can also be used to guide surgical decisions in pediatric OSA and improve outcomes. The overall objective of
this study is to test the effectiveness of a novel personalized approach to the surgical treatment of OSA in
children. It is our central hypothesis that a personalized DISE-directed surgical approach in children
with small tonsils will be superior to the standard first line treatment of AT. To test this hypothesis, we
propose an unprecedented randomized controlled trial of DISE-directed surgery vs AT in children ages 2-18
years with clinically small tonsils with the following specific aims:
Aim 1: Compare the physiological outcomes of DISE-directed surgery vs AT in children with small tonsils.
Hypothesis 1: DISE-directed surgery will result in a clinically significantly greater improvement in the
obstructive apnea-hypopnea index (OAHI) compared to the standard AT intervention.
Aim 2: Compare the clinical outcomes of DISE-directed surgery vs AT in children with small tonsils.
Hypothesis 2: DISE-directed surgery will result in a clinically significantly greater improvement in disease-
specific QOL (OSA18) compared to the standard AT intervention.
Aim 3: Determine if OSA severity is associated with specific anatomic endotypes in children with small tonsils.
Hypothesis 3: Baseline OSA severity (defined by OAHI) is correlated with increasing severity of obstruction
(i.e., number of anatomic sites with complete obstruction on DISE rating scale).
Aim 4: Identify potential associations between baseline patient characteristics (e.g. age, obesity) and specific
anatomic endotypes (e.g., severe nasal obstruction, severe base of tongue obstruction) in children with
clinically small tonsils (exploratory aim).
This comparative effectiveness trial will be the first to directly compare a personalized surgical
approach to the standard treatment in children where the outcome of AT is uncertain. This novel
approach may improve OSA outcomes and reduce the burden of unnecessary AT or secondary surgery for
persistent OSA after an ineffective AT.

## Key facts

- **NIH application ID:** 10931337
- **Project number:** 5R61HL162771-02
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Erin Marie Kirkham
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $324,317
- **Award type:** 5
- **Project period:** 2023-09-20 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10931337

## Citation

> US National Institutes of Health, RePORTER application 10931337, A Personalized Surgical Approach for the Treatment of Children with Obstructive Sleep Apnea and Small Tonsils (5R61HL162771-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10931337. Licensed CC0.

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