Objective: To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data. Design: Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. Outcome Measures: Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate. Results: Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0 ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/hr (p < 0.04) with a mean difference (MD) of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (P<0.00001). LSAT improved from 87.8 ± 5.7 to 90.1 ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (P<0.0001). Conclusion: Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective, but there is heterogeneity in reported outcomes influenced by confounding factors. Key Words: Drug Induced Sleep Endoscopy; Pediatric Sleep Apnea; Tongue Surgery