International Journal of Pediatric Otorhinolaryngology
Changes in sleep apnea after supraglottoplasty in infants with laryngomalacia
Introduction
Although often overlooked, the most common cause of laryngeal obstruction in infants, laryngomalacia (LM), has been shown to be a source of significant obstructive sleep apnea (OSA) [1], [2], [3]. While the true incidence of OSA in infants with LM is unknown, it has been reported in up to 100% of patients undergoing supraglottoplasty (SGP) for severe LM [1], [2]. Patients with less severe LM have also been shown to suffer from significant OSA and benefit from SGP [3]. Polysomnography (PSG) is considered to be the “gold standard” in diagnosing OSA and a useful objective outcome measure after SGP in these patients [1], [2], [3]. Definitive guidelines regarding the role of PSG in evaluating patients with LM, however, have not yet been established. Likewise, the use of SGP to treat OSA in the setting of LM is not well understood. In this study, we present our experience using pre and postoperative polysomnorgaphic parameters to evaluate the affect a SGP has on OSA in infants (<1 year old) with severe LM.
Section snippets
Methods
With institutional review board approval, a retrospective chart review of infants with LM treated at our institution between 2003 and 2009 was performed. Inclusion criteria included patients less than one year of age who underwent PSG pre- and post-SGP. Two subgroups were analyzed according to their surgical indication. The first group had “severe” LM and presented with failure to thrive or signs of severe respiratory distress, such as cyanotic spells, severe retractions, or prolonged apneas
Results
20 patients with a median follow up of 9.5 months (range of 1–24 months) were reviewed. See Table 1 for patient characteristics and Table 2 for pre- and postoperative PSG findings. Subjects ranged in age at the time of surgery from 2 weeks to 10 months with a median age of 3.9 months. Stridor improved or resolved in all patients after SGP. No cases of supraglottic stenosis occurred from SGP. Five patients had self-limiting dysphagia that resolved within one month after SGP. There was no
Discussion
Surgical indications for infants with LM are not always straight forward. Only about 5–10% of patients will have a clear reason to operate, such as failure to thrive or severe apnea causing cyanosis or life-threatening levels of hypoxia [9], [10]. A good portion of patients have more moderate symptoms [3], such as stridor and sleep disordered breathing with associated retractions and/or intermittent problems with feeding. Indications for surgery in this group can be more ambiguous, and PSG may
Conclusion
In this study, PSG parameters improved in infants with LM and moderate to severe OSA after SGP. Infants with mild OSA (AHI <5) but severe LM did not show PSG improvement after SGP. Confounding factors such as reflux therapy and age did not seem to influence PSG outcomes after SGP, but larger controlled studies are needed to validate this finding. Reported improvements in SDB and stridor correlated with improved PSG parameters in 85% and 80% of patients, respectively. There were no reports of
Acknowledgements
Dr. Kris Sekar, pediatric neonatologist, for assistance on information and advice regarding sleep study parameters.
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