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Sanford JN, Lam DJ. Management of Obstructive Sleep Apnea in the Infant and Newborn. Otolaryngol Clin North Am 2024; 57:395-405. [PMID: 38523051 DOI: 10.1016/j.otc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Obstructive sleep apnea in newborns and infants presents a unique challenge with distinct differences in sleep physiology, etiologies, and management compared to older children. The indications for and interpretation of polysomnography are less well defined in infants. There are also no broadly accepted clinical practice guidelines for treating sleep apnea in this age group. Etiologies include general causes of upper airway obstruction in infants such as laryngomalacia, micrognathia, and nasal obstruction in addition to adenotonsillar hypertrophy. Treatment strategies must be tailored to the specific anatomic features and comorbidities of the specific patients and often require a multidisciplinary approach.
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Affiliation(s)
- Jillian N Sanford
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Derek J Lam
- Pediatric Otolaryngology Division, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
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Lajili M, Teissier N, Dudoignon B, Benoit C, Bellanger S, Kahn L, Van Den Abbeele T, Delclaux C, Bokov P. Nap polysomnography in infants with laryngomalacia as a tool to predict treatment strategy. Eur Arch Otorhinolaryngol 2024; 281:3107-3113. [PMID: 38573510 PMCID: PMC11065937 DOI: 10.1007/s00405-024-08623-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This study aimed to investigate the role of nap polysomnography (NPSG) in predicting treatment strategies for infants with moderate to severe laryngomalacia and to explore the association between obstructive sleep apnea (OSA) severity, weight gain, and laryngomalacia severity. METHODS A retrospective analysis was conducted on infants diagnosed with moderate to severe laryngomalacia who underwent NPSG between January 2019 and June 2023. Clinical variables, NPSG parameters, and treatment decisions were collected. Weight gain rate and its correlation with NPSG indices were assessed. Logistic regression analyses were performed to predict treatment strategies based on NPSG findings. RESULTS Of the 39 infants included (median age: 3.3 months), 77% exhibited OSA, with 69% having moderate to severe OSA [apnea-hypopnea index (AHI) > 5/h]. Weight gain rate correlated negatively with indices of OSA severity, including the hypopnea index (HI) and the AHI. In a multiple logistic regression analysis incorporating the severity of OSA (AHI), weight gain rate, and laryngomalacia severity, only AHI predicted the decision for surgical or non-invasive ventilation treatment (OR = 2.1, CI95 [1.6; 2.8], p ≤ 10-4). The weight gain rate was predicted (r2 = 0.28) by the AHI and the presence of retractions of auxiliary inspiratory muscles. CONCLUSION This study underscores the importance of NPSG in assessing infants with moderate to severe laryngomalacia. The AHI from NPSG emerged as a potential predictor for treatment decisions and weight gain rate, emphasizing its clinical relevance. These findings advocate incorporating NPSG into the diagnostic and management process for infants with laryngomalacia.
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Affiliation(s)
- Mariem Lajili
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, 75019, Paris, France
| | - Natacha Teissier
- Service d'Oto-Rhino-Laryngologie, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 75019, Paris, France
| | - Benjamin Dudoignon
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Charlotte Benoit
- Service d'Oto-Rhino-Laryngologie, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 75019, Paris, France
| | - Sophie Bellanger
- Service d'Oto-Rhino-Laryngologie, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 75019, Paris, France
| | - Laureline Kahn
- Service d'Oto-Rhino-Laryngologie, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 75019, Paris, France
| | - Thierry Van Den Abbeele
- Service d'Oto-Rhino-Laryngologie, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 75019, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris-Cité, 48, Boulevard Sérurier, 75019, Paris, France.
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Casellas NJ, Shah S, Ravikumar S, Vandjelovic ND, Faria J, Allen PD, McKenna Benoit MK. Polysomnogram outcomes in patients with laryngomalacia and obstructive sleep apnoea treated surgically versus non-surgically. J Laryngol Otol 2024; 138:436-442. [PMID: 37212024 PMCID: PMC10950448 DOI: 10.1017/s0022215123000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To compare supraglottoplasty versus non-surgical treatment in children with laryngomalacia and mild, moderate and severe obstructive sleep apnoea. METHODS Patients were classified based on their obstructive apnoea hypopnoea index on initial polysomnogram, which was compared to their post-treatment polysomnogram. RESULTS Eighteen patients underwent supraglottoplasty, and 12 patients had non-surgical treatment. The average obstructive apnoea hypopnoea index after supraglottoplasty fell by 12.68 events per hour (p = 0.0039) in the supraglottoplasty group and 3.3 events per hour (p = 0.3) in the non-surgical treatment group. Comparison of the change in obstructive apnoea hypopnoea index in the surgical versus non-surgical groups did not meet statistical significance (p = 0.09). CONCLUSION All patients with laryngomalacia and obstructive sleep apnoea had a statistically significant improvement in obstructive apnoea hypopnoea index after supraglottoplasty irrespective of obstructive sleep apnoea severity, whereas patients who received non-surgical treatment had more variable and unpredictable results. Direct comparison of the change between the two groups did not find supraglottoplasty to be superior to non-surgical treatment. Larger prospective studies are recommended.
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Affiliation(s)
- Nicolas J Casellas
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shalini Shah
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Saiganesh Ravikumar
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Nathan D Vandjelovic
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul D Allen
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Margo K McKenna Benoit
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
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Morse E, Pereira N, Liu K, Veler H, Maresh A. Management and outcomes of obstructive sleep apnea in infants. Int J Pediatr Otorhinolaryngol 2023; 168:111558. [PMID: 37075592 DOI: 10.1016/j.ijporl.2023.111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/03/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To characterize the clinical characteristics of infants with obstructive sleep apnea (OSA), define the resolution rate of infant OSA, and identify factors associated with OSA resolution. METHODS We identified infants diagnosed with OSA via retrospective chart review at less than one year of age at a tertiary care center. We identified patient comorbidities, flexible or rigid airway evaluations, surgical procedures, and oxygen/other respiratory support administration. We identified infants as having resolved OSA based on clinical or polysomnogram resolution. We compared the frequency of comorbid diagnoses and receipt of interventions in infants with resolved versus non-resolved OSA by χ2 analysis. RESULTS 83 patients were included. Prematurity was found in 35/83 (42%), hypotonia-related diagnoses in 31/83 (37%), and craniofacial abnormalities in 34/83 (41%). Resolution was observed in 61/83 (74%), either clinically or by polysomnogram, during follow up. On χ2 analysis, surgical intervention was not associated with likelihood of resolution (73% versus 74% in those without surgical intervention, p = 0.98). Patients with airway abnormalities on flexible or rigid evaluation were less likely to have OSA resolution than those without (63% versus 100%, p = 0.010), as were patients with hypotonia-related diagnoses (58% versus 83%, p = 0.014). In patients with laryngomalacia, there was no association of supraglottoplasty with increased resolution (88% with supraglottoplasty versus 80% without, p = 1.00). CONCLUSIONS We identified a group of infants with OSA with diverse comorbidities. There was a high rate of resolution. This data can assist with treatment planning and family counselling for infants with OSA. A prospective clinical trial is needed to better assess consequences of OSA in this age.
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Affiliation(s)
- Elliot Morse
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
| | - Nicola Pereira
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
| | - Katie Liu
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
| | - Haviva Veler
- Weill Cornell Medicine, Department of Pediatrics, 1305 York Avenue, New York, NY, 10065, USA.
| | - Alison Maresh
- Weill Cornell Medicine, Department of Otolaryngology-Head and Neck Surgery, 1305 York Avenue, New York, NY, 10065, USA.
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Chen J, Xu H, Li X. Von Mises stress peak (VMSP) and laryngomalacia severity score (LSS) are extremely useful in the selection of treatment for laryngomalacia. Eur Arch Otorhinolaryngol 2023; 280:3287-3293. [PMID: 36757513 DOI: 10.1007/s00405-023-07866-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To analyze the judgment efficiency of a computer stress model and severity score in severity evaluation and treatment plan selection of laryngomalacia patients. METHODS Twenty-two children (12 cases in the operation group and 10 cases in the follow-up group) with moderate to severe laryngomalacia were assessed by laryngomalacia severity score (LSS) which included visual analogue scale (VAS) and clinical score. A computer stress model of the laryngeal cavity was constructed for all children, with the von Mises stress peak (VMSP) of the model used as another quantitative evaluation method. The ROC curves of two quantitative evaluation methods, the LSS and the VMSP, were analyzed respectively, according to the clinical guideline which is regarded as the gold standard for judging whether surgery is needed. The diagnostic efficiency indexes such as sensitivity, specificity, and accuracy were calculated. The area under ROC curves (AUC) of the two methods were compared by a DeLong model. Spearman correlation analysis and Kappa test were used to test the correlation and consistency of the two quantitative evaluation methods. The independent sample t test was used to compare the difference of LSS and VMSP between operation group and follow-up group. RESULTS The sensitivity, specificity, and accuracy of LSS in judging whether laryngomalacia was operated or not were 83.33%, 80.00% and 81.82%, respectively, and the area under ROC curve (AUC) was 0.825 (p < 0.05). The sensitivity, specificity, and accuracy of the computer stress model for laryngomalacia were 58.33%, 90.00% and 72.73%, respectively, and the AUC was 0.796 (p < 0.05). The spearman correlation coefficient between LSS and VMSP was 0.833, p < 0.001, which is statistically significant. LSS (t = 3.251, p = 0.004) and VMSP (t = 2.435, p = 0.024) of the two groups were statistically different. CONCLUSION VMSP and LSS have high diagnostic efficacy in the quantitative evaluation of the severity of laryngomalacia and the selection of treatment plan. The consistency of the two quantitative evaluation methods is good, which has practical value for the evaluation of the severity of laryngomalacia and has guiding significance for surgery.
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Affiliation(s)
- Jiali Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China
| | - Hongming Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China
| | - Xiaoyan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, 355th Luding Road, Shanghai, 200062, People's Republic of China.
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A novel sleep oximetry scoring tool for pediatric laryngomalacia. Int J Pediatr Otorhinolaryngol 2022; 160:111220. [PMID: 35816969 DOI: 10.1016/j.ijporl.2022.111220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Despite being a more accessible and less resource intensive modality than polysomnography, the utility of sleep oximetry (SO) in pediatric laryngomalacia (LM) is not well understood or validated. We aimed to retrospectively evaluate the utility of overnight home based SO in children with LM by developing and internally validating the Modified Laryngomalacia Oximetry Score (MLOS) scoring system to triage severity and guide clinical decision making. METHODS We evaluated pediatric patients with a diagnosis of LM at our tertiary referral centre. Data from initial and post-treatment SO including mean oxygen saturation (spO2) nadir and mean oxygen desaturation index (ODI) were aggregated. The MLOS ranging from I-VI (inconclusive to severe) was created by two otolaryngologists to incorporate bradycardia associated desaturation events during SO. Corresponding McGill Oximetry Score (MOS) was also determined. RESULTS 172 patients were included in final analysis. The average age was 9.2 ± 14.3 months. 98 (57%) of patients were identified as Thompson severity score 1, and 87 (50.6%) of patients underwent supraglottoplasty. The surgical cohort had a significantly higher MLOS and MOS scores of 4 and 2 respectively, and higher mean ODI and spO2 nadir metrics. When evaluating post-supraglottoplasty SO tracings, all parameters improved significantly, including median MLOS score from 4 to 1. Only the mean ODI improved in the non-surgical cohort. Patients with Thompson severity score 2/3 had significantly higher MLOS. CONCLUSION We present a simple scoring system based on overnight SO, the MLOS, to help triage severity of pediatric LM and guide decision-making. MLOS is associated with worse clinical severity and a need for surgery, and shows significant improvement after surgery.
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Makhout S, Boudewyns A, Van Hoorenbeeck K, Verhulst S, Van Eyck A. Nocturnal pulse oximetry as a possible screening method for obstructive sleep apnea in infants with laryngomalacia. Sleep Med 2022; 90:91-95. [DOI: 10.1016/j.sleep.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Cialente F, Meucci D, Tropiano ML, Salvati A, Torsello M, Savignoni F, Landolfo F, Dotta A, Trozzi M. Changes in Breathing Patterns after Surgery in Severe Laryngomalacia. CHILDREN 2021; 8:children8121120. [PMID: 34943316 PMCID: PMC8700109 DOI: 10.3390/children8121120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
Background: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. Objective: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. Study design: A series of retrospective cases at a tertiary referral children’s hospital. Methods: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children’s Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3–6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student T-test. Results: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child’s age. Conclusions: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests.
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Affiliation(s)
- Fabrizio Cialente
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
- Correspondence:
| | - Duino Meucci
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Maria Luisa Tropiano
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Antonio Salvati
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Miriam Torsello
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Ferdinando Savignoni
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.S.); (F.L.); (A.D.)
| | - Francesca Landolfo
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.S.); (F.L.); (A.D.)
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.S.); (F.L.); (A.D.)
| | - Marilena Trozzi
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
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Ruda J, Pinto S, Allarakhia Z. Utility of polysomnography and video swallow studies in the management of pediatric patients with congenital idiopathic bilateral vocal fold dysfunction. Int J Pediatr Otorhinolaryngol 2020; 138:110273. [PMID: 32745788 DOI: 10.1016/j.ijporl.2020.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/25/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Congenital idiopathic bilateral vocal fold dysfunction (BVFD) is an uncommon cause of neonatal stridor and respiratory distress postnatally. Approximately 50% of affected neonates or infants will historically require tracheostomy for this condition. Timing and candidacy for tracheostomy in BVFD patients is often subjective and poorly understood. Polysomnography (PSG) and video swallow studies (VSS) may be helpful in the management of patients with BVFD prior to tracheostomy by quantifying their degree of upper airway obstruction during sleep and feeding dysfunction while awake. METHODS We performed a single-institution retrospective case series of BVFD patients from 2000 to 2018 who had postnatal PSGs performed prior to tracheostomy. Demographics, gestational age, and VSS results prior to PSG were recorded for all patients. Findings from PSGs included non-REM AHI, REM AHI, oxygen nadir, % total sleep time (TST) O2<90%, peak end-tidal (ET) CO2, % TST ETCO2 >52 torr. Rates of post-PSG tracheostomy, gastrostomy tube (G-tube) placement, and home O2 supplementation were noted for all patients. RESULTS From 2000 to 2018, 12/46 (26%) BVFD patients had postnatal PSGs performed prior to tracheostomy. Median patient age at BVFD diagnosis, VSS, and PSG was 5.5 days, 12.5 days, and 17.5 days, respectively. Mild, moderate, and severe obstructive sleep apnea (OSA) was found in 7/12, 3/12, and 4/12 patients, respectively. Hypercapnia (ETCO2 >52 torr) was found in 5/12 patients on PSG while hypoxemia (SpO2 <90% for >4% TST) was not found in any patient. VSS results demonstrated normal swallowing, inconsistent laryngeal penetration, and silent aspiration in 7/12, 2/12, and 3/12 patients, respectively. Tracheostomy and G-tube placement was performed in 3/12 and 2/12 patients, respectively. There was no association between the severity of OSA or any PSG abnormality, VSS findings, and the performance of tracheostomy in any BVFD patient. CONCLUSIONS OSA was found in all BVFD patients undergoing postnatal PSG at our institution while feeding dysfunction was found in approximately 50% of patients. The presence of feeding dysfunction, severe OSA, or any PSG abnormality was not individually associated with the subsequent performance of a tracheostomy in our patients. PSG is likely useful in supporting but not supplanting one's clinical decision-making in the management of patients with congenital idiopathic BVFD.
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Affiliation(s)
- James Ruda
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
| | - Swaroop Pinto
- Department of Pediatric Pulmonology and Sleep Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pulmonology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
| | - Zahir Allarakhia
- College of Medicine, The Ohio State University, Columbus, OH, USA.
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Verkest V, Verhulst S, Van Hoorenbeeck K, Vanderveken O, Saldien V, Boudewyns A. Prevalence of obstructive sleep apnea in children with laryngomalacia and value of polysomnography in treatment decisions. Int J Pediatr Otorhinolaryngol 2020; 137:110255. [PMID: 32896360 DOI: 10.1016/j.ijporl.2020.110255] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/05/2020] [Accepted: 07/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Children with laryngomalacia may present with obstructive sleep apnea (OSA). The role of polysomnography (PSG) in treatment decision making for laryngomalacia is not well defined. We aimed to investigate the prevalence of OSA in children with laryngomalacia and the role of PSG in treatment decision. METHODS Retrospective medical record review of children with laryngomalacia, confirmed by direct laryngoscopy, during a period of 3 years. Demographic data, presenting symptoms, severity classification, comorbidities and pre- and postoperative PSG data were retrieved and analyzed. Data are expressed as a median (25th - 75th percentile). RESULTS Forty-six patients were with diagnosed laryngomalacia between March 2016 and April 2019. A complete data set was available for 44 patients, 24 males and 20 females. The median age at the time of PSG was 12 weeks (6.3-29.8). Thirty-four children (77.4%) were diagnosed with concomitant OSA. A diagnosis of OSA changed the severity classification and treatment decision in 24 cases (54.5%). Twenty-three patients underwent supraglottoplasty, five patients were treated with continuous positive airway pressure (CPAP) and nine patients had both treatments. Seven patients received conservative treatment. The obstructive apnea/hypopnea index decreased from 8.9 events/hour (4.4-12.1) to 2.4 events/hour (1.5-4.4) after supraglottoplasty (p = 0.009). CONCLUSIONS A diagnosis of OSA was established in 77.4% of patients with larygomalacia The presence of OSA may increase the severity of symptoms in laryngomalacia, leading to a transition from watchful-waiting to active intervention with CPAP therapy or supraglottoplasty. Supraglottoplasty is a safe and effective surgical procedure for laryngomalacia. When performed in the setting of laryngomalacia with concomitant OSA, it also significantly improves OSA symptomatology.
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Affiliation(s)
- Valérie Verkest
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stijn Verhulst
- Department of Pediatrics, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kim Van Hoorenbeeck
- Department of Pediatrics, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Olivier Vanderveken
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vera Saldien
- Department of Anesthesiology, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - An Boudewyns
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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Cortes MC, Villamor P, de la Torre González C, Álvarez-Neri H. Complete polysomnographic parameters in infants with severe laryngomalacia prior to and after supraglottoplasty. Int J Pediatr Otorhinolaryngol 2019; 119:131-135. [PMID: 30708179 DOI: 10.1016/j.ijporl.2019.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laryngomalacia is the most common congenital laryngeal anomaly. Because of supraglottic prolapse, laryngomalacia may be associated with obstructive sleep apnea (OSA) and sleep disturbances. The effects of OSA and sleep disorders in children include failure to thrive, cognitive and behavioral disturbances, cardiovascular compromise, and an association with sudden infant death syndrome. OBJECTIVE To evaluate the presence of OSA and sleep disturbances in children with severe laryngomalacia through complete nocturnal polysomnography, as well as to establish the effects of supraglottoplasty in each of the polysomnographic parameters. RESULTS Nine infants with severe laryngomalacia were included, all with a complete polysomnographic study prior to and after supraglottoplasty. The average age was 5.5 months. All patients presented an Apnea-Hypopnea Index (AHI) within the range of severe OSA. After supraglottoplasty, a significant reduction in AHI was found, from 34.87 ± 20.34 to 9.44 ± 5.28 after surgery (p: 0.022). Additionally, sleep efficiency had a significant increase, from 21.4% to 56.29% of total sleep time (p: 0.0013). All patients presented a significant decrease in obstructive apnea episodes (p < 0.0001), as well as in hypopnea episodes (p: 0.0154). The mean and minimum peripheral oxygen saturation (SpO2) had a significant increase after supraglottoplasty from 88.2% to 94.09% (p: 0.0002), and from 81.01% to 89.33% (p < 0.0001), respectively. CONCLUSION Polysomnography (PSG) may provide better surgical sustenance in infants with severe laryngomalacia and OSA, as well as, serving as a monitoring tool of success. However, the surgical decision should not be reduced to polysomnographic results, and a good history and examination remain as the fundamental criteria.
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Affiliation(s)
- María Cristina Cortes
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Perla Villamor
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico.
| | | | - Hiram Álvarez-Neri
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
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Abstract
AbstractBackground:The advent of supraglottoplasty clearly has transformed the surgical management of severe laryngomalacia. The condition, however, generally runs a milder course, with spontaneous resolution the norm.Objectives:To identify gaps in the knowledge and identify topics for future study.Method:Systematic review of the literature.Results:The literature suggests that there is a range of abnormalities leading to the typical collapsing upper airway, and that neurological disease, other airway abnormalities, syndromes and gastroesophageal reflux all contribute to disease severity and influence outcomes. The procedures involved in supraglottoplasty are rarely specified, the indications for surgery are vaguely defined and the role of medical therapy is unclear.Conclusion:Every review article or survey of opinion suggests that there is still a marked variation in individual practice and a lack of consensus.
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