Abstract
Objectives
To determine if supraglottoplasty is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea.
Methods
10 patients with laryngomalacia and obstructive sleep apnea as documented by polysomnography underwent supraglottoplasty at a tertiary referral children's hospital between 2005 and 2007. Retrospective data collection included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index (OAI), obstructive apnea/hypopnea index (OAHI), respiratory disturbance index (RDI), and low arterial oxygen saturation (O2 nadir) after supraglottoplasty. Pre- and postoperative mean data were calculated, and comparisons were made with a Student's T-test.
Results
All 10 patients were successfully extubated following supraglottoplasty. There were no perioperative or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed following supraglottoplasty at 11 weeks (range 2–29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow-up visit 4 weeks after hospital discharge. Marked improvements were observed in OAI, OAHI, RDI and O2 nadir, all of which were statistically significant (p<0.05).
Conclusions
Polysomnography should be included in the initial evaluation of infants with laryngomalacia to rule out obstructive sleep apnea. Supraglottoplasty is an effective treatment for infants with laryngomalacia and obstructive sleep apnea. The significant benefits of the procedure outweigh the low morbidity. Improvement after surgery can be reliably confirmed by polysomnography.
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