Incidence and Risk Factors for Central Sleep Apnea in Infants with Laryngomalacia

Abstract

Objectives:

Identify the incidence of and risk factors for central sleep apnea in infants diagnosed with laryngomalacia.

Methods:

We conducted a retrospective study in infants with laryngomalacia. All infants had diagnostic polysomnography (PSG) performed during 2003-2012. Infants who underwent supraglottoplasty or other upper airway surgery prior to PSG were excluded. Central sleep apnea (CSA) was defined as central apnea index ≥ 5. Demographic data, underlying diseases, and PSG data were reviewed and analyzed.

Results:

Fifty-four patients met the inclusion criteria. The mean age at the date PSG was performed was 3.35±2.69 months. The incidence of central sleep apnea in infants with laryngomalacia was 46.30%. There was a significantly higher incidence of CSA in patients with the following conditions: underlying neurologic disease or hypotonia (61.11% vs. 38.89%, P = 0.0029), premature infants (62.5% vs. 43.48%, P = 0.0045), history of apparent life threatening events (66.67% vs. 42.22%, P = 0.0006), and age less than 3 months (54.84% vs. 34.78%, P = 0.0068). Severity of obstructive sleep apnea, history of gastroesophageal reflux, pulmonary disease, and symptom severity were not significantly associated with increased risk for CSA. Analysis of sleep architecture revealed a decrease in total sleep time (345.38 ± 70.61 minutes vs. 393.45 ± 68.25 minutes, P = 0.02) and sleep efficiency (67.69 ± 8.93% vs. 75.22 ± 9.28%, P = 0.004) in the CSA group.

Conclusions:

Central sleep apnea is relatively common in infants with laryngomalacia, especially in high risk groups as described above. The presence of CSA can lead to alteration in sleep architecture. In addition to clinical evaluation, polysomnography may be warranted for the evaluation of infants with laryngomalacia and associated complex medical conditions.