Sleep Apnea in Children with Down Syndrome and Laryngomalacia: Objective Outcomes after Supraglottoplasty

Abstract

Objectives:

Examine the effect of supraglottoplasy in children who have Down Syndrome and findings suggestive of state-dependent laryngomalacia (SDL) on measures of obstructive sleep apnea syndrome (OSAS) including the number of obstructive events per hour, apnea hypopnea index (AHI), and the minimum oxygen saturation.

Setting:

Tertiary care children’s hospital. Study design: A retrospective review of 11 pediatric patients with DS, OSAS, and SDL between 2006 and 2012. The diagnosis of SDL was made via sleep endoscopy under light general anesthesia. All patients underwent pre- and postoperative polysomnography.

Results:

The number of obstructive events per hour (OAI) decreased following supraglottoplasy for 9 (82%, 95% CI: 48% to 98%) of the 11 patients, which was a statistically significant reduction in the number of events (P = 0.05). AHI and minimum oxygen desaturation was not statistically different after supraglottoplasty. Snoring improved or ceased in 60% of patients. Coughing associated with eating was worse in 2/10 patients postoperatively.

Conclusions:

Children with DS, OSAS, and SDL statistically improved after supraglottoplasty, though not in all measures. This response is less significant than in children without DS. Furthermore, this population may have increased risk of postoperative aspiration. Larger series in children with OSAS, SDL, and DS are needed to confirm these findings.