Laryngeal pathologies as an etiologic factor of obstructive sleep apnea syndrome in children

Pinto, José Antônio; Kohler, Rodrigo; Wambier, Henrique; Gomes, Leonardo Marques; Mizoguchi, Elcio Izumi; Reis, Rodrigo Prestes dos

doi:10.1016/j.ijporl.2012.12.018

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…Laryngeal disease and anomalies have been proposed to have a causative role in OSA . Nevertheless, the physiopathologic role of the larynx in OSA has never been completely understood.…”

Section: Discussionmentioning

confidence: 99%

“…Laryngeal disease and anomalies have been proposed to have a causative role in OSA. 14,15 Nevertheless, the physiopathologic role of the larynx in OSA has never been completely understood. Following our observations and the findings in the literature, we might assume that reduction of the glottal space or lack of coordination between inspiration and glottal aperture may have a role in larynx-induced OSA.…”

Section: Discussionmentioning

confidence: 99%

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Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy

et al. 2015

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SUMMARYThis study aimed to evaluate the prevalence and the relationship of sleep breathing disorders (SBDs) and laryngeal motility alterations in patients with drug-resistant epilepsy after vagus nerve stimulator (VNS) implantation. Twenty-three consecutive patients with medically refractory epilepsy underwent out-of-center sleep testing before and after VNS implantation. Eighteen eligible subjects underwent endoscopic laryngeal examination post-VNS implantation. Statistical analysis was carried out to assess an association between laryngeal motility alterations and the onset/worsening of SBDs. After VNS implantation, 11 patients showed a new-onset mild/moderate SBD. Half of the patients already affected by obstructive sleep apnea (OSA) showed worsening of SBD. All of the patients with a new-onset OSA had a laryngeal pattern with left vocal cord adduction (LVCA) during VNS stimulation. The association between VNS-induced LVCA and SBD was statistically significant. This study suggests an association between VNS and SBD, hinting to a pivotal role of laryngeal motility alterations. The relationship between SBD and VNS-induced LVCA supports the need to routinely investigate sleep respiratory and laryngeal motility patterns before and after VNS implantation. KEY WORDS: Sleep breathing disorders, Drug-resistant epilepsy, Vocal cord dysfunction.Sleep breathing disorder (SBD) appearance in patients with epilepsy who are treated with vagus nerve stimulator (VNS) was first reported by Malow and colleagues and confirmed by other authors. [1][2][3][4][5][6][7][8] The mechanisms by which VNS can induce SBD are not clearly understood. A possible explanation is based on the effects on laryngeal muscles related to VNS. 9 The aim of this study is to evaluate the prevalence of SBD and laryngeal functional obstruction after VNS implantation in order to ascertain the correlation between these two clinical issues. Materials and Methods PatientsTwenty-three consecutive patients (16 female) were recruited from the Regional Epilepsy Centre of San Paolo Hospital, University of Milan, Italy. All of the patients were affected by drug-resistant epilepsy and were taking antiepileptic polytherapy. Patients' demographics and clinical characteristics are summarized in Table S1.All patients underwent an out-of-center sleep testing (OCST) before and after VNS implantation. All patients with sufficient collaboration (18 patients) underwent postimplantation awake endoscopic laryngeal examination.VNS stimulation parameters, body mass index (BMI), and epileptologic data for each patient are reported in Table S2. OCSTAll 23 patients underwent an OCST with a portable device, Embletta (Embla, Broomfield, CO, U.S.A.), which allows measurement of thoracic and abdominal respiratory 10 Respiratory events index (REI) was used to describe obstructive sleep apnea (OSA). REI equals the ratio between apnea and hypopnea events to reported total sleep time. An REI ≥5 was chosen to define clinically significant OSA.In addition, we analyzed variation of REI in the...

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“…Laryngeal disease and anomalies have been proposed to have a causative role in OSA . Nevertheless, the physiopathologic role of the larynx in OSA has never been completely understood.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy

et al. 2015

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“…Forty‐four studies were excluded for the following reasons: the number of patients undergoing polysomnography pre‐ and postsupraglottoplasty was not provided; no quantitative data for polysomnograms was provided; only adults were included; procedure(s) were performed in addition to the supraglottoplasty with no stratification of data for those who underwent isolated supraglottplasty; only preoperative data was available; some children were sedated with choral hydrate; the postoperative data was only available for a fraction of patients; portable pulse‐oximetry was used instead of formal polysomnography; or they were review articles …”

Section: Resultsmentioning

confidence: 99%

“…Forty-four studies were excluded for the following reasons: the number of patients undergoing polysomnography pre-and postsupraglottoplasty was not provided 43 ; no quantitative data for polysomnograms was provided 12,18,21,22,[24][25][26]28,29,[32][33][34][35][36][37][38][39]41,42,[44][45][46]49,51,53,54,56,58,61,64,66 ; only adults were included 19 ; procedure(s) were performed in addition to the supraglottoplasty with no stratification of data for those who underwent isolated supraglottplasty 27,50,63 ; only preoperative data was available 55 ; some children were sedated with choral hydrate 47 ; the postoperative data was only available for a fraction of patients 30 ; portable pulse-oximetry was used instead of formal polysomnography 31 ; or they were review articles. 40,52,62 Overall, there were a total of 138 patients (ages 1 month-12.6 years) with quantitative polysomnographic data who underwent isolated supraglottoplasty.…”

Section: Resultsmentioning

confidence: 99%

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Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta‐analysis

et al. 2015

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Objectives/Hypothesis: To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children.Study Design: Systematic review and meta-analysis. Methods: Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015.Results: A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) 6 standard deviation (SD) of 14.0 6 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 6 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M 6 SD of 84.8 6 8.4% (95% CI 82.8, 86.8) to 87.6 6 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M 6 SD of 20.4 6 23.9 (95% CI 12.8, 28.0) to 4.0 6 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M 6 SD of 74.5 6 11.9% (95% CI 70.9, 78.1) to 88.4 6 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data).Conclusion: Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured.

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Perioperative Care of Children with OSA

Bertolizio

Brown

2016

Anesthesia, Intensive Care and Pain in Neonates and Children

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Laryngeal pathologies as an etiologic factor of obstructive sleep apnea syndrome in children

Cited by 6 publications

References 7 publications

Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy

Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy

Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta‐analysis

Perioperative Care of Children with OSA

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