Objective assessment of supraglottoplasty outcomes using polysomnography

O’Connor, Tony; Bumbak, Paul; Vijayasekaran, Shyan

doi:10.1016/j.ijporl.2009.05.007

Cited by 44 publications

(69 citation statements)

References 16 publications

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“…Previous studies have shown that supraglottoplasty is effective in the treatment of infants [15,21,22] and school-aged children [18] with laryngomalacia and OSAS, as was also seen in our patient population. Our study furthers the description of late-onset laryngomalacia, as our larger numbers (19) and identification of patients prior to empiric adenotonsillectomy allowed for improved assessment of the true presenting features of these patients and how they compare to the presentation of patients without laryngomalacia.…”

Section: Discussionsupporting

confidence: 83%

“…In these patients, laryngomalacia, with its tell-tale stridor, is often diagnosed first, with subsequent polysomnography being used to demonstrate the resulting obstructive sleep apnea and to prompt the intervention of supraglottoplasty for treatment. Zafereo et al [21], O'Connor et al [22] and Pereira Valera et al [15] have reported statistically significant improvements in polysomnography parameters, to include respiratory distress index [15,21,22] and lowest oxygen saturation levels, [21,22] in patients who underwent supraglottoplasty as a treatment for moderate to severe laryngomalacia. These studies and their results can be correlated with Group A in this study where the most common symptoms were stridor (71%) and apnea (71%), most patients were of normal weight, no patients had adenotonsillar hypertrophy, and supraglottoplasty was an effective treatment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Late-onset laryngomalacia: A cause of pediatric obstructive sleep apnea

Revell

Clark

2011

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Late-onset laryngomalacia: A cause of pediatric obstructive sleep apnea

Revell

Clark

2011

International Journal of Pediatric Otorhinolaryngology

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“…Indications for surgery in this group can be more ambiguous, and PSG may play an important role in the decision making process for some of these patients [3]. While the accuracy of subjective caregiver reports and clinical assessment by physicians in predicting sleep apnea in children is unclear [11,12], PSG is an effective ''gold standard'' in identifying and quantifying sleep apnea and may provide valuable information in the workup of infants with moderate LM [2,13]. In this study, nine children with a non-severe LM were found to have moderate or severe OSA and subsequently underwent a SGP.…”

Section: Discussionmentioning

confidence: 99%

Changes in sleep apnea after supraglottoplasty in infants with laryngomalacia

Powitzky¹,

Stoner²,

Fisher³

et al. 2011

International Journal of Pediatric Otorhinolaryngology

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“…However, approximately 20% of infants with laryngomalacia will have severe OSA, hypoxemia, or failure to thrive, and may require surgical therapy. Supraglottoplasty has been reported to reduce obstructive events, increase the total sleep time, and improve oxygen saturation (29,30). Although infants usually improve after supraglottoplasty, considerable residual OSA may remain (29,30), particularly with comorbid conditions including micrognathia, neuromuscular disease, tracheomalacia, or tonsillar hypertrophy (31, 32).…”

Section: Congenital and Acquired Airway Abnormalitiesmentioning

confidence: 99%

“…Surgical management of laryngomalacia in infants with OSA has evolved away from tracheotomy in favor of supraglottoplasty, using endoscopic techniques, resulting in reduced morbidity and resolution of OSA in the majority of infants (29,30). A supraglottoplasty includes incising the aryepiglottic folds to release the epiglottis, removing redundant soft tissue overriding the accessory cartilages, and removing the lateral edges of the epiglottis.…”

Section: Surgical Therapymentioning

confidence: 99%

Obstructive Sleep Apnea in Infants

Katz

Mitchell

D’Ambrosio

2012

Am J Respir Crit Care Med

208

224

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Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities; including a superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability. Congenital abnormalities of the airway, such as laryngomalacia, hemangiomas, pyriform aperture stenosis, choanal atresia, and laryngeal webs, may also have adverse effects on airway patency. Additional exacerbating factors predisposing infants toward airway collapse include neck flexion, airway secretions, gastroesophageal reflux, and sleep deprivation. Obstructive sleep apnea in infants has been associated with failure to thrive, behavioral deficits, and sudden infant death. The proper interpretation of infant polysomnography requires an understanding of normative data related to gestation and postconceptual age for apnea, arousal, and oxygenation. Direct visualization of the upper airway is an important diagnostic modality in infants with obstructive apnea. Treatment options for infant obstructive sleep apnea are predicated on the underlying etiology, including supraglottoplasty for severe laryngomalacia, mandibular distraction for micrognathia, tonsillectomy and/or adenoidectomy, choanal atresia repair, and/or treatment of gastroesophageal reflux.Keywords: sleep-disordered breathing; adenotonsillar hypertrophy; craniofacial; micrognathia; laryngomalacia Infants experience a wide range of sleep-disordered breathing patterns, including periodic breathing (1), apnea of prematurity (2), and central apnea, but little attention has been given to obstructive sleep apnea (OSA). Infants are particularly vulnerable to obstructive sleep-disordered breathing related to their upper airway structure (3), adverse pulmonary mechanics (4), ventilatory control (5), arousal threshold (6), laryngeal chemoreflex (7), and an REM-predominant sleep state distribution (8). The anatomical and physiological predispositions toward airway obstruction in infants are summarized in Table 1. Airway collapse may occur passively related to the balance between the viscoelastic properties of the pharynx, pharyngeal dilators, and the transmural pressure. Alternatively, obstructive apnea may result from active glottic closure, termed the laryngeal chemoreflex. The diagnosis of OSA in infants is confirmed by polysomnography and the etiology is often determined via direct endoscopic visualization of the airway. Infants with severe OSA will often have marked hypoxemia or sleep fragmentation, which is likely to result in considerable morbidity. As such, successful therapy is mandatory, even if this requires invasive treatment including nasopharyngeal tubes, continuous positive airway pressure (CPAP), supraglottoplasty, or even tracheostomy. This review focuses on the clinical features, polysomnographic patterns, pathogenesis, diagnosis, and mana...

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Objective assessment of supraglottoplasty outcomes using polysomnography

Cited by 44 publications

References 16 publications

Late-onset laryngomalacia: A cause of pediatric obstructive sleep apnea

Late-onset laryngomalacia: A cause of pediatric obstructive sleep apnea

Changes in sleep apnea after supraglottoplasty in infants with laryngomalacia

Obstructive Sleep Apnea in Infants

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