Prevalence of obstructive sleep apnea in children with laryngomalacia and value of polysomnography in treatment decisions

Verkest, Valérie; Verhulst, Stijn; Hoorenbeeck, Kim Van; Vanderveken, Olivier M.; Saldien, Vera; Boudewyns, An

doi:10.1016/j.ijporl.2020.110255

Cited by 19 publications

(20 citation statements)

References 11 publications

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“…Despite these limitations, we conclude that (given the high prevalence of lower airway anomalies in this population [5,6,8]), the threshold for complete airway evaluation should be lower than in the general population (especially when other symptoms such as chronic cough, recurrent wheeze or stridor are present). A thorough pulmonary assessment of these children is still of utmost importance.…”

Section: Discussionmentioning

confidence: 82%

“…Airway anomalies such as laryngo-and tracheomalacia are also more common in children with DS compared to controls: Retrospective studies show the presence of one or multiple airway anomalies in over 70% of patients with DS who underwent endoscopic evaluation, which is significantly higher than in control populations [5][6][7]. Few data are available on the impact of these lower airway anomalies on OSA severity and treatment outcome in children with DS (where so many different factors contribute to the development of OSA); however, it seems plausible that these children present with more severe OSA, lower saturation, and/or more treatment failure [8].…”

Section: Introductionmentioning

confidence: 95%

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Obstructive Sleep Disorders in Down Syndrome’s Children with and without Lower Airway Anomalies

et al. 2021

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(1) Background: Obstructive sleep apnea (OSA) and lower airway anomalies are both highly prevalent in children with Down syndrome (DS). However, little is known on the interaction between both. We aim to investigate the co-occurrence of OSA (defined as obstructive apnea/hypopnea index (oAHI) ≥ 2/h) and lower airway anomalies in children with DS and explore their impact on OSA severity and treatment outcome. (2) Methods: Retrospective analysis of data from airway endoscopy and polysomnography (PSG) in a cohort of children with DS. (3) Results: Data on both lower airway evaluation and PSG were available for 70 patients with DS. Our study population was relatively young (mean age 3.5 years), not obese and presented with severe OSA (mean oAHI 13.1/h). Airway anomalies were found in 49/70 children (70%), most frequently laryngomalacia, tracheomalacia or a combined airway malformation. In the remaining 21 cases (30%), endoscopy was normal. A comparison between both groups showed a similar distribution of gender, age and BMI z-scores. The prevalence of OSA was not significantly higher in DS patients with airway anomalies (89.6% vs 71.4%, p = 0.078). Additionally, OSA severity or treatment choice (conservative, upper airway surgery or CPAP) were not significantly different. Follow-up data (available for 49/70 patients) showed a significant improvement of OSA in both groups. There is a not significant tendency to more patients with persistent OSA among those with lower airway anomalies (34.3% vs 7.1%, p = 0.075). (4) Conclusions: We found no significant differences in OSA severity, treatment choice or outcome between children with DS with and without lower airway anomalies. Further studies should investigate the role of DISE-directed treatment and compare the outcome of different treatment modalities in larger patient groups.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 95%

Obstructive Sleep Disorders in Down Syndrome’s Children with and without Lower Airway Anomalies

et al. 2021

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“…2,4 We suggest that the reason for a decreased tendency toward upper airway obstruction by age may be in part be due to the stiffening of epiglottal and laryngeal structures or to the disappearance of GERD-related upper airway mucosal swallowing. 6,29 We do not suppose that any of the treatment provided would have had a significant effect on natural improvement of OSA.…”

Section: Natural Evolution Of Upper Airway Obstruction In Infantsmentioning

confidence: 98%

Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement

Kukkola

Kirjavainen

2022

Pediatric Pulmonology

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Objectives The natural evolution of obstructive sleep apnea (OSA) in young infants is not established. Methods We re‐evaluated 10‐year pediatric sleep center infant polysomnography (PSG) data, excluding infants with syndromes, genetic defects, structural anomalies or periodic breathing > 5% of sleep time. Results Obstructive events > 1 h‐1 were evident in 255 infants, of which 91 were eligible for the study. Of the 38 infants in a follow‐up study, 30 (79%) were male, 15 (40%) were born prematurely, 25 (66%) had observed apneas, and 13 (33%) had experienced a brief, unexplained event or had a sibling of the infant died suddenly. The first PSG was performed at a median corrected age of 4 weeks (interquartile range [IQR] 2−7) and the second at 11 weeks (IQR 9−14). The obstructive apnea and hypopnea index (OAHI) was greater in the supine compared to side‐sleeping position in both recordings (p < 0.001), whereas OAHI dropped from 10 h‐1 (IQR 6−24) in the first PSG to 3 h‐1 (IQR 1−9) in the second PSG (p < 0.001). OSA alleviation was also observable as a decrease in the number of oxygen desaturations (p < 0.001), as a decrease in transcutaneous (p = 0.001) and end‐tidal carbon dioxide (p = 0.01) 95th percentile levels, and work of breathing (p = 0.002). Seven infants had a third PSG to verify a satisfactory improvement of OSA. Conclusions OSA in young infants without a clear syndrome or structural anomaly is sleep position dependent and shows improvement during the following few months.

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“…In these patients, the epiglottis can easily block the upper airway and cause apnea. Verkest et al [18] reported a 77% prevalence of OSA in children with laryngomalacia. The proposed mechanisms to date include 1) a delayed maturation or "hypotonia" of the supporting cartilaginous structures of the larynx; 2) redundant soft tissue in the supraglottis; and 3) a foreshortened or aryepiglottic fold [19][20][21].…”

Section: Underdevelopment Of the Epiglottismentioning

confidence: 99%

Epiglottic Collapse in Obstructive Sleep Apnea

Bae

Chung

2021

Sleep Med Res

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Along with the development of diagnostic techniques, many studies have been conducted to find the anatomical causes of obstructive sleep apnea (OSA). The velum, oropharynx, tongue base, and epiglottis have been widely considered to be the common obstruction sites. However, the role of the epiglottis in sleep apnea is poorly understood compared to the other anatomical sites. The epiglottis causes OSA either alone or simultaneously with other obstruction sites. We have here reviewed the epidemiology, pathophysiology, diagnosis, and treatment of epiglottic collapse in patients with OSA based on the literature published to date.

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Prevalence of obstructive sleep apnea in children with laryngomalacia and value of polysomnography in treatment decisions

Cited by 19 publications

References 11 publications

Obstructive Sleep Disorders in Down Syndrome’s Children with and without Lower Airway Anomalies

Obstructive Sleep Disorders in Down Syndrome’s Children with and without Lower Airway Anomalies

Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement

Epiglottic Collapse in Obstructive Sleep Apnea

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