Prognosis of airway obstruction and feeding difficulty in the Robin sequence

Smith, Mark C.; Senders, Craig W

doi:10.1016/j.ijporl.2005.07.003

Cited by 101 publications

(101 citation statements)

References 13 publications

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“…A PSG is indicated whenever the clinical evaluation is suggestive of sleep-disordered breathing, particularly in infants with risk factors for OSA including craniofacial abnormalities, prematurity, obesity, neurological disorders, and genetic conditions. Of considerable importance is the observation that many infants with micrognathia and OSA do not snore, thus necessitating routine polysomnography (119,120). A followup polysomnogram after treatment is recommended in infants with moderate to severe OSA, craniofacial abnormalities, or neurological disorders (118).…”

Section: Diagnosismentioning

confidence: 99%

“…We recommend continuous pulse oximetry monitoring of all infants placed prone. Positional therapy was successful by clinical report in improving airway obstruction in 72% of infants with nonsyndromic PRS and 50% of infants with syndromic PRS (120). However, the observation that micrognathic infants with OSA may be relatively silent during apnea mandates that comprehensive polysomnography be used to verify improvement (119,120).…”

Section: Medical Therapymentioning

confidence: 99%

“…Positional therapy was successful by clinical report in improving airway obstruction in 72% of infants with nonsyndromic PRS and 50% of infants with syndromic PRS (120). However, the observation that micrognathic infants with OSA may be relatively silent during apnea mandates that comprehensive polysomnography be used to verify improvement (119,120). Approximately one-third of infants with PRS who fail to respond sufficiently to positional therapy will respond to nasopharyngeal airway intubation (120).…”

Section: Medical Therapymentioning

confidence: 99%

“…However, the observation that micrognathic infants with OSA may be relatively silent during apnea mandates that comprehensive polysomnography be used to verify improvement (119,120). Approximately one-third of infants with PRS who fail to respond sufficiently to positional therapy will respond to nasopharyngeal airway intubation (120). A standard 3.0-or 3.5-sized endotracheal tube placed transnasally to the level of the hypopharynx is used to stent open the airway, thus alleviating OSA.…”

Section: Medical Therapymentioning

confidence: 99%

“…The mean duration of tracheostomy placement in infants with OSA is 17 months in nonsyndromic children with PRS, and 32 months in syndromic children with PRS (120). Most infants undergoing tracheostomy will have a resolution of their OSA after mandibular growth during this interval (120).…”

Section: Surgical Therapymentioning

confidence: 99%

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Obstructive Sleep Apnea in Infants

Katz

Mitchell

D’Ambrosio

2012

Am J Respir Crit Care Med

219

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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Section: Diagnosismentioning

confidence: 99%