Sleep Apnea in Children with Laryngomalacia

Digoy, G. Paul; Shukry, Mohanad; Stoner, Julie A.

doi:10.1177/0194599812446903

Cited by 50 publications

(20 citation statements)

References 24 publications

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“…In a surgical series of children older than 1 year with both SDB and LM by Digoy et al, 5 there was a statistically significant improvement in apnea-hypopnea index and minimum oxygen saturation on PSG following supraglottoplasty as well as subjective symptom improvement in the majority of children.…”

Section: Discussionmentioning

confidence: 89%

“…[4][5][6][7][8][9] Researchers have also proposed that LM may be state dependent, manifesting only during sleep or precipitated by exercise. 7,[10][11][12][13] Concomitantly, some series have gone on to report the success of supraglottoplasty in alleviating symptoms in these atypical situations 4,5,8,9 We have noticed that large series reporting presenting features have focused on classic LM and excluded older children and atypical presentations. 14,15 Therefore, to our knowledge, there are no large studies that document the distribution of these presentations and the characteristics of these subgroups within a large population of children diagnosed as having LM.…”

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confidence: 99%

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Primary Presentations of Laryngomalacia

Cooper

Benoît

Erickson

et al. 2014

JAMA Otolaryngol Head Neck Surg

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Section: Discussionmentioning

confidence: 89%

mentioning

confidence: 99%

Primary Presentations of Laryngomalacia

Cooper

Benoît

Erickson

et al. 2014

JAMA Otolaryngol Head Neck Surg

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“…There are several features of DS that may increase risk for sleep-disordered breathing including decreased pharyngeal muscle tone, retroglossia, macroglossia, midfacial hypoplasia, lymphoid hyperplasia, and high BMI [6]. Commonly identified sites of obstruction include the lingual tonsils, tongue base and the supraglottis, none of which can be seen on direct physical exam, but all of which can be corrected surgically [19–20].…”

Section: Discussionmentioning

confidence: 99%

Does drug induced sleep endoscopy-directed surgery improve polysomnography measures in children with Down Syndrome and obstructive sleep apnea?

Akkina

Cheng

Kirkham

et al. 2018

Acta Oto-Laryngologica

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Background: Children with Down Syndrome (DS) and obstructive sleep apnea (OSA) are difficult to treat, as first line therapies may not lead to significant improvement. Drug-induced sleep endoscopy (DISE) directed surgery may be particularly beneficial for these patients. Objective: To assess change in polysomnography (PSG) measures of patients with DS who underwent DISE-directed surgery. Methods: Retrospective chart review was performed on patients with DS who underwent DISE-directed surgery and had pre- and post-surgery PSG. Patients were analyzed in groups defined by previous adenotonsillectomy. Two-sided t-tests with equal variances were used to assess statistical significance. Results: Of 24 patients reviewed, 14 were surgically naïve and 10 had undergone prior adenotonsillectomy. The primary outcome was change in PSG parameters including apnea hypopnea index, obstructive apnea hypopnea index, oxygen nadir, oxygen desaturation index, and mean carbon dioxide level. While improvement was seen in all PSG parameters, only improvement in oxygen nadir in children who had undergone prior adenotonsillectomy was statistically significant (88.5% to 90.9%, p = 0.04). Conclusions and Significance: DISE-directed surgery may be beneficial for children with DS and OSA, with improvement in the means of main PSG measures observed. A larger, prospective study is warranted to further explore DISE utility.

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“…Secondary analysis showed that for patients with laryngomalacia, there was no significant difference in effect if the surgery was performed as a primary intervention or secondarily after another type of airway surgery, such as AT [ 51 ]. Digoy et al reported postoperative coughing and dysphagia [ 52 ]. These studies suggest that supraglottoplasty is an effective treatment for patients with underlying laryngomalacia, although it is still not 100% effective [ 51 ].…”

Section: Surgical Proceduresmentioning

confidence: 99%

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

et al. 2020

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Continuous positive airway pressure (CPAP) is considered first-line treatment in the management of pediatric patients without a surgically correctible cause of obstruction who have confirmed moderate-to-severe obstructive sleep apnea (OSA). The evidence supports its reduction on patient morbidity and positive influence on neurobehavioral outcome. Unfortunately, in clinical practice, many patients either refuse CPAP or cannot tolerate it. An update on alternative approaches to CPAP for the management of OSA is discussed in this review, supported by the findings of systematic reviews and recent clinical studies. Alternative approaches to CPAP and adenotonsillectomy for the management of OSA include weight management, positional therapy, pharmacotherapy, high-flow nasal cannula, and the use of orthodontic procedures, such as rapid maxillary expansion and mandibular advancement devices. Surgical procedures for the management of OSA include tongue-base reduction surgery, uvulopalatopharyngoplasty, lingual tonsillectomy, supraglottoplasty, tracheostomy, and hypoglossal nerve stimulation. It is expected that this review will provide an update on the evidence available regarding alternative treatment approaches to CPAP for clinicians who manage patients with pediatric OSA in daily clinical practice.

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Sleep Apnea in Children with Laryngomalacia

Abstract: Laryngomalacia may contribute significantly to OSAS in some children who are 12 months and older. Sleep endoscopy appears to be an effective method in the diagnosis of SDL. When present, a supraglottoplasty can be an effective procedure and may significantly improve symptoms of OSAS.

Cited by 50 publications

References 24 publications

Primary Presentations of Laryngomalacia

Primary Presentations of Laryngomalacia

Does drug induced sleep endoscopy-directed surgery improve polysomnography measures in children with Down Syndrome and obstructive sleep apnea?

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

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