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05-10-2011 | Otolaryngology | Article

Supraglottoplasty feasible solution for pediatric obstructive sleep apnea


Free abstract

MedWire News: Infants with moderate to severe obstructive sleep apnea (OSA) arising from laryngomalacia (LM) may experience an improvement in symptoms after supraglottoplasty (SGP), according to study findings.

Furthermore, the use of polysomnography (PSG) may assist the identification of children who require this intervention and help to determine the level of benefit obtained postoperatively, say G Paul Digoy (Oklahoma University Health Sciences Center, Oklahoma City, USA) and team.

"In this study, PSG parameters improved in infants with LM and moderate to severe OSA after SGP. Infants with mild OSA (apnea-hypopnea index [AHI] <5) but severe LM did not show PSG improvement after SGP," add the authors in the International Journal of Pediatric Otorhinolaryngology.

Powitzky and colleagues recruited 20 children aged younger than 1 year with severe (n=11) or nonsevere (n=9) LM. Severe LM was defined as the presence of failure to thrive or evidence of respiratory distress on presentation. Nonsevere LM was defined as the presence of stridor or dysphagia, but no failure to thrive or respiratory distress.

Of note, infants with nonsevere LM had evidence of moderate to severe OSA, defined as AHI greater than or equal to 5.

All infants underwent PSG before and after SGP, during which AHI, oxygen saturation, and obstructive-apnea index values were measured.

Postoperatively, all infants had improvement or resolution of stridor, and three out of four patients with pre-operative dysphagia had an improvement in swallowing after surgery.

Overall, the median AHI value reduced significantly, by 6.4, after surgery compared with before surgery. This improvement in postoperative AHI values positively correlated with improvement in stridor severity in 80% of the infants.

The median obstructive-apnea index score showed significant improvement, by 2.9, after surgery compared with before surgery. And the number of infants with an oxygen saturation of less than 80% fell nonsignificantly from six pre-operatively to three postoperatively.

The authors note that although the infant's median AHI improved postoperatively, this change was due to improved AHI values among those with moderate to severe OSA, but not in those with severe LM.

Indeed, patients with a pre-operative AHI value less than 5 had a worsening of AHI value post-SGP.

Powitzky et al conclude: "The findings of this pilot study warrant a larger, prospective, and controlled study to further evaluate SGP as an effective and safe treatment of OSA."

By Lauretta Ihonor

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