Do the apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) in children with obstructive sleep apnea (OSA) improve following isolated supraglottoplasty for laryngomalacia?
Background: A subset of children with OSA has laryngomalacia, in which supraglottic tissue collapses and subsequently obstructs normal airflow, which can lead to inspiratory stridor. In congenital laryngomalacia (CL), patients have symptoms during wakefulness and sleep; in sleep exclusive laryngomalacia (SEL), the collapse occurs only during sleep. Studies have reported that supraglottoplasty has successfully treated or even cured OSA in patients with laryngomalacia.
Explore this issue:May 2016
Study design: Systematic review and meta-analysis of 13 case reports, case series studies, or case control studies through September 30, 2015, with a total of 138 patients.
Setting: Google Scholar, PubMed, Scopus, Embase, The Cochrane Library, Web of Science, Book Citation Index–Science, Cumulative Index to Nursing and Allied Health Literature and Conference Proceedings Citation Index–Science.
Synopsis: In the SEL group (64 patients), AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 to 3.3 ± 4.0 events/hour. The MD was 10.7 events/hour. The relative mean value reduction was 76.4%. A subanalysis using random effects modeling was performed, showing an AHI MD at -9.38 events/hour. Overall mean pre- and post-supraglottoplasty LSAT (M ± SD) scores in this group were 84.8% ± 8.4% and 87.6% ± 4.4%. In the subanalysis, the MD was 1.79 points. In the CL group (74 patients), AHI decreased from 20.4 ± 23.9 to 4.0 ± 4.5 events/hour. The MD was -16.4 events/hour, and the relative reduction was 80.4%. In the subanalysis, AHI MD was -8.78 events/hour. The overall mean pre- and post-supraglottoplasty LSAT scores were 74.5 ± 11.9% and 88.4 ± 6.6%. In the subanalysis, the MD was 12.18. Cure (AHI < one event/hour) was observed in two out of 19 patients with SEL and in 10 of 38 patients with CL. Several variables improved after supraglottoplasty, including postoperative weight for length percentile, stridor, and feeding difficulties postoperatively. Complications included a postoperative increase in coughing and throat clearing, dysphagia for greater than six months, and a need for revision supraglottoplasty or adenotonsillectomy to alleviate OSA. Limitations included a lack of pre- and/or postoperative polysomnograms for the most severe laryngomalacia and hypopnea scoring criteria differences.
Bottom line: Supraglottoplasty has improved AHI and LSAT in children with OSA and either SEL or CL; however, the majority of them are not cured, and additional research is needed.