Literature Review: A Roundup of Important Recent Studies

• Observation, T&A Common Interventions for Obstructive Sleep Events in Infants
• CT, MRI Not Useful for Evaluation of ED Patients with Dizziness
• Combined Use of EEA and TORS Effective for Skull Base Surgery
• Cartilaginous Tissue Regeneration with Bioengineered Trachea

Observation, T&A Common Interventions for Obstructive Sleep Events in Infants

What types of nonsurgical and surgical interventions are commonly used for obstructive sleep events in infants?

Background: Previous studies suggest that infants are particularly vulnerable to obstructive sleep events and may have an increased predilection for more severe obstructive sleep apnea (OSA). Both nonsurgical and surgical interventions are used to treat pediatric OSA. Although polysomnography (PSG) is the standard for OSA diagnosis, there is still debate regarding diagnostic criteria and severity grading in infants.

Study design: Retrospective medical record review of patients aged three to 24 months at the time of diagnosis of OSA by PSG.

Setting: Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center.

Synopsis: A total of 295 patients met inclusion criteria (196 males, 99 females). Medical records were analyzed for the duration of their care in the otolaryngology/pulmonary clinics after diagnosis, including interventions/outcomes occurring after age 24 months. In general, as OSA severity increased, there was a concomitant increase in the percentage of patients with abnormal arousal index and oxygen desaturation. Gastroesophageal reflux disease (GERD) was the most common comorbidity, followed by recurrent otitis media/Eustachian tube dysfunction. Congenital syndromes were diagnosed in 38 patients, with Down syndrome the most common. A total of 364 interventions were performed, with some infants undergoing more than one. The most frequent: for mild OSA, observation, adenotonsillectomy (T&A) and adenoidectomy; for moderate OSA, T&A adenoidectomy and observation; for severe OSA, T&A, adenoidectomy and supplemental O2. Data showed that, subjectively, T&A was the most effective intervention, while supplemental O2 was the least. Limitations included the fact that only 105 interventions could be assessed for objective efficacy and that the relatively low cure rate is likely a poor representation of true efficacy due to infrequent post-intervention PSGs.

Bottom line: Observation was the most common nonsurgical intervention and the most common intervention in patients younger than 12 months, while T&A was the most common surgical and overall intervention and had the greatest subjective efficacy.

Citation: Robison JG, Wilson C, Otteson TD, Chakravorty SS, Mehta DK. Analysis of outcomes in treatment of obstructive sleep apnea in infants. Laryngoscope. 2013;123:2306-2314.