title: Changes in sleep apnea after supraglottoplasty in infants with laryngomalacia.
abstract: OBJECTIVE
  To determine the clinical and polysomnography outcomes in infants with laryngomalacia undergoing supraglottoplasty.
  
  
  METHODS
  Infants (<1 year old) who underwent polysomnography pre- and post-supraglottoplasty at our tertiary referral center between 2003 and 2009 were reviewed retrospectively. Outcome measures included changes in stridor, sleep disordered breathing, swallowing, and polysomnography parameters before and after surgery. Pre- and postoperative distributions were compared using a Wilcoxon signed-rank test.
  
  
  RESULTS
  20 children met inclusion criteria. Statistically significant improvements were found in pre- to postoperative median values for apnea-hypopnea index (AHI) (median change: -6.4 points, p=0.02) and obstructive apnea index (median change: -2.9 points, p=0.01) values. Obstructive AHI, O₂ saturation nadir, and percentage of sleep spent with <90% O₂ saturation improved, although not significantly. Postoperative AHI scores correlated with improvements in stridor in 80% of patients. Stratification showed similar improvements in AHI after supraglottoplasty regardless of reflux treatment, secondary airway lesions, age at supraglottoplasty, or time lag between supraglottoplasty and postoperative polysomnography. Secondary airway lesions are the only potential confounders shown to have significantly better improvements in O₂ nadir. While the sleep study improved in patients with AHI >5, infants with AHI <5 had worse polysomnography parameter values postoperatively. Five patients had dysphagia that resolved within one month postoperatively; otherwise, supraglottoplasty resulted in no complications.
  
  
  CONCLUSIONS
  Supraglottoplasty may be an effective and safe option to improve moderate to severe obstructive sleep apnea in infants with laryngomalacia. In addition, polysomnography may be useful in infants with laryngomalacia to identify obstructive sleep apnea and/or to objectively measure outcomes after supraglottoplasty. This pilot study warrants a larger, prospective, and controlled study to validate these findings.
authors.affiliation: Oklahoma University Health Science Center, Oklahoma City, OK, USA. rosser-powitzky@ouhsc.edu
authors.forename: Rosser
authors.initials: R
authors.lastname: Powitzky
authors.forename: Julie
authors.initials: J
authors.lastname: Stoner
authors.forename: Tyson
authors.initials: T
authors.lastname: Fisher
authors.forename: G Paul
authors.initials: GP
authors.lastname: Digoy
mesh_terms: D001193:Arytenoid Cartilage / Q000601:surgery*; D003413:Cricoid Cartilage / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000150:complications / Q000601:surgery*; D007828:Laryngoscopy; D008297:Male; D017286:Polysomnography; D020545:Respiratory Mucosa / Q000601:surgery; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome