title: Sleep apnea in children with laryngomalacia: diagnosis via sedated endoscopy and objective outcomes after supraglottoplasty.
abstract: OBJECTIVE
  The authors study the contribution of laryngomalacia to obstructive sleep apnea syndrome (OSAS) in children older than 12 months. The clinical and polysomnographic outcomes in patients with OSAS who underwent a supraglottoplasty were also studied.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  A case series with chart review.
  
  
  METHODS
  A review of consecutive pediatric patients diagnosed with both OSAS and state-dependant laryngomalacia (SDL) between 2005 and 2008. The diagnosis of SDL was made via laryngoscopy under light general anesthesia (sleep endoscopy). All subjects underwent a supraglottoplasty.
  
  
  RESULTS
  A total of 43 patients met inclusion criteria, and 36 patients had complete pre- and postoperative data available for review. The apnea-hypopnea index (AHI) score decreased following supraglottoplasty for 33 (92%; 95% confidence interval [CI], 78%-98%) of the 36 patients. The mean (SD) change in AHI score (calculated as the postoperative minus the preoperative measure) was -9.2 (11.2), representing a statistically significant reduction (95% CI, -13.0 to -5.5; P < .0001). The mean (SD) preoperative AHI was 13.3 (12.9). The minimum oxygen saturation increased following supraglottoplasty for 21 (58%; 95% CI, 41%-74%). The mean (SD) change in the minimum oxygen saturation was 3.5 (8.3), which was a statistically significant increase (95% CI, 0.7-6.3; P = .015).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. Paul-Digoy@ouhsc.edu
authors.forename: G Paul
authors.initials: GP
authors.lastname: Digoy
authors.forename: Mohanad
authors.initials: M
authors.lastname: Shukry
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stoner
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D005931:Glottis / Q000601:surgery; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000175:diagnosis* / Q000601:surgery*; D007828:Laryngoscopy; D053685:Laser Therapy; D008297:Male; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen