title: Polysomnography: assessment of decannulation readiness in chronic upper airway obstruction.
abstract: OBJECTIVE
  To evaluate the clinical value of polysomnography in patients with a tracheotomy due to chronic upper airway obstruction prior to attempting decannulation.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Subjects with chronic upper airway obstruction were identified using a clinical database between 2000 and 2014. All subjects had a tracheotomy, were assessed by the senior author in a tertiary care academic center, and underwent polysomnography prior to attempting decannulation. Patients were excluded if they did not undergo polysomnography or had severe obstructive sleep apnea as the primary indication for tracheotomy.
  
  
  RESULTS
  Fifteen patients were identified. The majority (87.5%) of patients were successfully decannulated after their first polysomnography showed acceptable results when carried out with the tracheotomy occluded. Obstructive sleep apnea was identified in four of the nine patients who tolerated overnight tracheotomy occlusion, and continuous positive airway pressure (CPAP) was initiated. An additional four of the remaining six patients were decannulated after subsequent polysomnography demonstrated improvement with CPAP, and two required an additional airway procedure.
  
  
  CONCLUSIONS
  Chronic upper airway obstruction requiring tracheotomy can be challenging to treat and successfully decannulate. Indirect laryngoscopy is essential to evaluate the anatomy of the larynx; however, it cannot assess potential increased obstruction during sleep. The study indicates that polysomnography can assist with the evaluation of decannulation readiness in patients with chronic upper airway obstruction as an adjunct measure in addition to imaging and laryngoscopy.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nikolaus E
authors.initials: NE
authors.lastname: Wolter
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D002908:Chronic Disease; D015331:Cohort Studies; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D011175:Positive-Pressure Respiration; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D014140:Tracheotomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Polysomnography; bilateral vocal cord paralysis; decannulation; laryngeal stenosis