title: Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis.
abstract: OBJECTIVE
  To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA.
  
  
  METHODS
  The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities.
  
  
  RESULTS
  Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166).
  
  
  CONCLUSIONS
  Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.
authors.affiliation: Speech Language Pathologist, Child Developmental Assessment and Intervention Center, Taipei City Hospital, Taipei, Taiwan, ROC.
authors.forename: Chia-Fan
authors.initials: CF
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Hsu
authors.affiliation: Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC.
authors.forename: Chia-Hsuan
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan, ROC. Electronic address: lightpool2010@gmail.com.
authors.forename: Ming-Tzer
authors.initials: MT
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC. Electronic address: kang.kuntai@msa.hinet.net.
authors.forename: Kun-Tai
authors.initials: KT
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004825:Epiglottis / Q000601:surgery*; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000150:complications / Q000601:surgery*; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D011184:Postoperative Period; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Child; Epiglottoplasty; Laryngomalacia; Polysomnography; Sleep apnea syndromes; Supraglottoplasty