Supraglottoplasty for occult laryngomalacia to improve obstructive sleep apnea syndrome

Abstract

Objective: To evaluate the polysomnographic outcomes after supraglottoplasty (SGP) performed for obstructive sleep apnea syndrome (OSAS) associated with occult laryngomalacia.

Design: Retrospective case series with medical chart review.

Setting: Tertiary pediatric medical center.

Patients: Twenty-two patients aged 2 to 17 years met the inclusion criteria of polysomnography-proven OSAS and occult laryngomalacia seen on flexible fiber-optic sleep endoscopy. Infants with congenital laryngomalacia were excluded.

Intervention: Carbon dioxide laser SGP was performed either alone or in conjunction with other operations for OSAS.

Main outcome measure: Preoperative and postoperative nocturnal polysomnographic data were paired and analyzed statistically.

Results: Supraglottoplasty for occult laryngomalacia resulted in statistically significant reduction in the apnea-hypopnea index (AHI) (from 15.4 to 5.4) (P <.001). Subgroup analysis of children who underwent either SGP alone or in combination with other interventions showed comparable reductions in AHI. Medical comorbidities were associated with worsened postoperative outcomes, although still significantly improved compared with baseline. Overall, 91% of children had an improvement in AHI, and 64% had only mild or no residual OSAS after SGP.

Conclusion: Supraglottoplasty is an effective technique for the treatment of OSAS associated with occult laryngomalacia.