Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.
JAMA Otolaryngol Head Neck Surg. 2016 Jul 1;142(7):665-71. doi: 10.1001/jamaoto.2016.0830.
Surgical intervention is the main treatment alternative for patients with severe laryngomalacia. Supraglottoplasty offers effective treatment results not only for laryngomalacia but also for concurrent obstructive sleep apnea (OSA).
To quantify the objective outcomes of supraglottoplasty for laryngomalacia with OSA via polysomnography data in the pediatric population.
A comprehensive literature search of the PubMed database was performed on May 20, 2015, using the search terms supraglottoplasty, epiglottoplasty, aryepiglottoplasty, laryngomalacia, obstructive sleep apnea, Apnea-Hypopnea Index (AHI), children, and polysomnography. There were no date restrictions.
The literature search identified English-language studies that used polysomnography to evaluate patients with laryngomalacia and OSA after supraglottoplasty. Two reviewers screened titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis.
Numerical polysomnography data were extracted and compared among studies where appropriate. A fixed- or random-effects model was used, when appropriate, to analyze the data and calculate effect sizes.
Four studies were included in various subsets of the meta-analysis. After supraglottoplasty, the Apnea-Hypopnea Index (AHI) improved by a mean of 12.5 points in 4 studies (95% CI, -21.14 to -3.78; P = .005), oxygen saturation as measured by pulse oximetry nadir by 9.49 in 4 studies (95% CI, 4.87-14.12; P < .001), and Obstructive AHI by 21 points in 2 studies (95% CI, -50.3 to -8.29; P = .16). Twenty-nine of 33 children (88%) had residual disease. Patients 7 months and older had significant improvement in the AHI (P = .03).
Supraglottoplasty is an effective treatment modality for patients with laryngomalacia and OSA with objectively measurable benefits; however, patients will frequently have residual disease. Additional polysomnography after treatment is advised to ensure adequate resolution of the disorder.
手术干预是严重先天性喉软化症患者的主要治疗选择。杓状软骨成形术不仅对喉软化症，而且对并发阻塞性睡眠呼吸暂停（OSA）都有有效的治疗效果。
通过儿科人群多导睡眠图数据，定量评估杓状软骨成形术治疗伴阻塞性睡眠呼吸暂停的先天性喉软化症的客观结果。
2015 年 5 月 20 日，对 PubMed 数据库进行了全面的文献检索，使用的检索词包括杓状软骨成形术、会厌成形术、杓会厌成形术、先天性喉软化症、阻塞性睡眠呼吸暂停、呼吸暂停低通气指数（AHI）、儿童和多导睡眠图。未设置时间限制。
文献检索确定了使用多导睡眠图评估伴阻塞性睡眠呼吸暂停的先天性喉软化症患者的英文研究。两位审查员筛选了研究的标题和摘要。检查了研究的全文，以评估其与荟萃分析的相关性。
适当情况下，从研究中提取数值多导睡眠图数据并进行比较。在适当的情况下，使用固定或随机效应模型来分析数据并计算效应量。
荟萃分析的不同部分纳入了四项研究。杓状软骨成形术后，四项研究的呼吸暂停低通气指数（AHI）平均改善 12.5 分（95%CI，-21.14 至-3.78；P=0.005），四项研究的脉搏血氧饱和度最低值平均改善 9.49（95%CI，4.87-14.12；P<0.001），两项研究的阻塞性 AHI 平均改善 21 分（95%CI，-50.3 至-8.29；P=0.16）。33 名儿童中有 29 名（88%）有残留疾病。7 个月及以上的患儿 AHI 显著改善（P=0.03）。
杓状软骨成形术是治疗伴阻塞性睡眠呼吸暂停的先天性喉软化症患者的有效治疗方法，具有客观可测量的益处；然而，患者通常会有残留疾病。建议在治疗后进行额外的多导睡眠图检查，以确保疾病得到充分缓解。
