Love Harrison, Slaven James E, Mitchell Ryan M, Bandyopadhyay Anuja
Indiana University School of Medicine, 403 W. Vermont St. Apt 465, Indianapolis, IN, 46202, USA.
Department of Biostatistics, Indiana University, Indianapolis, IN, USA.
Int J Pediatr Otorhinolaryngol. 2020 Nov;138:110351. doi: 10.1016/j.ijporl.2020.110351. Epub 2020 Sep 1.
Obstructive sleep apnea (OSA) in young children is caused by upper airway obstruction and is associated with changes in cognitive development, temperament and behavior. Adenotonsillectomy (AT) is often utilized as first line therapy for pediatric OSA. Children with laryngomalacia (LM) have a high chance of residual OSA after AT. There is paucity of literature regarding surgically naïve young children with OSA and laryngomalacia. Our study aimed to compare demographics, comorbidities and outcomes associated with OSA in surgically naïve young children with and without laryngomalacia.
Retrospective chart review of surgically naïve young children (<2-year-old) with polysomnogram (PSG) diagnosed OSA. All young children underwent pre-operative PSG followed by drug-induced sleep endoscopy (DISE) directed intervention. Variables documented included demographics, comorbidities, history of adenotonsillectomy, DISE directed surgical interventions and pre and post PSG findings. Laryngomalacia was defined as presence of obstruction (Chan Parikh score ≥ 2) at the supraglottic level on DISE evaluation. Demographics and prevalence of comorbidities of those with and without LM were compared using t-test (continuous) and Chi Square (categorical). P value is significant for <0.05.
79 surgically naïve young children with PSG diagnosed OSA performed between 2015 and 2019 were included in the study. Children with LM were younger in age (11 months) and had a higher OSA-18 score (35) compared to children without LM (17 months) (OSA-18 score: 5). No significant difference was noted in the pre-DISE PSG parameters in the 2 groups. 56.1% of children with OSA and laryngomalacia did not need AT. Both children with and without laryngomalacia showed improvement in AHI on post-DISE PSG. Higher baseline AHI was associated with greater improvement in AHI.
Surgically naïve young children with OSA and LM present earlier than those without LM and report a significantly worse quality of life Young children with a higher baseline AHI were found to have greater improvement in severity of OSA post-DISE and surgical intervention. Majority of children with OSA and laryngomalacia did not need adenotonsillectomy after a preprocedural DISE assessment yet showed similar improvement in AHI. More studies are needed to determine which patients with OSA and laryngomalacia will need multilevel interventions.
幼儿阻塞性睡眠呼吸暂停（OSA）由上呼吸道阻塞引起，与认知发展、气质和行为的变化有关。腺样体扁桃体切除术（AT）常被用作小儿OSA的一线治疗方法。患有喉软化症（LM）的儿童在AT后残留OSA的可能性很高。关于未经手术治疗的OSA和喉软化症幼儿的文献较少。我们的研究旨在比较未经手术治疗的有和没有喉软化症的幼儿中与OSA相关的人口统计学、合并症和治疗结果。
对经多导睡眠图（PSG）诊断为OSA的未经手术治疗的幼儿（<2岁）进行回顾性病历审查。所有幼儿均在术前进行PSG检查，随后进行药物诱导睡眠内镜检查（DISE）指导下的干预。记录的变量包括人口统计学、合并症、腺样体扁桃体切除术史、DISE指导下的手术干预以及PSG检查前后的结果。喉软化症定义为在DISE评估中声门上水平存在阻塞（Chan Parikh评分≥2）。使用t检验（连续变量）和卡方检验（分类变量）比较有和没有LM的儿童的人口统计学和合并症患病率。P值<0.05具有统计学意义。
本研究纳入了2015年至2019年间79例经PSG诊断为OSA的未经手术治疗的幼儿。与没有LM的儿童（17个月）相比，患有LM的儿童年龄更小（11个月），OSA-18评分更高（35）（OSA-18评分：5）。两组在DISE前的PSG参数上没有显著差异。56.1%患有OSA和喉软化症的儿童不需要进行AT。有和没有喉软化症的儿童在DISE后的PSG上AHI均有改善。较高的基线AHI与AHI的更大改善相关。
未经手术治疗的患有OSA和LM的幼儿比没有LM的幼儿发病更早，生活质量明显更差。发现基线AHI较高的幼儿在DISE和手术干预后OSA严重程度有更大改善。大多数患有OSA和喉软化症的儿童在术前DISE评估后不需要进行腺样体扁桃体切除术，但AHI有类似改善。需要更多研究来确定哪些OSA和喉软化症患者需要多级干预。
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