Sleep Center, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, Chonburi Hospital, Chonburi, Thailand.
J Clin Sleep Med. 2021 Apr 1;17(4):767-777. doi: 10.5664/jcsm.9046.
Obstructive sleep apnea (OSA) and central sleep apnea (CSA) are common in infants with laryngomalacia. The purpose of this study was to evaluate developmental changes in sleep-related breathing disorders over time in infants with laryngomalacia and understand the effect of supraglottoplasty (SGP) and nonsurgical treatment.
This is a retrospective review of infants with laryngomalacia who had at least 2 diagnostic polysomnography studies performed from January 2000 and May 2015. We included infants who had either OSA or CSA. Comparison of sleep and respiratory parameters by age group (0-6, 6-12, and >12 months old) was performed in both SGP and non-SGP groups using a mixed-effect regression model. A log-normal mixed model was used to explore the changes in sleep and respiratory parameters with age. The time to resolution of CSA and OSA was analyzed using nonparametric survival analysis.
A total of 102 infants were included; 57 had only OSA and 45 had both CSA and OSA. There were significant decreases in apnea-hypopnea index, obstructive index, central apnea index, and arousal index with increasing age in both SGP and non-SGP groups. The mean age at resolution of CSA (central apnea index < 5) was 7.60 months old for SGP and 12.57 months old for non-SGP (P < .05). There were no significant differences in the mean age at resolution of OSA (obstructive index < 1; 35.18 [SGP] vs 41.55 months [non-SGP]; P = .60) between SGP and non-SGP groups. Infants with neurologic disease, congenital anomalies, or genetic syndromes required significantly more time to resolve OSA (28.12 [normal] vs 53.13 [neurological] vs 59.53 months [congenital anomalies and genetic]; P < .01).
Both OSA and CSA improve in infants with laryngomalacia with increasing age regardless of SGP. The mechanism underlying these changes may involve airway growth and maturation of respiratory control. Time to resolution of OSA is affected by the presence of neurologic diseases, congenital anomalies, and genetic syndromes. Further studies are needed to confirm these findings and to evaluate long-term outcomes in this population.
在患有喉软化症的婴儿中，阻塞性睡眠呼吸暂停（OSA）和中枢性睡眠呼吸暂停（CSA）很常见。本研究的目的是评估喉软化症婴儿随时间推移的睡眠相关呼吸障碍的发展变化，并了解杓状软骨成形术（SGP）和非手术治疗的效果。
这是一项回顾性研究，纳入了 2000 年 1 月至 2015 年 5 月期间至少进行了 2 次诊断性多导睡眠图检查的喉软化症婴儿。我们纳入了患有 OSA 或 CSA 的婴儿。通过混合效应回归模型比较了 SGP 和非 SGP 组中不同年龄组（0-6 个月、6-12 个月和>12 个月）的睡眠和呼吸参数。使用对数正态混合模型来探讨睡眠和呼吸参数随年龄的变化。使用非参数生存分析来分析 CSA 和 OSA 缓解的时间。
共纳入 102 例婴儿，其中 57 例仅患有 OSA，45 例同时患有 CSA 和 OSA。在 SGP 和非 SGP 组中，随着年龄的增长，呼吸暂停低通气指数、阻塞指数、中枢性呼吸暂停指数和觉醒指数均显著下降。CSA（中枢性呼吸暂停指数<5）缓解的平均年龄在 SGP 组为 7.60 个月，在非 SGP 组为 12.57 个月（P<.05）。SGP 和非 SGP 组中 OSA（阻塞指数<1）缓解的平均年龄（35.18[SGP]与 41.55 个月[非 SGP]；P=.60）之间无显著差异。患有神经疾病、先天性异常或遗传综合征的婴儿需要更长的时间才能缓解 OSA（28.12[正常]与 53.13[神经]与 59.53 个月[先天性异常和遗传]；P<.01）。
无论是否接受 SGP，患有喉软化症的婴儿的 OSA 和 CSA 均随年龄增长而改善。这些变化的机制可能涉及气道生长和呼吸控制的成熟。OSA 缓解的时间受神经疾病、先天性异常和遗传综合征的影响。需要进一步的研究来证实这些发现，并评估该人群的长期结局。
