Division of Otolaryngology-Head and Neck Surgery, Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Division of Otolaryngology-Head and Neck Surgery, Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Int J Pediatr Otorhinolaryngol. 2022 Sep;160:111220. doi: 10.1016/j.ijporl.2022.111220. Epub 2022 Jul 4.
Despite being a more accessible and less resource intensive modality than polysomnography, the utility of sleep oximetry (SO) in pediatric laryngomalacia (LM) is not well understood or validated. We aimed to retrospectively evaluate the utility of overnight home based SO in children with LM by developing and internally validating the Modified Laryngomalacia Oximetry Score (MLOS) scoring system to triage severity and guide clinical decision making.
We evaluated pediatric patients with a diagnosis of LM at our tertiary referral centre. Data from initial and post-treatment SO including mean oxygen saturation (spO2) nadir and mean oxygen desaturation index (ODI) were aggregated. The MLOS ranging from I-VI (inconclusive to severe) was created by two otolaryngologists to incorporate bradycardia associated desaturation events during SO. Corresponding McGill Oximetry Score (MOS) was also determined.
172 patients were included in final analysis. The average age was 9.2 ± 14.3 months. 98 (57%) of patients were identified as Thompson severity score 1, and 87 (50.6%) of patients underwent supraglottoplasty. The surgical cohort had a significantly higher MLOS and MOS scores of 4 and 2 respectively, and higher mean ODI and spO2 nadir metrics. When evaluating post-supraglottoplasty SO tracings, all parameters improved significantly, including median MLOS score from 4 to 1. Only the mean ODI improved in the non-surgical cohort. Patients with Thompson severity score 2/3 had significantly higher MLOS.
We present a simple scoring system based on overnight SO, the MLOS, to help triage severity of pediatric LM and guide decision-making. MLOS is associated with worse clinical severity and a need for surgery, and shows significant improvement after surgery.
尽管睡眠血氧仪（SO）比多导睡眠图更容易获得且资源需求较少，但在小儿杓状软骨软化症（LM）中的应用尚未得到充分理解或验证。我们旨在通过开发并验证改良的杓状软骨软化症血氧仪评分（MLOS）评分系统，对基于家庭的夜间 SO 在 LM 患儿中的应用进行回顾性评估，以对严重程度进行分类并指导临床决策。
我们评估了在我们的三级转诊中心诊断为 LM 的儿科患者。汇总初始和治疗后 SO 的数据，包括平均血氧饱和度（SpO2）最低值和平均氧减指数（ODI）。两位耳鼻喉科医生创建了 MLOS，范围从 I-VI（不确定到严重），以纳入 SO 期间与心动过缓相关的缺氧事件。还确定了相应的麦吉尔血氧仪评分（MOS）。
172 例患者纳入最终分析。平均年龄为 9.2±14.3 个月。98 例（57%）患者被确定为 Thompson 严重程度评分 1，87 例（50.6%）患者行杓状软骨成形术。手术组的 MLOS 和 MOS 评分分别显著更高，为 4 和 2，且平均 ODI 和 SpO2 最低值更高。在评估杓状软骨成形术后的 SO 描记曲线时，所有参数均显著改善，包括中位数 MLOS 评分从 4 降至 1。仅在非手术组中，平均 ODI 改善。Thompson 严重程度评分 2/3 的患者 MLOS 显著更高。
我们提出了一种基于夜间 SO 的简单评分系统，即 MLOS，以帮助分类小儿 LM 的严重程度并指导决策。MLOS 与更严重的临床严重程度和手术需求相关，且术后显著改善。
