Kirjavainen Turkka, Kanerva Mervi, Kukkola Hanna-Leena, Nokso-Koivisto Johanna
Department of Pediatrics, New Children's Hospital, Helsinki, Finland.
Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki, Finland.
Pediatr Res. 2025 Feb 13. doi: 10.1038/s41390-025-03919-z.
Laryngomalacia is the most common congenital airway anomaly causing breathing difficulties in infants. Severe laryngomalacia is often associated with obstructive sleep apnea (OSA).
We re-evaluated 14-year pediatric sleep center polysomnography (PSG) data in infants with fluoroscopy-verified laryngomalacia.
The study included 79 infants, with a median corrected age of 8 weeks (interquartile range, IQR 5-13) and a laryngomalacia clinical score of 10/14 (IQR 7-11). Most (78%) PSG studies were daytime studies. In PSG, laryngomalacia-related breathing difficulty appeared as a sleep stage and position-dependent OSA with laborious breathing. PSG allowed position comparison in 69 infants. In the supine sleeping position, a median obstructive apnea and hypopnea-index (OAHI) was 22 h (IQR 10-50) compared with 7 h (IQR 1-26) in the side sleeping position (p < 0.0001). In the supine, breathing was also more laborious, and end-tidal carbon dioxide 99th percentile levels were higher than in the side sleeping position (p < 0.0001). The degree of OSA (OAHI) showed only a weak correlation with the laryngoscopy severity score (R 0.10, p = 0.005).
In infant laryngomalacia, the degree of upper airway obstruction is frequently more severe in the supine than in the side sleeping position. However, some variability remains in the response.
Laryngomalacia is the most common congenital airway anomaly causing breathing difficulties in infants. Obstructive breathing events and obstructive sleep apnea are common in severe laryngomalacia even though the stridor often diminishes or resolves during sleep. We observed that in young infants with laryngomalacia, the appearance of upper airway obstruction is both sleep position and sleep-stage dependent. Compared to the supine sleeping position, the side sleeping position reduced the frequency of obstructive events and breathing effort, and lowered end-tidal carbon dioxide 99th percentile levels.
喉软化是引起婴儿呼吸困难的最常见先天性气道异常。重度喉软化常与阻塞性睡眠呼吸暂停（OSA）相关。
我们重新评估了经荧光透视证实为喉软化的婴儿的14年儿科睡眠中心多导睡眠图（PSG）数据。
该研究纳入了79名婴儿，校正年龄中位数为8周（四分位间距，IQR 5 - 13），喉软化临床评分为10/14（IQR 7 - 11）。大多数（78%）PSG检查为日间检查。在PSG中，与喉软化相关的呼吸困难表现为睡眠阶段和体位依赖性OSA伴呼吸费力。PSG对69名婴儿进行了体位比较。仰卧睡眠体位时，阻塞性呼吸暂停和低通气指数（OAHI）中位数为22次/小时（IQR 10 - 50），而侧卧睡眠体位时为7次/小时（IQR 1 - 26）（p < 0.0001）。仰卧位时呼吸也更费力，呼气末二氧化碳第99百分位数水平高于侧卧睡眠体位（p < 0.0001）。OSA程度（OAHI）与喉镜检查严重程度评分仅呈弱相关（R 0.10，p = 0.005）。
在婴儿喉软化中，上气道阻塞程度通常仰卧位比侧卧睡眠体位更严重。然而，反应仍存在一些变异性。
喉软化是引起婴儿呼吸困难的最常见先天性气道异常。即使喘鸣在睡眠期间常减轻或消失，阻塞性呼吸事件和阻塞性睡眠呼吸暂停在重度喉软化中也很常见。我们观察到，在患有喉软化的幼儿中，上气道阻塞的出现既与睡眠体位有关，也与睡眠阶段有关。与仰卧睡眠体位相比，侧卧睡眠体位减少了阻塞性事件的频率和呼吸努力，并降低了呼气末二氧化碳第99百分位数水平。
