Supraglottoplasty for laryngomalacia with obstructive sleep apnea

Objectives/Hypothesis: To determine if supraglottoplasty (SGP) is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea (OSA). Study Design: Retrospective case series at a tertiary referral children's hospital. Methods: Ten patients with laryngomalacia and OSA as documented by polysomnography underwent SGP between 2005 and 2007. Data collected included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index, obstructive apnea/hypopnea index, respiratory disturbance index, and low arterial oxygen saturation (O ₂ nadir) after SGP. Results: All 10 patients were successfully extubated after SGP. There were no peri-or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed after SGP at 11 weeks (range 2-29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow-up visit 4 weeks after discharge. Marked improvements were observed in obstructive apnea index, obstructive apnea/hypopnea index, respiratory disturbance index and O ₂ nadir, all of which were statistically significant (P <.05). Conclusions: Polysomnography should be considered in the initial evaluation of infants with moderate laryngomalacia to rule out OSA. SGP is an effective treatment for infants with laryngomalacia and OSA. The significant benefits of the procedure outweigh the low morbidity. Improvement after surgery was reliably confirmed by polysomnography in this study.