Management of Obstructive Sleep Apnea in Children with Cerebral Palsy

Abstract

Objective: 1) Determine the efficacy of combined surgical techniques for improving obstructive sleep apnea (OSA) in pediatric patients with cerebral palsy (CP). 2) Evaluate the addition of tongue base suspension for children with CP that have moderate to severe OSA. Method: Seven-year retrospective chart review of 14 children with CP undergoing surgical management of OSA, including adenotonsillectomy (T&A) and uvulopalatopharyngoplasty (UPPP), with or without tongue base suspension (TBS). Response to treatment was determined by its impact on PSG parameters: apnea/hypopnea index (AHI) and arousal index (AI). Results: Children with CP who received TBS had a mean preoperative AHI of 27.2 compared with an AHI of 6.8 in the group that underwent only T&A and UPPP (non-TBS). AHI decreased by a mean of 16.5 (TBS) vs 5.0 (non-TBS); ( P value .03 vs 04). AI also improved in both groups (33.1 to 20.7 and 11.0 to 5.8); ( P value .05 vs 10). Hospital length of stay was slightly longer for the TBS groups than the non-TBS groups (mean 9.3 days and 6.6 days) but was not statistically significant ( P = .09). Average length of follow-up was 52 months with no surgical complications. Conclusion: Combined surgical therapy improves OSA in children with CP. Children with CP and moderate to severe OSA (AHI>15) may safely benefit from the addition of tongue base suspension to T&A and UPPP to maximize treatment.