Sleep-disordered breathing in children with laryngomalacia

Abstract

Introduction: Laryngomalacia (LM) is one of the most frequent causes of the upper airway obstruction in children. Aims: To determine the presence of sleep-disordered breathing (SDB) in these patients and the need of non invasive ventilatory support. Methods: We studied 18 children with LM. The diagnosis of LM was confirmed by flexible laryngoscopy in all children. Polysomnography or respiratory polygraphy was performed at diagnosis and control. Results: Eleven of them (61.1%) were females and 4 (22.2%) of them were premature. The mean values for age and weight were 3.38±3.01 months and 4674±1418 grams. LM type 1 was present in 38.9%, type 2 in 33.3% and type 3 in 27.8%. Stridor was the most frequent symptom in 83.3% followed by the presence of feeding difficulties in 44.4% and apneas in 38.8%. Gastroesophageal reflux disease was confirmed by Phmetry in 55.5% of them. In the first sleep study, the mean values were: sleep efficiency 83%(±5.85), apnea-hypopnea index (AHI) 13.74±10.90, the cumulative percentage of time spent at saturation 90 ) 2.09%(±4.72), mean oxygen saturation 96%(±1.94) and heart rate 126±14.24 bpm. 16 children (88.8%) were diagnosed of SDB and 11(61.1%) of them required non invasive ventilatory support with a mean time of 9.45±5.26 months. In the control sleep study the mean values were: AHI 3.67±5.13, CT 90 0.43%(±1.64), mean oxygen saturation 96%(±1.38) and heart rate 111±15.01 bpm. Compared the first sleep study to control, we observed differences in AHI (p 90 (p=0.05) and mean heart rate (p=0.005). Conclusion: SDB are frequent in children with LM. Children with LM should be evaluated with sleep study in order to establish severity and the need of non invasive ventilatory support.