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, and it is frequently associated with sleep-disordered breathing (SDB). Our main objective was to determine the presence of SDB in these patients and the need for ventilatory support. Materials and methods A review of 18 children with clinical suspected of LM. The diagnosis of LM was confirmed and classified by flexible laryngoscopy in all children. All of them went under sleep study: polysomnography (PSG) or respiratory polygraphy (RP) was performed at diagnosis and control. Results 18 children were studied; 5 of them by PSG and 13 by RP in the first study, 16 by PSG and 2 by RP in control. 11 (61.1%) were females, 4 (22.2%) of them were premature; with mean age 3.38 ( ± 3.01) months and weight 4674 ( ± 1418) grams. LM type 1 was present in 7 (38.9%), type 2 in 6 (33.3%) and type 3 in 5 (27.8%). Stridor was the most frequent symptom in 15 (83.3%) followed by the presence of feeding difficulties in 8 (44.4%) and apneas in 7 (38.8%). Gastroesophageal reflux disease was observed in 10 (55.5%). 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% (CT90) 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: 11 (61.1%) required ventilatory support with a mean time of 9.45 ( ± 5.26) months. In the study control the mean values were: sleep efficiency 71% ( ± 20.95), AHI 3.67 ( ± 5.13), CT90 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 0.001), CT90 (p = 0.05) and mean heart rate (p = 0.005).4 children continued with SBD at study control, 2 of them continued with ventilatory support. Conclusion SDB are frequent in children with LM. We believe children with LM should be evaluated with sleep study in order to establish severity and the need of ventilatory support. Acknowledgements The authors would like to thank Dra. Navazo Eguia and the Sleep Unit staff at the Universitary Hospital of Burgos for their help.