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Original Investigation |

Objective Outcomes of Supraglottoplasty for Children With Laryngomalacia and Obstructive Sleep Apnea A Meta-analysis

Zachary Farhood, MD1; Adrian A. Ong, MD1; Shaun A. Nguyen, MD, MA, CPI1; M. Boyd Gillespie, MD1; Christopher M. Discolo, MD1; David R. White, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. 2016;142(7):665-671. doi:10.1001/jamaoto.2016.0830.
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Importance  Surgical intervention is the main treatment alternative for patients with severe laryngomalacia. Supraglottoplasty offers effective treatment results not only for laryngomalacia but also for concurrent obstructive sleep apnea (OSA).

Objective  To quantify the objective outcomes of supraglottoplasty for laryngomalacia with OSA via polysomnography data in the pediatric population.

Data Sources  A comprehensive literature search of the PubMed database was performed on May 20, 2015, using the search terms supraglottoplasty, epiglottoplasty, aryepiglottoplasty, laryngomalacia, obstructive sleep apnea, Apnea-Hypopnea Index (AHI), children, and polysomnography. There were no date restrictions.

Study Selection  The literature search identified English-language studies that used polysomnography to evaluate patients with laryngomalacia and OSA after supraglottoplasty. Two reviewers screened titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis.

Data Extraction  Numerical polysomnography data were extracted and compared among studies where appropriate. A fixed- or random-effects model was used, when appropriate, to analyze the data and calculate effect sizes.

Results  Four studies were included in various subsets of the meta-analysis. After supraglottoplasty, the Apnea-Hypopnea Index (AHI) improved by a mean of 12.5 points in 4 studies (95% CI, −21.14 to −3.78; P = .005), oxygen saturation as measured by pulse oximetry nadir by 9.49 in 4 studies (95% CI, 4.87–14.12; P < .001), and Obstructive AHI by 21 points in 2 studies (95% CI, −50.3 to −8.29; P = .16). Twenty-nine of 33 children (88%) had residual disease. Patients 7 months and older had significant improvement in the AHI (P = .03).

Conclusions and Relevance  Supraglottoplasty is an effective treatment modality for patients with laryngomalacia and OSA with objectively measurable benefits; however, patients will frequently have residual disease. Additional polysomnography after treatment is advised to ensure adequate resolution of the disorder.

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Figure 1.
Literature Search Results

OSA indicates obstructive sleep apnea.

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Figure 2.
Forest Plot for Apnea-Hypopnea Index or Respiratory Disturbance Index Outcomes

IV indicates inverse variance.

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Figure 3.
Forest Plot for Oxygen Saturation as Measured by Pulse Oximetry Nadir Outcomes

IV indicates inverse variance.

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