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Polisomnographic findings on children with laryngopathies
Michele Themis Moraes Gonçalves1, Juliana Sato, Melissa A G Avelino
1UNIFESP, Brazil. michelethemis@gmail.com
Insights
Children with laryngomalacia often experience central breathing events during sleep, unlike those with other laryngeal diseases. Polysomnography is key for diagnosing these sleep-related breathing disorders in children.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Otolaryngology
Background:
- Obstructive sleep apnea syndrome (OSAS) in children is commonly caused by adenotonsillar hypertrophy.
- Laryngomalacia is a frequent cause of pediatric stridor, with uncertain pathophysiology.
- Polysomnography is the standard diagnostic tool for childhood OSAS.
Purpose of the Study:
- To characterize polysomnographic findings in children diagnosed with laryngomalacia or isolated laryngeal alterations.
- To differentiate sleep-disordered breathing patterns associated with laryngomalacia versus other laryngeal conditions.
Main Methods:
- A cohort of 29 children with isolated laryngeal issues underwent otorhinolaryngological examination, nasofibrolaryngoscopy, and polysomnography.
- Participants were categorized into two groups: laryngomalacia and other laryngeal diseases.
- Data collected included age and findings from nasofibrolaryngoscopy and polysomnography.
Main Results:
- All 18 children with laryngomalacia exhibited central breathing events, frequently accompanied by oxyhemoglobin desaturation and bradycardia.
- Three children in the laryngomalacia group also had obstructive events.
- Among 11 children with other laryngeal alterations, 4 had central and 2 had obstructive breathing events, with no predominant type.
Conclusions:
- Laryngomalacia in children is predominantly associated with central-type apneas.
- Children with diverse laryngeal diseases do not show a specific pattern of apnea type.
Unlabelled:
Polysomnography is the goldstandard exam for child OSAS. When possible, polysomnography clearly distinguishes between those with isolated primary snoring and patients with sleep apnea (obstructive, central and mixed). The most common cause of OSAS in childhood is adenotonsillar hypertrophy. Laryngomalacia is the most common cause of stridor in childhood, though its physiopathology remains unknown. Among the most prominent theories are immaturity of the cartilaginous framework of the larynx and/or neuromuscular immaturity.
Objective:
Our proposal was to describe polysomnographic findings in children with laryngomalacia or other isolated laryngeal alterations, that is, without other alterations in the upper airways.
Methods:
The sample included 29 children with exclusively laryngeal alterations. All of them underwent an otorhinolaryngological exam, nasofibrolaryngoscopy and polysomnography. Information was recorded concerning age, nasofibrolaryngoscopy and polysomnography. For analysis, the children were divided into two groups: those with laryngomalacia and those with other laryngeal diseases.
Results:
Among the 18 children with a diagnosis of laryngomalacia, 18 had central breathing events, knowing that the majority had showed desaturation of oxihemoglobin and bradycardia. In this same group, 3 children had obstructive events. On the other hand, 11 children with other laryngeal alterations showed no predominance of one type or another of apnea. Of these, 4 had central type breathing events and 2 obstructive type.
Conclusion:
The majority of patients with laryngomalacia showed a central type apnea. Patients with various laryngeal diseases did not present a predominant type of apnea.
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