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Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis
Chia-Fan Lee1, Wei-Chung Hsu2, Chia-Hsuan Lee3
1Speech Language Pathologist, Child Developmental Assessment and Intervention Center, Taipei City Hospital, Taipei, Taiwan, ROC.
Insights
Supraglottoplasty effectively reduces the apnea-hypopnea index and improves oxygen saturation in children with obstructive sleep apnea (OSA) and laryngomalacia. While beneficial, it does not fully resolve OSA in most cases, necessitating further research into treatment outcomes.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Surgical Outcomes Research
Background:
- Obstructive sleep apnea (OSA) in children often co-occurs with laryngomalacia, presenting complex management challenges.
- Supraglottoplasty is a surgical intervention explored for treating OSA in this pediatric population.
Purpose of the Study:
- To systematically review the impact of supraglottoplasty on sleep parameters in children with OSA and laryngomalacia.
- To evaluate the success rates of supraglottoplasty for pediatric OSA and identify factors influencing treatment outcomes.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, MEDLINE, EMBASE, Cochrane).
- Included studies focused on pediatric patients undergoing supraglottoplasty for OSA, analyzing changes in apnea-hypopnea index (AHI) and minimum oxygen saturation (MinSaO2).
- Subgroup analyses examined outcomes based on primary vs. secondary treatment and presence of comorbidities.
Main Results:
- Eleven studies involving 121 children were analyzed, showing a significant reduction in AHI (8.9 events/h) and an increase in MinSaO2 (3.7%) post-surgery.
- Overall success rates varied: 28% achieved AHI <1, and 72% achieved AHI <5.
- Outcomes were similar whether supraglottoplasty was the primary or secondary treatment, and in children with or without comorbidities.
Conclusions:
- Supraglottoplasty demonstrates efficacy in improving sleep parameters for pediatric OSA associated with laryngomalacia.
- Complete resolution of OSA is not consistently achieved, highlighting the need for further investigation into factors influencing treatment success.
Objective:
To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA.
Methods:
The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities.
Results:
Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166).
Conclusions:
Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.
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