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Nap polysomnography in infants with laryngomalacia as a tool to predict treatment strategy
Mariem Lajili1, Natacha Teissier2, Benjamin Dudoignon3
1Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, 75019, Paris, France.
Insights
Nap polysomnography (NPSG) is crucial for infants with laryngomalacia. The apnea-hypopnea index (AHI) from NPSG helps predict treatment decisions and impacts infant weight gain, guiding clinical management.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Physiology
Background:
- Laryngomalacia is a common cause of upper airway obstruction in infants.
- Moderate to severe laryngomalacia can be associated with obstructive sleep apnea (OSA).
- Accurate assessment is vital for appropriate treatment planning.
Purpose of the Study:
- To evaluate nap polysomnography (NPSG) in predicting treatment strategies for infants with moderate to severe laryngomalacia.
- To examine the relationship between obstructive sleep apnea (OSA) severity, weight gain, and laryngomalacia severity.
Main Methods:
- Retrospective analysis of 39 infants with moderate to severe laryngomalacia undergoing NPSG.
- Collected clinical data, NPSG parameters, and treatment decisions.
- Assessed weight gain rate and its correlation with NPSG indices; used logistic regression to predict treatment.
Main Results:
- 77% of infants had OSA, with 69% having moderate to severe OSA (AHI > 5/h).
- Weight gain rate negatively correlated with OSA severity (AHI, HI).
- Apnea-hypopnea index (AHI) predicted surgical or ventilation treatment (OR=2.1); AHI and retractions predicted weight gain (r²=0.28).
Conclusions:
- NPSG is essential for assessing infants with moderate to severe laryngomalacia.
- The AHI from NPSG is a significant predictor for treatment decisions and infant weight gain.
- NPSG should be integrated into the diagnostic and management protocols for laryngomalacia.
Purpose:
This study aimed to investigate the role of nap polysomnography (NPSG) in predicting treatment strategies for infants with moderate to severe laryngomalacia and to explore the association between obstructive sleep apnea (OSA) severity, weight gain, and laryngomalacia severity.
Methods:
A retrospective analysis was conducted on infants diagnosed with moderate to severe laryngomalacia who underwent NPSG between January 2019 and June 2023. Clinical variables, NPSG parameters, and treatment decisions were collected. Weight gain rate and its correlation with NPSG indices were assessed. Logistic regression analyses were performed to predict treatment strategies based on NPSG findings.
Results:
Of the 39 infants included (median age: 3.3 months), 77% exhibited OSA, with 69% having moderate to severe OSA [apnea-hypopnea index (AHI) > 5/h]. Weight gain rate correlated negatively with indices of OSA severity, including the hypopnea index (HI) and the AHI. In a multiple logistic regression analysis incorporating the severity of OSA (AHI), weight gain rate, and laryngomalacia severity, only AHI predicted the decision for surgical or non-invasive ventilation treatment (OR = 2.1, CI95 [1.6; 2.8], p ≤ 10-4). The weight gain rate was predicted (r2 = 0.28) by the AHI and the presence of retractions of auxiliary inspiratory muscles.
Conclusion:
This study underscores the importance of NPSG in assessing infants with moderate to severe laryngomalacia. The AHI from NPSG emerged as a potential predictor for treatment decisions and weight gain rate, emphasizing its clinical relevance. These findings advocate incorporating NPSG into the diagnostic and management process for infants with laryngomalacia.
