Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis
Corresponding Author
Macario Camacho MD
Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford Hospital and Clinics, Stanford, California, U.S.A.
Send correspondence to Macario Camacho, MD, Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859. E-mail: [email protected]Search for more papers by this authorBrandyn Dunn MPH
John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
Search for more papers by this authorCarlos Torre MD
Department of Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A.
Search for more papers by this authorJodie Sasaki MS
John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
Search for more papers by this authorRaymond Gonzales BS
Department of Otorhinolaryngology/Sleep Medicine Centre–Hospital CUF, University of Porto, Porto, Portugal
Search for more papers by this authorStanley Yung-Chuan Liu MD, DDS
Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California San Francisco, San Francisco, California, U.S.A.
Search for more papers by this authorDylan K. Chan MD, PhD
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A.
Search for more papers by this authorVictor Certal MD, PhD
CINTESIS–Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
Search for more papers by this authorBenjamin B. Cable MD
Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
Search for more papers by this authorCorresponding Author
Macario Camacho MD
Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford Hospital and Clinics, Stanford, California, U.S.A.
Send correspondence to Macario Camacho, MD, Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859. E-mail: [email protected]Search for more papers by this authorBrandyn Dunn MPH
John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
Search for more papers by this authorCarlos Torre MD
Department of Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A.
Search for more papers by this authorJodie Sasaki MS
John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
Search for more papers by this authorRaymond Gonzales BS
Department of Otorhinolaryngology/Sleep Medicine Centre–Hospital CUF, University of Porto, Porto, Portugal
Search for more papers by this authorStanley Yung-Chuan Liu MD, DDS
Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California San Francisco, San Francisco, California, U.S.A.
Search for more papers by this authorDylan K. Chan MD, PhD
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A.
Search for more papers by this authorVictor Certal MD, PhD
CINTESIS–Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
Search for more papers by this authorBenjamin B. Cable MD
Otolaryngology–Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
Search for more papers by this authorThe authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objectives/Hypothesis
To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children.
Study Design
Systematic review and meta-analysis.
Methods
Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015.
Results
A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month–12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data).
Conclusion
Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246–1255, 2016
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