Prevalence and Risk Factors for Central Sleep Apnea in Infants with Laryngomalacia

• Published in: Otolaryngology-head and neck surgery Vol. 150; no. 4; pp. 677 - 683
• Main Authors: Tanphaichitr, Archwin, Tanphaichitr, Pattraporn, Apiwattanasawee, Polporn, Brockbank, Justin, Rutter, Michael J., Simakajornboon, Narong
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2014
• Subjects: central sleep apnea; Cohort Studies; Comorbidity; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Premature; laryngomalacia; Laryngomalacia - congenital; Laryngomalacia - diagnosis; Laryngomalacia - epidemiology; Laryngomalacia - surgery; Laryngoscopy - methods; Male; Odds Ratio; polysomnography; Polysomnography - methods; Prevalence; Reference Values; Registries; Retrospective Studies; Risk Factors; Severity of Illness Index; Sleep Apnea, Central - diagnosis; Sleep Apnea, Central - epidemiology; Sleep Apnea, Central - therapy; Treatment Outcome; laryngomalacia; central sleep apnea; polysomnography
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599814521379

Objective
To identify the prevalence of and risk factors for central sleep apnea (CSA) in infants who are diagnosed with laryngomalacia.
Study Design
Case series with chart review.
Setting
Quaternary care pediatric hospital.
Subjects and Methods
We performed a chart review in infants with laryngomalacia. All infants had diagnostic polysomnography (PSG) performed from 2003 to 2012. Infants who underwent supraglottoplasty or other upper airway surgery prior to PSG were excluded. CSA was defined as central apnea index ≥ 5. Demographic data, underlying diseases, and PSG data were reviewed and analyzed.
Results
Fifty-four patients met the inclusion criteria. The mean age at the date PSG was performed was 3.4 ± 2.7 months. The prevalence of CSA in infants with laryngomalacia was 46.3%. Odds ratio (OR) of CSA was above 2.0 in patients with the following risk factors: underlying neurologic disease, hypotonia, or syndrome (OR = 2.5, P = .13), history of apparent life-threatening events (OR = 2.7, P = .19), premature infants (OR = 2.2, P = .33), and age less than 3 months (OR = 2.3, P = .15). However, none of the risk factors were statistically significant. Analysis of sleep architecture revealed a decrease in total sleep time (345.4 ± 70.6 minutes vs 393.5 ± 68.3 minutes, P = .02) and sleep efficiency (67.7 ± 8.9% vs 75.2 ± 9.3%, P = .004) in the CSA group.
Conclusion
CSA is relatively common in infants with laryngomalacia. There seems to be a higher prevalence of CSA in infants with certain risk factors, but none of the risk factors are statistically significant. The presence of CSA can lead to alteration in sleep architecture. In addition to clinical evaluation, polysomnography may be warranted for the evaluation of infants with laryngomalacia and associated complex medical conditions.