Children with laryngomalacia requiring supraglottoplasty: an association with future development of sleep disordered breathing

Abstract

Background: Laryngomalacia is the most common cause of stridor in infants. Approximately 20% of patients experience sequalae ranging from feeding difficulties, aspiration, respiratory distress and sleep disordered breathing (SDB). SDB is a spectrum of disorders ranging from simple snoring to obstructive sleep apnea (OSA). SDB and laryngomalacia can be simultaneously present with a reported incidence of 75%. While the majority of patients with laryngomalacia can be managed conservatively, definitive treatment for this cohort of patients is via supraglottoplasty. We aim to review the subsequent onset of paediatric SDB in otherwise well patients who have previously undergone supraglottoplasty for infantile laryngomalacia. Methods: A retrospective review of children who underwent supraglottoplasty in the first 18 months of life from 2014 to 2021 was performed. The incidence of SDB was established upon subsequent follow-up. This was confirmed via clinical presentation by an otolaryngologist or via formal polysomnogram (PSG). Results: Thirty-one patients who underwent supraglottoplasty for laryngomalacia were assessed, with 58% (18/31) being male and 42% (13/31) being female. A total of 39% were subsequently diagnosed with SDB. The mean age of post-operative SDB diagnosis was 23 months (standard deviation: ±14 months). No difference in incidence of SDB was found between sexes (P=0.2). Of these patients with SDB, 25% required further surgical intervention. Conclusions: Establishing a correlation between laryngomalacia and the subsequent development of SDB in children who have previously undergone supraglottoplasty, may lead the surgeon to follow up patients beyond the routine 2 years post-surgery or educate parents to be vigilant of the child developing signs and symptoms of SDB.