Sleep-disordered breathing and laryngomalacia

Abstract

Congenital laryngomalacia, the most frequent cause of inspiratory stridor in infants, can be associated with sleep-disordered breathing. A high prevalence of obstructive sleep apnea (OSA) has been documented among infants with laryngomalacia and surgical treatment by supraglottoplasty improves OSA severity. Consequently, polysomnography plays a role in the diagnostic evaluation, therapeutic decision making and follow-up after treatment of congenital laryngomalacia. A subgroup also presents with central apneas but the effect of treatment on the central apneas is rarely reported. Sleep-dependent laryngomalacia may be the primary cause of OSA in a minority of children and is the 2^nd most common cause of persistent OSA after adenotonsillectomy. Children with sleep-dependent laryngomalacia are typically older (> 2 years), present with OSA related symptoms but do not have an inspiratory stridor while awake. Sleep-dependent laryngomalacia can be readily diagnosed by sleep-endoscopy and responds to surgical intervention by supraglottoplasty.