In reference to supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta‐analysis
Author(s) -
Lee ChiaFan,
Lee ChiaHsuan,
Kang KunTai,
Hsu WeiChung
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25950
Subject(s) - christian ministry , medicine , obstructive sleep apnea , family medicine , otorhinolaryngology , pediatrics , surgery , political science , law
We have read with interest the article “Supraglottoplasty for Laryngomalacia With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis” by Camacho et al. The article addresses the current research gap concerning the effectiveness of supraglottoplasty in treating pediatric obstructive sleep apnea (OSA). However, we would like to highlight some points of concern. The authors coined the term “sleep exclusive laryngomalacia” to describe noncongenital laryngomalacia, including occult laryngomalacia, late-onset laryngomalacia, and state-dependent laryngomalacia. Occult laryngomalacia presents with stridor in children limited to sleep or exercise. Late-onset laryngomalacia begins at age 2 years or above in patients without a medical history of prior diseases or symptoms. Amin and Isaacson identified state-dependent laryngomalacia in infants who exhibit normal breathing when awake, but develop stridor while asleep. They dubbed the condition “statedependent,” because the finding varied with level of consciousness. Care should be taken concerning the subtle differences between these terms. The authors presented and analyzed data concerning two subgroups, those with congenital laryngomalacia and those with sleep exclusive laryngomalacia. The authors assumed the existence of discrepancies in basic characteristics and surgical outcomes between the two groups. The success rate for postoperative apnea-hypopnea index <1 seems to be lower in children with sleep exclusive laryngomalacia than in those with congenital laryngomalacia (10.5% vs. 26.5%). Therefore, the authors should further compare the surgical outcomes of the two groups, as it could easily be done by calculating changes in the standardized mean difference (effect size) and success rate for each group, and by providing a P value for subgroup analyses to determine whether the surgical outcomes differ significantly between the groups. We are surprised that the authors did not consider difference between the surgical outcomes of children with and without comorbidities. Laryngomalacia may present as an isolated disease or be associated with comorbidities, such as gastroesophageal reflux disease, craniofacial anomalies, or neurocognitive disease, many of which are possible risk factors for pediatric OSA. A systematic review by Preciado and Zalzal has demonstrated that comorbidities increase surgical failure and complications in children with laryngomalacia. We believe that the surgical outcomes of children with and without comorbidities will be of great interest to readers and should be considered in this article.