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Introduction Supraglottoplasty (SGP) is the surgical treatment of choice for laryngomalacia and obstructive sleep apnea (OSA). Several recent studies have shown that oxygen can act to stabilize ventilatory control in infants with OSA and high loop gain. However, there is very limited information on the effect of SGP on OSA in infants with laryngomalacia and evidence of high loop gain. Methods A retrospective chart review was performed in infants with laryngomalacia and OSA at Cincinnati Children’s Hospital Medical Center from January 2008 to June 2022. Only patients treated with oxygen prior to SGP were included in the analysis. The pre-surgical polysomnograms (PSGs) were classified by responsiveness to oxygen into 2 groups; oxygen responders ([R]; >50% decrease in apnea-hypopnea index (AHI) with oxygen, indirect evidence of high loop gain) and non-responders ([NR]; < 50% decrease in AHI). Data were reported as mean±SD. The comparison of AHI and obstructive AHI (OAHI) between pre-surgical and post-surgical PSGs were performed in each group using paired t-test or Wilcoxon signed rank test. The differences of percentage decreases in AHI and OAHI after surgery between R and NR were calculated using Wilcoxon Rank Sum test. Results Forty-nine infants (with 52 SGPs) met the study enrollment criteria, with 33 (67.3%) male and 16 (32.7%) female patients. There were no statistically significant differences in age or sex between oxygen responders and non-responders. AHI after SGP in both oxygen responders (50.1±59.2/hr [pre] vs 17.6±21.1/hr [post]; P< 0.0001) and oxygen non-responders (25.2±13.3/hr [pre] vs 12.4±9.4/hr [post] vs; P=0.0006] decreased significantly. Similarly, there were significant decreases in OAHI after SGP in both groups. Additionally, there were no significant differences in the percentage decreases of AHI (57.3±26.1% [R] vs 41.4±48.8%[NR]; P=0.6410) and OAHI (64.0±21.9% [R] vs 50.3±41.4% [NR]; P=0.5260) between the 2 groups. Conclusion Both oxygen responders and non-responders had significant decreases in AHI and OAHI after surgery with similar magnitude of improvement. Supraglottoplasty is an effective treatment in infants with larygnomalacia and OSA, even in those with evidence of high loop gain. We speculate that non-anatomic traits such as high loop gain would only manifest in the context of significant respiratory disturbances from anatomic traits. Support (if any)

Introduction The relationship between obstructive sleep apnea (OSA) and periodic limb movements of sleep (PLMS) is not completely understood, especially among pediatric patients. Previous research describes varied changes in PLMS following OSA treatment, including increased, decreased, or unchanged PLMS frequency. This study aimed to evaluate the effect of surgical OSA treatment on the periodic limb movement index (PLMI) in pediatric patients with OSA and significant PLMS. Methods Retrospective chart review was performed to identify pediatric patients who had polysomnography demonstrating significant PLMS (PLMI ≥ 5/hour) and OSA (obstructive apnea-hypopnea index (OAHI) ≥ 1.5/hour) that was treated with upper airway surgery. Patients aged 1-18 years were included if significant PLMS was present on either pre-treatment or post-treatment polysomnograms between 1/1/2010 and 7/31/2022. Patients were evaluated for changes in PLMI and OAHI between a pre- and post-treatment polysomnogram, each obtained within 12 months of OSA treatment. Patients with inadequate sleep time (< 2 hours) were excluded. Data are reported as mean ± standard deviation and results from mixed effect linear models. Results Medical record review identified 198 patients. The average age was 5.3±3.8 years (range 1.1-16.9 years) at pre-treatment polysomnogram, including 129 (65.2%) male patients. Adenotonsillectomy was the most common OSA treatment (n=136). For the whole group, the OAHI decreased from 12.3±15.3 to 5.3±8.1/hour and the PLMI increased from 5.5±8.5 to 7.0±8.7/hour after treatment, for an average PLMI increase of 1.5/hour (SE=0.7, p=0.04). Sub-group analysis of patients with decreased OAHI following treatment (n=152) showed an average PLMI increase of 2.3/hour (SE=0.8, p=0.004), while patients with increased OAHI following treatment (n=44) did not show a significant change in PLMI. There were 74 patients (37.4%) who developed significant PLMS following treatment and 36 patients (18.2%) with significant PLMS before and after treatment. Conclusion Effective OSA treatment led to increased PLMI among a majority of children, highlighting the potential for unmasking of PLMS in some pediatric patients with OSA. Furthermore, over one third of patients developed polysomnographic criteria for significant PLMS after OSA management. This may suggest a sub-group of children with OSA who have a PLMD phenotype that may not become apparent until appropriate OSA treatment. Support (if any)