Airway management for infant with multiple deformities and sleep apnea

• Published in: Pediatric Otorhinolaryngology Japan Vol. 32; no. 3; pp. 431 - 435
• Main Authors: Miwa, Takaki, Sato, Hitoshi, Sakai, Aya, Suzuka, Yuko
• Format: Journal Article
• Language: Japanese
• Published: Japan Society for Pediatric Otorhinolaryngology 2011; 日本小児耳鼻咽喉科学会
• Subjects: airway management; infant; multiple deformities; sleep apnea; 乳児; 多発奇形; 気道管理; 睡眠時無呼吸
• ISSN: 0919-5858; 2186-5957
• DOI: 10.11374/shonijibi.32.431

The major causes of airway obstruction in children with sleep apnea are palatine tonsil hypertrophy and adenoid hypertrophy. Pediatricians may hesitate to treat sleep apnea aggressively in infants with an underlying disease due to other complicating factors. We recently performed conservative airway management for a nine-month-old infant with multiple deformities who suffered from sleep apnea. Her parent's chief complaints were apnea attacks during sleep and stridor while awake. At the age of six months, magnetic resonance imaging of the head detected decreased oxygen saturation during sleep. Otorhinolaryngological findings included bilateral low-set ears, bilateral ear canal stenosis, and mild adenoid hypertrophy. Radiography and computed tomography revealed narrowing of the upper pharynx. An ambulatory sleep monitoring device showed a marked decrease in oxygen concentration, with an oxygen desaturation index of 50 events per hour and a lowest oxygen saturation level of 53%. Based on these findings, the cause of sleep apnea in this case was judged to be narrowing of the upper and middle pharynx due to hypoplasia of the medial face bones. A nasal airway tube inserted into her nose administered oxygen at 0.2 L/min only while she was asleep and prevented sleep apnea and decreased oxygen concentration. She was discharged and currently wears a nasal continuous positive airway pressure mask under oxygen inhalation. No decrease in her oxygen concentration at night has been observed since then, and she has had a favorable clinical course.