SURGICAL THERAPY FOR SEVERE REFRACTORY SLEEP-APNEA IN INFANTS AND CHILDREN - APPLICATION OF THE AIRWAY ZONE CONCEPT

Obstructive sleep apnea in children may result in hypoxia, right-sided heart failure, and sudden death. Children with craniofacial deformiti es and/or cerebral palsy are at high risk for the development of obstr uctive sleep apnea. Prompted by the excellent results obtained in adul ts when sleep apnea tvas managed by an aggressive surgical approach, w e undertook a similar treatment philosophy in children. Twenty-eight p atients representing four diagnostic groups were evaluated and operate d on for severe upper airway obstruction: Down syndrome (n = 5), cereb ral palsy (n = 12), Goldenhar syndrome (n = 4), and a mixed apnea grou p (n = 7). Tracheostomy was avoided in 25 of 28 patients (89 percent), with a marked decrease in apnea (median 90 percent) and hypopnea (med ian 87 percent) episodes. Tongue hyoid suspension and skeletal expansi on procedures, which were the mainstay of treatment, were applied for the first time in children and adolescents with obstructive sleep apne a.