UTILITY OF POLYSOMNOGRAPHY IN TRACHEOSTOMY DECANNULATION PROCESS IN CHILDREN.

Abstract Introduction Different approaches have been used to assess decannulation readiness including clinical observation with gradual tracheostomy downsizing, capping, and microlaryngoscopy and bronchoscopy. Polysomnograms with tracheostomy capping are being used at some centers prior to decannulation. We have previously shown that polysomnography is an important additional tool to predict successful decannulation. However, this study was based on a relatively small number of children. Thus the aim of this study is to review the polysomnographic features that predict decannulation outcomes in a large cohort of children with various conditions. Methods A retrospective chart review of polysomnography and medical records was performed for children 0-18 years of age preparing for tracheostomy decannulation from Feb. 2005 to June 2019 at Cincinnati Children’s Hospital Medical Center. Subjects with less than four hours of sleep time were excluded from the study. Results A total of 128 subjects were included in the study with 74 in the successful decannulation group (SD), 48 in the no decannulation group (ND) and 6 in the unsuccessful decannulation group. Underlying diagnosis included history of prematurity 41 (32%), genetic disorders 39 (30.5%), neurological disorders 17 (13.3%), airway abnormalities 108 (84.4%), and cardiac disease 24 (18.8%). Average age at the time of tracheostomy was 1.8±3.4 years and at decannulation was 5.7±3.6 years in the SD group. Favorable microlaryngoscopy/bronchoscopy (MLB) was significantly higher in SD group 73.8% vs. ND group 26.2% (p<0.001). Comparing polysomnographic respiratory sleep parameters showed significant differences between ND and SD groups for apnea hypopnea index (AHI)>10/h (88% [ND] vs. 12% [SD]; p<0.001) and obstructive apnea hypopnea index (OAHI)> 5/h (75.6% [ND] vs. 24.4% [SD]; p<0.001). Alveolar hypoventilation (CO2>50 for >25% of TST) was also significantly higher in the ND group (70.6%) vs. SD group (29.4%) (p<0.009). Conclusion In our large cohort of children undergoing decannulation, there were several differences in polysomnographic characteristics including AHI, obstructive AHI and CO2 parameters between those who were and were not successfully decannulated. In addition to unfavorable findings on airway evaluation, children who did not undergo decannulation were more likely to have moderate to severe degree of sleep disordered breathing and alveolar hypoventilation. Support (If Any) This study was supported by Cincinnati Children’s Hospital Research Fund.