Sleep-disordered Breathing in TEF/EA Patients: Evaluating the Role of Tracheomalacia and Surgical Outcomes

Monday, October 19, 2026

9:54 AM - 10:00 AM PT

Location: 409AB

Presenting Author(s)

AZ

Angela Zhang, N/A

Medical Student
Vanderbilt University School of Medicine, United States

Co-Author(s)

AZ

Angela Zhang, N/A

Medical Student
Vanderbilt University School of Medicine, United States
Annie Shen, BS

Medical Student
Vanderbilt University School of Medicine
Nashville, Tennessee, United States
Kalpnaben R. Patel, MD,CCRP

Pediatric Otolaryngology Research Coordinator
Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
Franklin, TN, United States
LD

Liping Du, PhD

Research Assistant Professor of Biostatistics
Vanderbilt University Department of Biostatistics, United States

Senior Author(s)

LW

Lyndy J. Wilcox, MD, MMHC

Associate Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure(s):

Kalpnaben R. Patel, MD,CCRP:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Tracheoesophageal fistula and/or esophageal atresia (TEF/EA) is a congenital malformation associated with persistent airway abnormalities, including tracheomalacia, that increase the risk of sleep-disordered breathing. Obstructive sleep apnea (OSA) is increasingly recognized in TEF/EA patients and is often refractory to standard surgical management, such as adenotonsillectomy (T&A). The relationship between airway Malacia and OSA severity in this population remains poorly defined.

Methods: We conducted a retrospective chart review of 89 patients with TEF/EA evaluated at a single tertiary care center between 2017 and 2025. Demographics, airway evaluations, and polysomnography results were collected. OSA severity was categorized based on sleep study findings. Airway Malacia was identified via bronchoscopic evaluation. OSA incidence and severity were compared between patients with and without airway Malacia using Pearson’s chi-squared test.

Results: Of 89 patients, 28 (31.5%) developed OSA. The cohort was 82.1% white and 53.6% female. Type C TEF/EA anomalies were present in 82.1% of patients. Mean age at OSA diagnosis was 4 years. Among those with OSA, 55% had mild disease, 25% had moderate, and 20% had severe. Adenotonsillectomy was performed in 46.4% of patients, 14.3% of which had refractory OSA. Bronchomalacia (p = 0.019) and bronchial anterior compression (p = 0.004) were significantly associated with increased OSA severity.

Conclusions: Our findings emphasize the importance of evaluating airway pathology in TEF/EA patients with OSA,  and  providing consistent screening for airway  Malacia in this high-risk population. Further analysis will help clarify risk factors associated with refractory OSA and poor response to T&A in this cohort.