Does Concurrent SGP with T&A Improve Sleep Apnea in Children?

Introduction: Multilevel airway obstruction is increasingly recognized as a contributor to pediatric obstructive sleep apnea (OSA). This study compares whether addressing supraglottic obstruction with concurrent supraglottoplasty (SGP) at the time of tonsillectomy and adenoidectomy (T&A) is associated with improved polysomnographic outcomes compared with T&A alone.

Methods: A retrospective matched cohort study was performed for children aged 0–17 years undergoing T&A with or without SGP for OSA at a tertiary pediatric center from 2018–2025. The primary outcome was change in AHI on polysomnography. Secondary outcomes included length of stay, 30-day postoperative complications, readmission, and return to the operating room. Patients were matched on age. Analyses included descriptive statistics and matched comparisons.

Results: Of 266 eligible patients, those undergoing T&A+SGP were younger prior to matching (p < 0.001). After age matching, 104 patients were analyzed (T&A+SGP n=26; T&A alone n=78) with comparable demographics, baseline AHI, BMI, and comorbidities. Congenital laryngomalacia and concurrent microlaryngoscopy and bronchoscopy or drug-induced sleep endoscopy were more frequent in the T&A+SGP group (p < 0.001). Median AHI improvement was similar between groups (14.5 vs 17.5 events/hour). Adjusted analyses demonstrated no significant differences in postoperative AHI outcomes, length of stay, 30-day readmission, or complications.

Conclusions: Concurrent SGP with T&A is a safe and effective surgical treatment for pediatric OSA. In this age-matched cohort, concurrent SGP at the time of T&A was not associated with significant differences in postoperative polysomnographic outcomes compared with T&A alone. Further studies are needed to better identify which patients are most likely to benefit from SGP, potentially through drug-induced sleep endoscopy–directed patient selection algorithms.