Polysomnography: assessment of decannulation readiness in chronic upper airway obstruction

Nikolaus E Wolter, Jennifer Anderson
Laryngoscope 2014, 124 (11): 2574-8

OBJECTIVES/HYPOTHESIS: To evaluate the clinical value of polysomnography in patients with a tracheotomy due to chronic upper airway obstruction prior to attempting decannulation.

STUDY DESIGN: Retrospective chart review.

METHODS: Subjects with chronic upper airway obstruction were identified using a clinical database between 2000 and 2014. All subjects had a tracheotomy, were assessed by the senior author in a tertiary care academic center, and underwent polysomnography prior to attempting decannulation. Patients were excluded if they did not undergo polysomnography or had severe obstructive sleep apnea as the primary indication for tracheotomy.

RESULTS: Fifteen patients were identified. The majority (87.5%) of patients were successfully decannulated after their first polysomnography showed acceptable results when carried out with the tracheotomy occluded. Obstructive sleep apnea was identified in four of the nine patients who tolerated overnight tracheotomy occlusion, and continuous positive airway pressure (CPAP) was initiated. An additional four of the remaining six patients were decannulated after subsequent polysomnography demonstrated improvement with CPAP, and two required an additional airway procedure.

CONCLUSIONS: Chronic upper airway obstruction requiring tracheotomy can be challenging to treat and successfully decannulate. Indirect laryngoscopy is essential to evaluate the anatomy of the larynx; however, it cannot assess potential increased obstruction during sleep. The study indicates that polysomnography can assist with the evaluation of decannulation readiness in patients with chronic upper airway obstruction as an adjunct measure in addition to imaging and laryngoscopy.


Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"