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Sleep Study with Tracheotomy

last modified on: Wed, 12/06/2017 - 11:41

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Sleep Study with Tracheotomy

Return to:Tracheotomy - Tracheostomy

The presence of an occluded ('corked') tracheotomy tube may impair airflow even when the patient can breath and speak around it.  The practice of performing a sleep study with the tracheotomy tube occluded is reasonable in some cases, but may not be optimal in all cases.

The practice of performing a sleep study with a tracheotomy tube in place can be difficult due to:

   a. Impaired airflow through a semi-occluded trachea (with the tube - see photos below)

   b. Difficulty with leakage around the tracheotomy tube with implementation of CPAP

S/P Chemoradiation and H/O OSAS desiring tracheotomy removalOther options for optimal testing (sleep study in a patient with a tracheotomy) include:

    a. Removal of trach tube in a controlled setting with taped occlusion of stoma – with capability to rapidly replace original tubes - with smaller tracheotomy tubes available if the stoma decreases in size during the study

    b. Interim use of a Montgomery canula (which does not obstruct the lument) occluded for the sleep study (see: Montgomery Canula Tracheotomy)

Past studies investigating the use of sleep study in patients with a tracheotomy prior to decannulation have reported varying protocols.  Mukherjee et al. (1999) and Tunkel et al. (1996) performed polysomnography on pediatric patients after the tracheotomy tube has been downsized 2 sizes and occluded for varying duration prior to sleep study.  Wolter and Anderson (2012) did not downsize the tracheostomy tube prior to occlusion and polysomnography in adult patients.

 

Mukherjee B, Bais AS, Bajaj Y. Role of polysomnography in tracheostomy decannulation in the paediatric patient. J Laryngol Otol. 1999 May;113(5):442-5

Tunkel DE, McColley SA, Baroody FM, Marcus CL, Carroll JL, Loughlin GM. Polysomnography in the evaluation of readiness for decannulation in children. Arch Otolaryngol Head Neck Surg. 1996 Jul;122(7):721-4

Wolter NE, Anderson J. Polysomnography: Assessment of Decannulation Readiness in Chronic Upper Airway Obstruction.  Triological Society Posters. 2012 December, accessed at http://www.triomeetingposters.org/wp-content/uploads/2012/12/2-213.pdf