Self-Supporting Nasopharyngeal Airway (ssNPA) Treating Upper Airway Obstruction in Hypotonia

Inclusion Criteria:

• Children with Hypotonic Upper Airway Obstruction (HUAO): This includes those whonewly diagnosed with obstructive sleep apnea (OSA). These children will undergoovernight polysomnography to determine the presence of OSA (apnea-hypopnea index [AHI]>10 or AHI>5 with nocturnal hypoxemia defined as oxygen saturation by pulseoximetry [SpO2] nadir <=75%).

• All subjects require the presence of at least one symptom of OSA (such as snoring 3or more nights per week, daytime sleepiness, or hyperactive/inattentive behaviors)

• Post adenotonsillectomy or those with contraindications to tonsillectomy.

• Tonsil size 2+ or smaller.

• Parent/caregivers willing and able to provide informed consent and child willing andable to provide assent, where appropriate.

Exclusion Criteria:

• AHI ≤10 on polysomnogram (PSG) without hypoxemia or AHI<5 with hypoxemia.

• Any medical reason why Self-Supporting Nasopharyngeal Airway (ssNPA) therapy may notbe suitable

• Active Coronavirus (COVID) 19 infections

• End-tidal carbon dioxide (ETCO2) or Transcutaneous carbon dioxide (TCO2) values >60mmHg for >10% of sleep time on PSG

• Psychiatric, medical, or social factors likely to invalidate assessments, makeadherence with ssNPA highly unlikely or make local follow-up at 8 weeks unfeasible.Some psychiatric conditions may be provoked or exacerbated by OSA, and those mostcommonly implicated - Attention Deficit/Hyperactivity Disorder, Conduct Disorder,and Oppositional Defiant Disorder - will not be exclusions. However, more pervasiveconditions such as severe autism will be excluded.

• Presence of supraglottic airway collapse or more distal airway stenosis or collapse (for example glottic, subglottic stenosis, or concern for distal airway stenosis ormalacia)

• Moderate/severe tracheobronchomalacia

• Need for anticoagulative therapy

• Bleeding disorder

• Restrictive thoracic disorders