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Polysomnographic results of prone versus supine positioning in micrognathia
Adam J Kimple1, Cristina M Baldassari2, Aliza P Cohen3
1Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, United States.
Insights
Prone positioning improved obstructive sleep apnea (OSA) in most micrognathic children studied. Polysomnography (PSG) is recommended to assess airway obstruction and oxygenation in these infants.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Neonatology
Background:
- Micrognathia in children often leads to upper airway obstruction and obstructive sleep apnea (OSA).
- Prone positioning is a common initial treatment for obstructive symptoms in infants with micrognathia.
- The study aimed to evaluate positioning's impact on oxygenation and airway obstruction via polysomnography (PSG).
Purpose of the Study:
- To assess the effect of prone versus supine positioning on polysomnography (PSG) indices in infants with micrognathia.
- To determine the impact of positioning on obstructive apnea-hypopnea index (oAHI) and oxygen saturation.
Main Methods:
- Three infants diagnosed with micrognathia underwent polysomnography (PSG).
- PSG recordings were conducted with infants in both prone and supine positions.
Main Results:
- Supine obstructive apnea-hypopnea indices (oAHI) were severe in all three infants (mean 21.9 events/hour).
- Prone positioning significantly improved oAHI in two of three infants (mean 5.1 events/hour).
- Oxygen saturation improved in two infants, with one showing increased central apnea events in the supine position.
Conclusions:
- Prone positioning demonstrated improvement in obstructive sleep apnea (OSA) indices in micrognathic infants.
- OSA persisted in two of three infants despite prone positioning.
- Routine polysomnography (PSG) is recommended for micrognathic children undergoing prone positioning for airway obstruction.
Background:
Children with micrognathia commonly present with upper airway symptoms and are at risk for developing obstructive sleep apnea (OSA). Prone positioning is widely used as first-line management for micrognathic children with obstructive symptoms. The aim of the present study was to document the effect of positioning on oxygenation and upper airway obstruction as measured by polysomnography (PSG).
Methods:
Three children with micrognathia from two institutions underwent PSG in both the prone and supine position.
Results:
Patient ages were 1 week, 3 months, and 7 months. Supine obstructive apnea-hypopnea indices (oAHI) were severe for all 3 children, with a mean of 21.9 events/hour (range 16.8 to 26.3). In the prone position, the oAHI significantly improved in 2 of 3 children, with a mean of 5.1 events/hour (range 0.3 to 10.3). The frequency of central apnea events increased in 1 child following supine positioning. Nadir oxygen saturation improved in 2 of 3 children and remained within normal limits in the third.
Conclusions:
This is the first report of the effect of positioning on changes in PSG indices of micrognathic children. Improvement in obstructive PSG indices occurred with prone positioning, though OSA persisted in 2 of 3 children. The effect of positioning on central apnea was unclear. In light of these findings, we recommend that routine PSG be considered in micrognathic children undergoing prone positioning for definitive therapy of upper airway obstruction.
