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Characteristics of sleep apnea in infants with Pierre-Robin sequence: Is there improvement with advancing age?

Jake J Lee1, Prasad J Thottam2, Matthew D Ford3

  • 1University of Pittsburgh School of Medicine, Department of Otolaryngology, 3550 Terrace St, Pittsburgh, PA 15261, United States.

International Journal of Pediatric Otorhinolaryngology
|October 3, 2015
PubMed

Insights

Infants with Pierre-Robin sequence (PRS) do not show decreased sleep apnea severity with age. Mandibular distraction osteogenesis (MDO) significantly improves both obstructive and central sleep apnea in these infants.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Craniofacial Surgery

Background:

  • Pierre-Robin sequence (PRS) is associated with upper airway obstruction and sleep-disordered breathing.
  • Obstructive sleep apnea (OSA) and central sleep apnea (CSA) are common in infants with PRS.
  • The natural course of sleep apnea severity with age in PRS is not well-established.

Purpose of the Study:

  • To evaluate changes in OSA and CSA in infants with PRS as they age.
  • To assess the impact of mandibular distraction osteogenesis (MDO) on sleep apnea in infants with PRS.

Main Methods:

  • Retrospective chart review of 141 infants with PRS.
  • Polysomnography (PSG) data analyzed for apnea-hypopnea index (AHI), obstructive apnea-hypopnea index (OAHI), and central apnea index (CAI).
  • Comparison of pre- and post-operative PSG data in 9 patients who underwent MDO.

Main Results:

  • 80% of infants with PRS had severe sleep apnea (AHI≥10) at initial PSG.
  • No significant decrease in AHI, OAHI, or CAI was observed with increasing age up to one year.
  • MDO significantly reduced AHI, OAHI, CAI, and improved oxygen saturation (SaO2) nadir and percentage of time with SaO2 <90%.

Conclusions:

  • Unlike in non-PRS populations, sleep apnea severity does not naturally decrease with age in infants with PRS.
  • MDO is an effective surgical intervention for improving both obstructive and central sleep apnea in infants with PRS.
Abstract

Keywords:
Airway obstructionCentral sleep apneaMandibular distraction osteogenesisObstructive sleep apneaPierre-Robin sequencePolysomnogram

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