Impact of prone positioning in infants with Pierre Robin sequence: a polysomnography study

Obstructive sleep apnea syndrome (OSA) is frequent in Pierre Robin sequence (PRS) infants. Prone positioning (PP) is commonly recommended but has never been studied by polysomnography (PSG). This study aimed to evaluate the impact of the PP on sleep and breathing outcomes measured by PSG.

Retrospective study conducted between 2015 and 2017 in a tertiary hospital. A PSG with pulse oximetry and transcutaneous carbon dioxide was performed in PRS infants in the supine position (SP) and the PP. Sleep and breathing outcome measures were compared between SP and PP.

Among the 18 PRS (mean ± SD age: 44 ± 26 days at evaluation), 11 had clinical manifestations of OSA. All had severe OSA diagnosed on PSG. In the PP, infants had a significantly higher sleep efficiency (median [IQR]: 83% [69-90]) than in the SP (70% [55-77], p = 0.04). During REM, there was a trend towards lower OAHI in the PP (50/h [28-82] versus 61/h [40-103], p = 0.05). For 13, the PP was the best sleep position (72%), and for four the SP was the best sleep position (22%; p < 0.01). The PP was sufficient alone to decrease OSA index <10 events/hour in three infants.

Positioning infants in the PP led to an improvement of sleep quality and an incomplete correction of OSAS in the vast majority of PRS infants. A nocturnal sleep recording seems to be indicated systematically in the early evaluation of these young patients to choose the best therapeutic option for OSAS.

Not applicable.