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

L Coutier1, A Guyon2, P Reix3

  • 1Service de pneumologie infantile, allergologie et centre de référence en mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; U1028, CNRL, Université de Lyon 1, France.

Sleep Medicine
|January 7, 2019
PubMed

Insights

Prone positioning improves sleep efficiency in infants with Pierre Robin sequence (PRS) and obstructive sleep apnea syndrome (OSAS). Polysomnography is recommended for early evaluation to determine the best treatment strategy.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Genetics and Rare Diseases

Background:

  • Obstructive sleep apnea syndrome (OSAS) is highly prevalent in infants with Pierre Robin sequence (PRS).
  • Prone positioning (PP) is a common recommendation for managing OSAS in PRS infants, but its efficacy has not been rigorously evaluated using polysomnography (PSG).

Purpose of the Study:

  • To investigate the impact of prone positioning (PP) on sleep and respiratory parameters in infants with Pierre Robin sequence (PRS) using polysomnography (PSG).

Main Methods:

  • A retrospective study involving 18 infants with PRS evaluated between 2015 and 2017.
  • Polysomnography (PSG) with pulse oximetry and transcutaneous carbon dioxide monitoring was conducted in both supine (SP) and prone positions (PP).
  • Sleep and respiratory outcomes were compared between the two positions.

Main Results:

  • Eleven of 18 PRS infants presented with clinical signs of OSAS, all diagnosed with severe OSAS on PSG.
  • Infants in the PP position demonstrated significantly higher sleep efficiency (83% vs. 70%, p=0.04) compared to the SP.
  • A trend towards a lower apnea-hypopnea index (AHI) during REM sleep was observed in the PP (50/h vs. 61/h, p=0.05).
  • Prone positioning was identified as the optimal sleep position for 72% of the infants.

Conclusions:

  • Prone positioning improves sleep quality in PRS infants with OSAS.
  • While PP offers benefits, it does not fully correct OSAS in most cases.
  • Systematic nocturnal polysomnography is crucial for early assessment and selecting the optimal therapeutic approach for OSAS in PRS infants.
Abstract

Keywords:
InfantsPediatricPierre Robin sequencePolysomnographyProne positioningSleep

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