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Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants

Hanna-Leena Kristiina Kukkola1,2, Pia Vuola2,3, Maija Seppä-Moilanen1,2

  • 1Department of Pediatrics, New Children's Hospital, Helsinki, Finland.

Archives of Disease in Childhood
|July 10, 2021
PubMed

Insights

Sleep positioning significantly impacts obstructive sleep apnoea (OSA) in Pierre Robin sequence (PRS) infants. Prone or side sleeping positions are milder for OSA compared to supine, supporting positional therapy.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Genetics and Rare Diseases

Background:

  • Obstructive sleep apnoea (OSA) and feeding difficulties are primary concerns for infants with Pierre Robin sequence (PRS).
  • Current management strategies for OSA in PRS infants lack standardized evaluation, particularly regarding the effectiveness of traditional sleep positioning.
  • The variability in OSA treatment approaches necessitates a clearer understanding of positional influences.

Purpose of the Study:

  • To evaluate the impact of different sleep positions on obstructive sleep apnoea (OSA) in infants diagnosed with Pierre Robin sequence (PRS).
  • To assess the efficacy of positional therapy as a component of OSA management in this specific infant population.

Main Methods:

  • A polysomnographic (PSG) evaluation was conducted on 67 infants with PRS under 3 months of age.
  • Daytime PSG recordings were performed in supine, side, and prone sleeping positions for each infant, when feasible.
  • Sleep recordings typically included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep per position.

Main Results:

  • A significant majority of infants (82%) exhibited OSA during PSG, with obstructive apnoea and hypopnoea index (OAHI) >5 per hour.
  • OSA severity was demonstrably position-dependent, being most severe in the supine position (median OAHI 31) and mildest in the side (median OAHI 16) or prone (median OAHI 19) positions (p=0.003).
  • For 68% of infants, positional therapy alone or no treatment was deemed sufficient, indicating the potential role of sleep positioning.

Conclusions:

  • The incidence of OSA in the studied PRS infant cohort was high (84%), with many cases being sleep position-dependent.
  • Polysomnography (PSG) is a valuable tool for evaluating OSA in PRS infants.
  • Sleep positioning should be considered a key component in the treatment strategy for OSA in Pierre Robin sequence infants.
Abstract

Keywords:
growthsleep

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