Should obstructive hypopneas be included when analyzing sleep studies in infants with Robin Sequence?

Area of Science:

• Pediatric Sleep Medicine
• Neonatology
• Genetics and Rare Diseases

Background:

• Robin sequence (RS) is a congenital condition often associated with upper airway obstruction and obstructive sleep apnea (OSA).
• Current treatment indications for OSA in RS infants vary, with some centers using an obstructive apnea index (OAI) ≥3, while others internationally use the obstructive apnea-hypopnea index (OAHI) ≥5.

Purpose of the Study:

• To compare the treatment indications derived from OAI and OAHI in infants with RS.
• To assess the interobserver variability associated with each scoring method.

Main Methods:

• Twenty overnight polysomnographies from infants with isolated RS were scored according to 2020 American Academy of Sleep Medicine guidelines.
• Scoring was performed both including and excluding obstructive hypopneas to calculate OAI and OAHI, respectively.

Main Results:

• The median OAI was 18, while the median OAHI was 35, effectively doubling the event rate when hypopneas were included.
• Reclassification of OSA severity occurred for two infants upon inclusion of hypopneas, but did not alter clinical management.
• Median interobserver agreement was higher for OAI (0.86) compared to OAHI (0.60).

Conclusions:

• Including obstructive hypopneas in OSA assessment for RS infants significantly increases the event rate but does not change clinical management decisions.
• The OAI demonstrates better interobserver agreement than the OAHI for this population.
• The findings suggest that the OAI may be a more reliable and clinically relevant metric for guiding OSA treatment in infants with Robin sequence.