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Upper airway obstruction during sleep in infants with laryngomalacia is frequently sleep-position-dependent

Turkka Kirjavainen1,2,3, Mervi Kanerva4, Hanna-Leena Kukkola5,6

  • 1Department of Pediatrics, New Children's Hospital, Helsinki, Finland. turkka.kirjavainen@hus.fi.

Pediatric Research
|February 13, 2025
PubMed

Insights

Infants with laryngomalacia experience more severe obstructive breathing when sleeping on their back. Side sleeping positions significantly reduce obstructive events and breathing effort in these infants.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Congenital Airway Anomalies

Background:

  • Laryngomalacia is the most frequent congenital anomaly affecting infant airways, often leading to breathing difficulties.
  • Severe cases of laryngomalacia are frequently linked to obstructive sleep apnea (OSA).

Purpose of the Study:

  • To investigate the impact of sleep position on obstructive breathing events in infants diagnosed with laryngomalacia.
  • To analyze polysomnography (PSG) data to quantify the severity of upper airway obstruction in different sleep positions.

Main Methods:

  • Retrospective analysis of polysomnography (PSG) data from 79 infants with fluoroscopy-verified laryngomalacia.
  • Evaluation of sleep stage and position-dependent breathing patterns, including obstructive apnea and hypopnea index (OAHI).
  • Comparison of respiratory parameters, such as OAHI and end-tidal carbon dioxide levels, between supine and side sleeping positions.

Main Results:

  • Obstructive breathing events were significantly more frequent and severe in the supine sleeping position (median OAHI: 22/h) compared to the side sleeping position (median OAHI: 7/h).
  • Breathing effort and end-tidal carbon dioxide levels were higher in the supine position, indicating more laborious breathing.
  • The severity of OSA (OAHI) showed a weak correlation with the clinical severity score of laryngomalacia.

Conclusions:

  • Upper airway obstruction in infants with laryngomalacia is significantly influenced by sleep position, being more severe when supine.
  • Side sleeping positions can effectively reduce the frequency and severity of obstructive breathing events in infants with laryngomalacia.
  • While side sleeping offers benefits, individual responses may vary, necessitating personalized management strategies.
Abstract

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