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Characterizing Differences in Polysomnography Data for Children With Robin Sequence Undergoing Conservative and

Angelica M Walker¹, Thomas Gao¹, Shaun A Nguyen¹

¹Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|October 14, 2025

Summary

Infants with Robin sequence (RS) often have severe obstructive sleep apnea. Surgical interventions like mandibular distraction osteogenesis (MDO) and tongue-lip adhesion (TLA) significantly improve sleep apnea findings.

Keywords:

Pierre Robin Robin sequence airway obstruction micrognathia obstructive sleep apnea polysomnography

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Area of Science:

Pediatric Sleep Medicine
Craniofacial Surgery
Genetics

Background:

Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction.
Obstructive sleep apnea (OSA) is a common and serious comorbidity in infants with RS, impacting their health and development.

Purpose of the Study:

To conduct a meta-analysis of polysomnography (PSG) findings in infants diagnosed with Robin sequence (RS).
To evaluate the effectiveness of different interventions for sleep-disordered breathing in this population.

Main Methods:

A systematic literature search was performed across CINAHL, Cochrane Library, PubMed, and Scopus.
Meta-analysis of mean differences, proportions, and continuous measures with 95% confidence intervals was conducted using random and fixed effects models for studies reporting PSG results before and after intervention.

Main Results:

Analysis of 45 studies (1881 infants) revealed that 79.88% of infants with RS presented with severe obstructive sleep apnea at baseline.
Mandibular distraction osteogenesis (MDO) and tongue-lip adhesion (TLA) interventions led to significant improvements in the apnea-hypopnea index (AHI) and SpO2 nadir.
While both MDO and TLA showed efficacy, TLA had slightly higher rates of postoperative tracheostomy.

Conclusions:

Infants with RS and an AHI nearing 30 commonly undergo surgical intervention.
PSG findings demonstrate significant improvement post-MDO and TLA, with a low need for further surgical procedures like tracheostomy.
Future research should focus on integrating PSG data with clinical information to develop management algorithms for RS-related sleep apnea.