Does a clinical assessment of upper airway obstruction in robin sequence correspond to sleep study results?

Upper airway obstruction (UAO) often remains undetected in infants and may result in an increased work of breathing, failure to thrive and fragmented sleep, potentially impairing neurocognitive development.

In a prospective randomized crossover study, we evaluated our neonatal care team's subjective assessment of obstructive sleep apnea severity in infants with Robin sequence admitted to Tuebingen University Children's hospital (April 2021-May 2023). Assessments were done in supine and prone position using a standardized questionnaire. Ratings were compared with polygraphy-derived metrics, including the obstructive apnea index (OAI), oxygen desaturation index <80%, mean pulse oximeter saturation and transcutaneous carbon dioxide levels, respiratory and heart rate.

Twenty-nine infants were included; 21 were assessed in both sleep positions, six only in supine and two only in prone position. A total of 143 questionnaires were completed (median of 5 [IQR: 1] evaluations per sleep position per infant). The supine position was associated with, on average, a 9.9 (95% CI 5.9, 13.9) events/hour higher subjective OAI than prone. Raters correctly identified severe obstructive sleep apnea (OSA) in 56% of cases in supine position and 58% in prone position. Subjective OAI estimates were systematically lower than objectively derived values, with polygraphy revealing, on average, a 12.7 (95% CI: 2.8, 22.5) events/hour higher OAI. Prediction accuracy did not significantly vary by profession or years of experience.

Subjective OAI estimates were significantly lower than objectively derived values, underscoring the need for sleep studies to avoid underestimating airway obstruction severity.