Sleep position and sleep apnea in newborns

Public health measures recommend that babies sleep supine, but at all other times of life this can worsen sleep apnea. To examine associations between infant sleep position and the apnea-hypopnea index (AHI), we studied polysomnograms of neonates with repaired myelomeningocele, who are often positioned nonsupine during wound healing, and of neonates without congenital anomalies who were recovering in the neonatal intensive care unit (NICU).

We evaluated sleep apnea severity, as reflected by the AHI, in different positions as recorded during polysomnograms from three cohort studies of infants in NICUs. Participants included 173 infants with myelomeningocele (multiple hospitals) and 88 NICU recovery infants across two single-center cohorts. The myelomeningocele cohort was subdivided by repair type (postnatal, open fetal, and fetoscopic surgery groups). We evaluated AHI in different sleep positions using generalized estimating equations to account for repeated measures.

Among 261 neonates, AHI was similar between supine and nonsupine positions in the NICU recovery, postnatal myelomeningocele, and open fetal myelomeningocele groups (adjusted analyses, all p > 0.33). In contrast, the fetoscopic myelomeningocele group had substantially lower AHI when supine (7.94, 95% CI 4.95-12.75) compared to nonsupine (22.1, 95% CI 14.02-35.01; p < 0.001).

Surprisingly, sleep apnea in neonates requiring NICU care may not be exacerbated by supine sleep, with possible exceptions in some specific conditions. Although we did not study healthy newborns, we speculate that obligate nasal breathing in neonates may protect against worsening of sleep apnea when supine. "Back to Sleep" remains life-saving and appears unlikely to increase sleep apnea risk.

Public health measures to prevent SIDS recommend that babies sleep supine. The degree to which sleep position influences sleep apnea in infants is unclear. We had a unique opportunity to study the position dependence of sleep apnea for neonates in the NICU setting, who sometimes sleep in nonsupine positions. As studies at older ages widely show sleep apnea to be worse supine than nonsupine, we hypothesized that we would find the same in neonates.

Study results suggest that sleep apnea severity in neonates who require NICU care is not exacerbated by supine sleep. "Back to Sleep" remains a life-saving intervention for infants upon discharge to home and, moreover, does not appear to increase risk for sleep apnea.