Impact of prone positioning in infants with Pierre Robin sequence: a polysomnography study

Coutier, Laurianne; Guyon, Aurore; Reix, Philippe; Franco, Patricia

doi:10.1016/j.sleep.2018.10.037

Cited by 24 publications

(10 citation statements)

References 21 publications

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“…OSA is sleep position dependent in adults, older children and in infants with PRS. 4 , 8 – 10 Only one polysomnography (PSG) -based study concerns the effect of sleep position on upper airway obstruction in infants without any syndrome. Orr and associates 11 showed in 65 infants that upper airway obstruction was neither position- nor sleep-stage dependent.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnea is position dependent in young infants

Kukkola

Kirjavainen

2022

Pediatr Res

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Background Obstructive sleep apnea in infants with Pierre Robin sequence is sleep-position dependent. The influence of sleep position on obstructive events is not established in other infants. Methods We re-evaluated ten-year pediatric sleep center data in infants aged less than six months, with polysomnography performed in different sleep positions. We excluded infants with syndromes, genetic defects, or structural anomalies. Results Comparison of breathing between supine and side sleeping positions was performed for 72 infants at the median corrected age of 4 weeks (interquartile range (IQR) 2-8 weeks). Of the infants, 74% were male, 35% were born prematurely, and 35% underwent study because of a life-threatening event or for being a SIDS sibling. Upper airway obstruction was more frequent (obstructive apnea-hypopnea index (OAHI), p < 0.001), 95th-percentile end-tidal carbon dioxide levels were higher (p = 0.004), and the work of breathing was heavier (p = 0.002) in the supine than in the side position. Median OAHI in the supine position was 8 h−1 (IQR 4–20 h−1), and in the side position was 4 h−1 (IQR 0-10 h−1). Conclusions Obstructive upper airway events in young infants are more frequent when supine than when sleeping on the side. Impact The effect of sleep position on obstructive sleep apnea is not well established in infants other than in those with Pierre Robin sequence. A tendency for upper airway obstruction is position dependent in most infants aged less than 6 months. Upper airway obstruction is more common, end-tidal carbon dioxide 95th-percentile values higher, and breathing more laborious in the supine than in the side-sleeping position. Upper airway obstruction and obstructive events have high REM sleep predominance. As part of obstructive sleep apnea treatment in young infants, side-sleeping positioning may prove useful.

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Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnea is position dependent in young infants

Kukkola

Kirjavainen

2022

Pediatr Res

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“…Very few studies however, objectively documented the effectiveness of prone positioning. A recent PSG‐study in 18 infants with RS (mean age, 1.5 months) found a significantly higher sleep efficiency in the prone position, but no significant reductions in OSA severity 21 . Another study performed sleep studies in supine and non‐supine position in 27 cleft infants with a mean age of 6 months, in whom 56% had RS.…”

Section: Conservative Management Of Rsmentioning

confidence: 99%

“…A recent PSG-study in 18 infants with RS (mean age, 1.5 months) found a significantly higher sleep efficiency in the prone position, but no significant reductions in OSA severity. 21 Another study performed sleep studies in supine and nonsupine position in 27 cleft infants with a mean age of 6 months, in whom 56% had RS. Again, no significant differences emerged between the infants' positions regarding obstructive AHI or the nadir pulse oximeter saturation (SpO 2 ).…”

Section: Prone Positioningmentioning

confidence: 99%

Pierre Robin and breathing: What to do and when?

Poets

Wiechers

Koos

et al. 2021

Pediatric Pulmonology

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Robin sequence is characterized by mandibular retrognathia, airway obstruction, and glossoptosis; 80%–90% also have a cleft palate. Various treatment approaches exist, and although controlled studies are rare, objective assessment of treatment outcomes that address the leading clinical issues, namely obstructive sleep apnea and failure to thrive, are essential. Sleep‐disordered breathing may be detected using cardiorespiratory polygraphy or polysomnography. Pulse oximetry alone may miss infants with frequent obstructive apneas, yet no intermittent hypoxia. Among conservative treatment options, the Tubingen Palatal Plate with a velar extension shifting the tongue base forward is the only approach that corrects the underlying anatomy and that has undergone appropriate evaluation. Of the surgical treatment options, which are not necessarily the first line of therapy, mandibular distraction osteogenesis (MDO) is effective and has been most extensively adopted. Notwithstanding, it is puzzling that MDO is frequently used in some countries, yet hardly ever in others, despite similar tracheostomy rates. Thus, prospective multicenter studies with side‐by‐side comparisons aimed at identifying an optimal treatment paradigm for this potentially life‐threatening condition are urgently needed.

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“…Nowadays, these therapeutic strategies vary from functional therapies as prone positioning (Evans et al, 2011), nasopharyngeal tube (de Buys Roessingh et al, 2007), continuous positive airway pressure (Sullivan et al, 1981) or pre-epiglottic baton plate (Poets et al, 2017) to surgical options as glossopexy-or tongue-lip adhesion (Kirschner et al, 2003), tracheotomy (Tomaski et al, 1995), or mandibular osteodistraction (Tibesar et al, 2010). However, the success rates of these therapeutic strategies are variable (Cheng et al, 2011;Coutier et al, 2019). Moreover, surgical treatments imply some potential risks, such as injuries to facial nerves or dental buds which are difficult to spot in the young patient (Schaefer et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

The Hypoplasic Mandible: What Makes it Different From the Healthy Child?

Remy

Godio‐Raboutet

Captier

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: This study aimed to analyze the morphology of the hypoplasic mandible and its evolution during the growth period to better understand how it differs from the pediatric healthy mandible. Method: Three-dimensional mandibular models of hypoplasic and healthy children aged from 39 gestational weeks to 7 years old were analyzed with a morphometric method including data clustering. Morphological distinctions between pathological and healthy mandibles were highlighted. Bilateral and unilateral mandibular hypoplasia were distinguished. Results: The study sample was composed of 31 hypoplasic children and as many sex- and age-matched healthy children. Morphological distinctions between pathological and healthy mandibles were highlighted only from the first year of life. In bilateral hypoplasia, the overall mandibular dimensions were reduced while there was only a ramus asymmetry in unilateral mandibular hypoplasia (mean ± SD of the difference between the Grp03c and Grp03b subgroups: 6.80 ± 6.37 – P value = 1.64e–3 for the height of the left ramus versus 0.18 ± 4.18 – P value = .82 for the height of the right ramus). Supervised classification trees were built to identify the pathology and discriminate unilateral from bilateral mandibular hypoplasia (prediction rates = 81% and 84%, respectively). Conclusions: Based on a morphometric analysis, we demonstrated that mandibular hypoplasia significantly impacts the mandibular morphology only from the first year of life, with a distinction between bilateral and unilateral hypoplasia.

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Impact of prone positioning in infants with Pierre Robin sequence: a polysomnography study

Cited by 24 publications

References 21 publications

Obstructive sleep apnea is position dependent in young infants

Obstructive sleep apnea is position dependent in young infants

Pierre Robin and breathing: What to do and when?

The Hypoplasic Mandible: What Makes it Different From the Healthy Child?

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