Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know

Bandyopadhyay, Anuja; Daftary, Ameet S.

doi:10.1177/0009922820915733

Cited by 6 publications

(8 citation statements)

References 56 publications

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“…Infants commonly experience single obstructive events during sleep. 1 – 3 However, severe adult-type obstructive sleep apnea (OSA) is rare and often related to syndromes such as Pierre Robin sequence (PRS). 1 , 3 , 4 Obstructive events in infants show REM-sleep dominancy, and they do not commonly interrupt sleep to the same degree as in adults.…”

Section: Introductionmentioning

confidence: 99%

“… 1 – 3 However, severe adult-type obstructive sleep apnea (OSA) is rare and often related to syndromes such as Pierre Robin sequence (PRS). 1 , 3 , 4 Obstructive events in infants show REM-sleep dominancy, and they do not commonly interrupt sleep to the same degree as in adults. 1 Gastroesophageal reflux appears to lead to increased numbers of obstructive events, although the reflux and apnea episodes do not generally appear simultaneously.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 3 , 4 Obstructive events in infants show REM-sleep dominancy, and they do not commonly interrupt sleep to the same degree as in adults. 1 Gastroesophageal reflux appears to lead to increased numbers of obstructive events, although the reflux and apnea episodes do not generally appear simultaneously. 5 The significance of OSA in infants is not yet established.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 7 Currently, no consensus exists: neither as to criteria for degree of upper airway obstruction should be considered OSA nor when OSA should be treated. 1 …”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 6 , 7 Currently, no consensus exists: neither as to criteria for degree of upper airway obstruction should be considered OSA nor when OSA should be treated. 1 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Obstructive sleep apnea is position dependent in young infants

Kukkola

Kirjavainen

2022

Pediatr Res

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“…1 Specifically, certain data suggests that as the infant airway matures and becomes larger in diameter, there is a natural decline in AHI. [6][7][8][9] Katz et al found that in normal neonates without OSA, the OAHI events per hour averages between 0.6-2 e/h under 2 months, and reaches an average of <0.5 e/hour by the time the child reaches 12 months. 1 Similarly, Brockmann et al also found different AHI values for children under 3 months compared with children older than 3 months.…”

Section: Discussionmentioning

confidence: 99%

Phenotypical Characterization of Obstructive Sleep Apnea in Premature Infants using Polysomnography

Zalzal,

Newman,

Behzadpour

et al. 2023

The Laryngoscope

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ObjectiveTo use objective quantification of polysomnographic (PSG) parameters in premature infants to define the severity and nature of obstructions (partial hypopnea vs. total obstruction), along with the impact on sleep fragmentation and oxygenation patterns.MethodsRetrospective comparison of PSG features in 207 infants (<12 months) referred for sleep disordered breathing. Our study groups included term (> = 37 weeks GA, n = 162) and premature (<37 weeks GA, n = 45) infants. Groups were compared for OSA sleep‐stage—specific apnea hypopnea (AHI) indexes (REM and NREM), hypopnea indexes (HI), obstructive apnea indexes (OI) and arousal indexes. Oxygenation was assessed as % of time with SpO2 < 90%, nadir with apneic events and frequency of SpO2 desaturations (>3%) calculated as stage‐specific O2 desaturation indexes.ResultsOverall, premature infants had greater apnea severity (AHI premature 13.9/h vs. Term 7.9/h, p = 0.018). Additional analyses showed that the primary difference between premature and term infants is seen in the group with partial obstructions (HI index) and severe OSA (OAHI> = 10/h). Premature infants also had greater arousal indexes (premature 13.8/h vs. term 10.5/h, p = 0.003). Although the percentage of time <90% at night and the median SpO2 nadir during apneic events was similar in premature vs. term, O2 desaturation indexes were greater in premature infants (10.3/h in term vs. 18.3/h in prematurity, p = 0.03).ConclusionsChildren born premature have an OSA phenotype in infancy characterized by greater severity mostly due to frequent partial obstructions (hypopneas) rather than full obstructions (obstructive apnea). Prematurity is also associated with more intermittent hypoxemia and sleep fragmentation.Level of Evidence3 Laryngoscope, 2023

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Infant sleep: control of breathing and common sleep problems

Gibb

Church

2023

Encyclopedia of Sleep and Circadian Rhythms

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Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know

Cited by 6 publications

References 56 publications

Obstructive sleep apnea is position dependent in young infants

Obstructive sleep apnea is position dependent in young infants

Phenotypical Characterization of Obstructive Sleep Apnea in Premature Infants using Polysomnography

Infant sleep: control of breathing and common sleep problems

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