Department of Pediatrics, New Children's Hospital, Helsinki, Finland.
Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
Pediatr Res. 2023 Apr;93(5):1361-1367. doi: 10.1038/s41390-022-02202-9. Epub 2022 Aug 16.
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.
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.
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 (IQR 4-20 h), and in the side position was 4 h (IQR 0-10 h).
Obstructive upper airway events in young infants are more frequent when supine than when sleeping on the side.
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.
患有 Pierre Robin 序列的婴儿的阻塞性睡眠呼吸暂停与睡眠姿势有关。其他婴儿的睡眠姿势对阻塞性事件的影响尚未确定。
我们重新评估了十年小儿睡眠中心的数据，这些数据来自年龄小于 6 个月的婴儿，在不同的睡眠姿势下进行了多导睡眠图检查。我们排除了患有综合征、遗传缺陷或结构异常的婴儿。
在中位校正年龄为 4 周（四分位距（IQR）2-8 周）的 72 名婴儿中，比较了仰卧位和侧卧位的呼吸情况。这些婴儿中，74%为男性，35%为早产儿，35%因威胁生命的事件或 SIDS 兄弟姐妹而进行研究。仰卧位时上气道阻塞更为频繁（阻塞性呼吸暂停低通气指数（OAHI），p<0.001），95%呼气末二氧化碳水平更高（p=0.004），呼吸功更重（p=0.002）。仰卧位时的 OAHI 中位数为 8 小时（IQR 4-20 小时），侧卧位时为 4 小时（IQR 0-10 小时）。
仰卧位时，婴儿的上气道阻塞性事件比侧卧时更为频繁。
除了患有 Pierre Robin 序列的婴儿外，睡眠姿势对阻塞性睡眠呼吸暂停的影响尚未得到充分证实。在大多数小于 6 个月的婴儿中，上气道阻塞倾向于与姿势有关。仰卧位时，上气道阻塞更常见，呼气末二氧化碳 95%分位值更高，呼吸更费力。上气道阻塞和阻塞性事件在 REM 睡眠中占主导地位。作为治疗婴儿阻塞性睡眠呼吸暂停的一部分，侧卧定位可能会证明有用。
