Kevat Ajay, Alwadhi Dhruv, Chew Ai Xin, Iyer Kartik, Chawla Jasneek, Suresh Sadasivam, Collaro Andrew
Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
J Sleep Res. 2025 Aug;34(4):e14443. doi: 10.1111/jsr.14443. Epub 2025 Jan 7.
Positional obstructive sleep apnea, in which there is a ≥ 2:1 predominance of obstructive events in the supine position, is a sleep-disordered breathing phenotype with a targeted treatment in the form of positional device therapy. We sought to determine the prevalence of positional obstructive sleep apnea in a cohort of children prescribed continuous positive airway pressure therapy, ascertain risk factors for the condition, and determine the associated continuous positive airway pressure treatment adherence rate. A retrospective cohort study of all children > 2 years old from a single tertiary paediatric centre prescribed continuous positive airway pressure therapy over an 8-year period was conducted. Positional obstructive sleep apnea prevalence was established by analysing positional and respiratory event data from the participants' original diagnostic polysomnography. Continuous positive airway pressure therapy adherence was determined using data from machine download. Univariable and multivariable logistic regression modelling was used to determine participant demographic and clinical factors associated with positional obstruction. Positional obstructive sleep apnea (defined by Bignold's criteria modified for paediatric use) prevalence in the cohort of 237 analysed participants was 38%. Suboptimal continuous positive airway pressure adherence was noted in 30% of this group based on initial machine download, performed a median of 96 days post-treatment initiation. Higher age and lower obstructive apnea-hypopnea index were independent predictors of positional obstructive sleep apnea, whereas neurodevelopmental diagnosis, presence/absence of rapid eye movement-related obstructive sleep apnea, overweight/obesity status and history of adenoidectomy/adenotonsillectomy were not. For children, positional device therapy is a treatment option worthy of further consideration and research.
体位性阻塞性睡眠呼吸暂停是一种睡眠呼吸紊乱表型，其仰卧位阻塞性事件占比≥2:1，可通过体位性装置疗法进行针对性治疗。我们试图确定接受持续气道正压通气治疗的儿童队列中体位性阻塞性睡眠呼吸暂停的患病率，确定该病症的危险因素，并确定相关的持续气道正压通气治疗依从率。对一家三级儿科中心8年内所有2岁以上接受持续气道正压通气治疗的儿童进行了一项回顾性队列研究。通过分析参与者原始诊断多导睡眠图中的体位和呼吸事件数据来确定体位性阻塞性睡眠呼吸暂停的患病率。使用机器下载数据确定持续气道正压通气治疗的依从性。采用单变量和多变量逻辑回归模型来确定与体位性阻塞相关的参与者人口统计学和临床因素。在237名接受分析的参与者队列中，体位性阻塞性睡眠呼吸暂停（根据针对儿科使用修改的比尼奥尔德标准定义）的患病率为38%。根据治疗开始后中位数为96天进行的首次机器下载，该组中有30%的人持续气道正压通气依从性欠佳。年龄较大和阻塞性呼吸暂停低通气指数较低是体位性阻塞性睡眠呼吸暂停的独立预测因素，而神经发育诊断、快速眼动相关阻塞性睡眠呼吸暂停的有无、超重/肥胖状态以及腺样体切除术/腺样体扁桃体切除术史则不是。对于儿童来说，体位性装置疗法是一个值得进一步考虑和研究的治疗选择。
