Xiao Lena, Baker Adele, Massicotte Colin, Reyna Myrtha E, Shi Jenny, Wolter Nikolaus E, Propst Evan J, Mahant Sanjay, Amin Reshma, Parekh Rulan S, Narang Indra
Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, M5G 1E8, Canada; University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada; Department of Pediatrics, British Columbia Children's Hospital, 4500 Oak Street, Vancouver, V6H 3N1, Canada; University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, V6T 1Z3, Canada.
Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, M5G 1E8, Canada.
Sleep Med. 2025 Jun;130:48-55. doi: 10.1016/j.sleep.2025.03.022. Epub 2025 Mar 28.
Obstructive sleep apnea (OSA) is prevalent in children, but many children remain untreated. Up to one half of children with OSA have positional OSA, a phenotype characterized by the predominance of airway obstruction while supine. Positional devices that prevent sleeping supine may be beneficial for positional OSA. We evaluated the efficacy of positional devices for treating positional OSA in children.
This was a randomized crossover trial of children aged 4-18 years old with positional OSA. There were two treatment periods separated by 1-4 weeks. Each period consisted of a one-night in-laboratory polysomnogram with the experimental intervention (positional device with inflated cushions) or the inactive control (positional device with no cushions). The primary outcome was the difference in the obstructive apnea-hypopnea index (OAHI) between positional therapy and the control.
24 participants were randomized (median age = 9.0 years, 63% males). The adjusted relative percentage difference in the OAHI (positional therapy minus control) was -29.9% (95% CI -55.9% to 11.6%; p = 0.13). The adjusted relative percentage differences for the desaturation index, arousal index, and percentage of total sleep time supine were -23.4% (95% CI -45.0% to 6.7%; p = 0.11), -16.7% (95% CI -30.8% to 0.22%; p = 0.053), and -65.9% (95% CI -79.3% to -43.9%; p<0.001), respectively. There were no significant differences in comfort scores or adverse events.
Positional therapy reduced supine sleep time, but did not reduce the OAHI in all participants. Future studies with larger sample sizes to evaluate heterogeneity of treatment effects are warranted.
阻塞性睡眠呼吸暂停（OSA）在儿童中很常见，但许多儿童仍未得到治疗。高达一半的OSA儿童患有体位性OSA，其特征是仰卧时气道阻塞占主导地位。防止仰卧睡眠的体位装置可能对体位性OSA有益。我们评估了体位装置治疗儿童体位性OSA的疗效。
这是一项针对4至18岁体位性OSA儿童的随机交叉试验。有两个治疗期，间隔1至4周。每个时期包括一个在实验室进行的一晚多导睡眠图检查，采用实验干预（带充气垫的体位装置）或无活性对照（无垫的体位装置）。主要结局是体位治疗与对照之间阻塞性呼吸暂停低通气指数（OAHI）的差异。
24名参与者被随机分组（中位年龄 = 9.0岁，63%为男性）。OAHI的调整后相对百分比差异（体位治疗减去对照）为-29.9%（95%可信区间-55.9%至11.6%；p = 0.13）。去饱和指数、觉醒指数和仰卧总睡眠时间百分比的调整后相对百分比差异分别为-23.4%（95%可信区间-45.0%至6.7%；p = 0.11）、-16.7%（95%可信区间-30.8%至0.22%；p = 0.053）和-65.9%（95%可信区间-79.3%至-43.9%；p<0.001）。舒适度评分或不良事件无显著差异。
体位治疗减少了仰卧睡眠时间，但并非所有参与者的OAHI都有所降低。有必要进行更大样本量的未来研究以评估治疗效果的异质性。
