Title: The Effect of Body Position on Sleep Apnea in Children Younger Than 3 Years

Authors: Kevin D. Periera, MD; Jeremy C. Roebuck, MD; Lori Howell, BS

Published: ARCH OTOLARYGOL HEAD NECK SURG/VOL 131. NOV 2005
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Summary:
The Objective of this study was "To determine the association between body position and obstructive events during determined by polysomnography (PSG) in very young children (age, <= 3 years) with obstructive sleep apnea syndrome.

All children subsequently underwent adenotonsillectomy.

"The PSGs were analyzed for data on the respiratory disturbance index (RDI), time spent in each body position, number of apneic events in each position, oxygen saturation, and time spent in each stage of sleep."

Results:
"Sixty patients satisfied the criteria for inclusion in the study. The mean supine sleep RDI was 8.5 compared with 4.9 for the mean nonsupine sleep RDI. The mean RDI increased from 5.6 to 8.5 when more than 50% of the time was spent in supine sleep. There was a further increase to 10.5 when supine sleep increased to 75% of the total sleep time. The mean RDI in rapid eye movement sleep was 20.5 compared with 5.3 in non-rapid eye movement sleep. The mean +- SD supine sleep RDI was 18.5 +- 5.1, and the mean nonsupine RDI was 7.2 +- 1.9, which was statistically significant (P=.02)."

"Obstructive Sleep Apnea syndrome is a serious medical problem, affecting 500,000 children per year in the United States. Pediatric OSAS peaks between the ages of 2 and 5 years, with an overall prevalence of 2% (3). The hallmarks of OSAS include episodes or partial or complete upper airway obstruction that occur during sleep, manifested by snoring, retractions, paradoxical chest motion, and poor quality of sleep. The condition is usally accompanied by a nocturnal reduction in oxygen saturation and bypercarbia (3). Symptoms during the day include mouth breathing, behavior problems, hyperactivity, and excessive daytime sleepiness (less than in adults). Nocturnal enuresis and asphyxic encephalopathy have also been reported. When these manifestations result from adenotonsillar hypertrophy, most of them have been shown to be reversed adenotonsillectomy (4)"

"The results of our study indicate that supine sleep does correlate with an increase in RDI as well as with OSAS in pediatric patients younger than 3 years. This finding is in contrast to previous studies that have demonstrated no correlation between sleep position and OSAS in children (2). In 2001, Penzel et al (6) demonstrated the collapsibility of the upper airways in adults who were in the supine position and showed that this outcome depended on sleep position and not sleep stage. However, adult sleep apnea differs from pediatric apnea in several aspects, and the exact mechanism of pediatrics OSAS has not been fully elucidated. A recent study suggested that children younger than 10 years actually breathe better in the supine position than in the lateral or the prone position (2). In that study, the patients had a lower RDI in the supine position compared with other positions. Our study in very young children showed evidence to the contrary. Our observations suggest that toddlers have sleep characteristics that are different from those of older children."