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Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants
  1. Hanna-Leena Kristiina Kukkola1,2,
  2. Pia Vuola2,3,
  3. Maija Seppä-Moilanen1,2,
  4. Päivi Salminen4,
  5. Turkka Kirjavainen1,2,5
  1. 1 Department of Pediatrics, New Children's Hospital, Helsinki, Finland
  2. 2 Pediatric Research Center, Helsinki, Finland
  3. 3 Cleft and Craniofacial Center Husuke, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
  4. 4 Department of Pediatric Surgery, New Children's Hospital, Helsinki, Finland
  5. 5 Department of Clinical Neurophysiology and Neurological Sciences, New Children's Hospital, Helsinki, Finland
  1. Correspondence to Dr Turkka Kirjavainen, Department of Pediatrics, New Children's Hospital, 00029 Helsinki, Finland; turkka.kirjavainen{at}


Introduction Obstructive sleep apnoea (OSA) and feeding difficulties are key problems for Pierre Robin sequence (PRS) infants. OSA management varies between treatment centres. Sleep positioning represents the traditional OSA treatment, although its effectiveness remains insufficiently evaluated.

Design To complete a polysomnographic (PSG) evaluation of effect of sleep position on OSA in PRS infants less than 3 months of age. We analysed a 10-year national reference centre dataset of 76 PRS infants. PSG was performed as daytime recordings for 67 in the supine, side and prone sleeping position when possible. In most cases, recording included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in each position.

Results One-third of infants (9/76, 12%) had severe OSA needing treatment intervention prior to PSG. During PSG, OSA with an obstructive apnoea and hypopnoea index (OAHI) >5 per hour was noted in 82% (55/67) of infants. OSA was most severe in the supine and mildest in the side or in the prone positions. The median OAHI in the supine, side and prone positions were 31, 16 and 19 per hour of sleep (p=0.003). For 68% (52/67) of the infants, either no treatment or positional treatment alone was considered sufficient.

Conclusions The incidence of OSA was 84% (64/76) including the nine infants with severe OSA diagnosed prior to PSG. For the most infants, the OSA was sleep position dependent. Our study results support the use of PSG in the evaluation of OSA and the use of sleep positioning as a part of OSA treatment.

  • sleep
  • growth

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Data availability statement

No data are available. Additional material is published online only.

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  • Contributors TK designed and supervised the project, made special purpose software, analysed polysomnography (PSG) studies and provided technical guidance and contributed to the statistical analyses. PS and PV provided guidance and feedback on the overall work and were responsible for the treatment of infants together with TK, H-LKK and MS-M completed statistical PSG analyses, and H-LK did the statistical analysis of the manuscript. H-LKK and TK drafted and finalised the figures and manuscript.

  • Funding This study was supported by by grants from the Pediatric Research Center, Helsinki, and Lastentautien Tutkimussäätiö (Finnish Pediatric Research Foundation).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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