Does a clinical assessment of upper airway obstruction in robin sequence correspond to sleep study results?

BACKGROUND: Upper airway obstruction (UAO) often remains undetected in infants and may result in an increased work of breathing, failure to thrive and fragmented sleep, potentially impairing neurocognitive development. METHODS: In a prospective randomized crossover study, we evaluated our neonatal care team's subjective assessment of obstructive sleep apnea severity in infants with Robin sequence admitted to Tuebingen University Children's hospital (April 2021-May 2023). Assessments were done in supine and prone position using a standardized questionnaire. Ratings were compared with polygraphy-derived metrics, including the obstructive apnea index (OAI), oxygen desaturation index <80%, mean pulse oximeter saturation and transcutaneous carbon dioxide levels, respiratory and heart rate. RESULTS: Twenty-nine infants were included; 21 were assessed in both sleep positions, six only in supine and two only in prone position. A total of 143 questionnaires were completed (median of 5 [IQR: 1] evaluations per sleep position per infant). The supine position was associated with, on average, a 9.9 (95% CI 5.9, 13.9) events/hour higher subjective OAI than prone. Raters correctly identified severe obstructive sleep apnea (OSA) in 56% of cases in supine position and 58% in prone position. Subjective OAI estimates were systematically lower than objectively derived values, with polygraphy revealing, on average, a 12.7 (95% CI: 2.8, 22.5) events/hour higher OAI. Prediction accuracy did not significantly vary by profession or years of experience. CONCLUSION: Subjective OAI estimates were significantly lower than objectively derived values, underscoring the need for sleep studies to avoid underestimating airway obstruction severity.