Impact of prone positioning on sleep and respiratory outcomes by polysomnography in Robin Infants: a cross-sectional study.

BACKGROUND: The use of prone positioning (PP) during sleep to prevent obstructive sleep apnea (OSA) in Robin sequence (RS) infants is controversial and varies among centers due to lack of data and increased risk of sudden infant death syndrome. OBJECTIVE: To evaluate PP impact on sleep and respiratory outcomes using polysomnography (PSG) in RS infants. METHODS: Cross-sectional study conducted from 2018 to 2022 in 2 tertiary centers including RS infants <3 months of age, assessed by PSG in supine position (SP) and PP comparing sleep and respiratory outcomes. RESULTS: Among the 29 RS infants, the median [IQR] age was 48 [40-61] days during PSG, and 28/29 (97%) had OSA in SP, with an OAHI>10/h in 20/28 (71%). In PP, sleep efficiency was greater (81% [73-88] versus 72% [59-80], p = 0.01) and obstructive apnea-hypopnea index (OAHI) was significantly lower in PP (10 events/h [8-17] versus 17 events/h [9-40], p < 0.001) compared to SP. Among the 20/28 infants with OAHI>10/h in SP, 11/20 (55%) remained with OAHI>10/h and 9/20 (45%) decreased their OAHI to 5-10/h. While PP was found effective in 13/29 (45%) infants, SP in room air was selected in 5/29 (17%) and respiratory support in 11/29 (38%) infants. CONCLUSION: In most young RS infants, PP improved sleep quality and reduced OSA. However, PP did not accurately correct OSA in more than a third of them. Early systematic nocturnal sleep recordings are indicated to determine the most effective therapeutic approach to manage OSA in RS infants.