The effect of body position on sleep apnea in children less than three years of age

Abstract

Objectives: To determine the association between body position and obstructive events during sleep as determined by polysomnography (PSG) in very young children (ages 3 or less) with obstructive sleep apnea (OSA).This is the first study of its kind in literature. Methods: Children ages 3 years and younger who had PSG to evaluate OSA and underwent adenotonsillectomy between December 1, 2000 and November 30, 2003 were included in the study. The polysomnograms 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. The results were analyzed statistically. Results: Sixty patients qualified for this study. The mean supine sleep RDI was 8.5 compared to 4.9 in nonsupine sleep. 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 (REM) sleep was 20.5 compared to 5.3 in non-REM sleep. Mean nonsupine sleep RDI was 4.9 compared to 7.4 of the full PSG. The differences were statistically significant. Conclusion: There is an increase in the RDI with increased time spent in supine sleep in very young children with OSA. Inadequate time spent in that position may underestimate the severity of obstructive sleep apnea. A combination of reduced REM sleep and increased nonsupine sleep may invalidate PSG in these children.