Obstructive Sleep Apnea In Infants Research Articles

Comparison of high flow nasal cannula therapy to nasal oxygen as a treatment for obstructive sleep apnea in infants.

Obstructive sleep apnea (OSA) in infants is treated with low flow oxygen via nasal cannula (NC), CPAP (continous positive airway pressure), or surgery. Literature supports the use of high flow NC (HFNC) in children in the outpatient setting, however there is limited data on the use of HFNC in infants. The purpose of this study was to compare HFNC and low-flow oxygen as treatments for OSA in infants. A prospective pilot study was performed at two institutions. Infants with primarily OSA underwent a 3-4 h sleep study with HFNC titration at 6-14 lpm for OSA, followed by clinical polysomnography (PSG) for oxygen titration (1/8-1 lpm). Infants with primarily central apnea were excluded. Nine infants were enrolled, with a mean age of 1.3 ± 1.7 months. Average apnea hypopnea index (AHI), average obstructive apnea hypopnea index (OAHI) and average central apnea index during the diagnostic PSG was 17.2 ± 7/h, 13.4 ± 5.4/h and 3.7 ± 4.8/h respectively. OSA improved in 44.4% of subjects with HFNC; the mean AHI and OAHI decreased from 15.6 ± 5.65/h and 12.8 ± 4.4/h on diagnostic PSG to 5.12 ± 2.5/h and 4.25 ± 2.5/h on titration PSG. OSA improved universally with low flow oxygen; the mean AHI decreased from 17.2 ± 7/h on diagnostic PSG to 4.44 ± 3.6/h on titration PSG. HFNC reduced OSA in some infants, though low flow oxygen reduced OSA in all subjects. Respiratory instability (high loop gain) in infants may explain why infants responded to low flow oxygen. More studies are needed to determine if HFNC is beneficial in selected groups of infants with OSA.

0791 Polysomnographic Outcomes of Obstructive Sleep Apnea in Infants with Pierre-Robin Sequence

0791 Polysomnographic Outcomes of Obstructive Sleep Apnea in Infants with Pierre-Robin Sequence

Gas exchange parameters for the prediction of obstructive sleep apnea in infants.

Sleep laboratory polysomnography (PSG) is the gold standard for obstructive sleep apnea (OSA) diagnosis in infants, but its access remains limited. Oximetry-capnography is another simple and widely used tool that can provide information on the presence of desaturations and alveolar hypoventilation. However, its reliability is debated. This study aimed at examining its use in determining OSA severity in infants. This retrospective study was conducted in a sleep unit in a tertiary hospital, in infants < 4 months old with clinical signs of OSA or Pierre Robin Sequence (PRS) who underwent a one-night PSG coupled with oximetry-capnography. Among the 78 infants included (median [IQR] age: 61 [45-89] days at PSG), 44 presented with PRS, and 34 presented with isolated airway obstruction. The clinical, sleep and respiratory characteristics were not significantly different between the two subgroups. In the entire cohort, 63.5% had severe OSA. Median OAHI was 14.5 events/h [7.4-5.9], SpO2 was 97.4% [96.5-98.1], and PtcCO2 was 41.1 mmHg [38.3-44.9]. The optimal threshold to predict OAHI > 10 events/h was 6 events/h for ODI3% (sensitivity 95.7%, specificity 51.9%) and 2 events/h for ODI4% (sensitivity 95.7%, specificity 48.1%). Whereas transcutaneous capnography does not appear to be sufficient in predicting severe OSA in infants < 4 months old with PRS or clinical signs of OSA, oximetry may be a useful alternative for the screening of severe OSA in infants in the absence of PSG.

0810 Effect of supraglottoplasty on respiratory parameters in infants and children with laryngomalacia and oxygen dependence

Abstract Introduction Supraglottoplasty (SGP) is the surgical treatment of choice for laryngomalacia and obstructive sleep apnea (OSA). Several recent studies have shown that oxygen can act to stabilize ventilatory control in infants with OSA and high loop gain. However, there is very limited information on the effect of SGP on OSA in infants with laryngomalacia and evidence of high loop gain. Methods A retrospective chart review was performed in infants with laryngomalacia and OSA at Cincinnati Children’s Hospital Medical Center from January 2008 to June 2022. Only patients treated with oxygen prior to SGP were included in the analysis. The pre-surgical polysomnograms (PSGs) were classified by responsiveness to oxygen into 2 groups; oxygen responders ([R]; &amp;gt;50% decrease in apnea-hypopnea index (AHI) with oxygen, indirect evidence of high loop gain) and non-responders ([NR]; &amp;lt; 50% decrease in AHI). Data were reported as mean±SD. The comparison of AHI and obstructive AHI (OAHI) between pre-surgical and post-surgical PSGs were performed in each group using paired t-test or Wilcoxon signed rank test. The differences of percentage decreases in AHI and OAHI after surgery between R and NR were calculated using Wilcoxon Rank Sum test. Results Forty-nine infants (with 52 SGPs) met the study enrollment criteria, with 33 (67.3%) male and 16 (32.7%) female patients. There were no statistically significant differences in age or sex between oxygen responders and non-responders. AHI after SGP in both oxygen responders (50.1±59.2/hr [pre] vs 17.6±21.1/hr [post]; P&amp;lt; 0.0001) and oxygen non-responders (25.2±13.3/hr [pre] vs 12.4±9.4/hr [post] vs; P=0.0006] decreased significantly. Similarly, there were significant decreases in OAHI after SGP in both groups. Additionally, there were no significant differences in the percentage decreases of AHI (57.3±26.1% [R] vs 41.4±48.8%[NR]; P=0.6410) and OAHI (64.0±21.9% [R] vs 50.3±41.4% [NR]; P=0.5260) between the 2 groups. Conclusion Both oxygen responders and non-responders had significant decreases in AHI and OAHI after surgery with similar magnitude of improvement. Supraglottoplasty is an effective treatment in infants with larygnomalacia and OSA, even in those with evidence of high loop gain. We speculate that non-anatomic traits such as high loop gain would only manifest in the context of significant respiratory disturbances from anatomic traits. Support (if any)

Management and outcomes of obstructive sleep apnea in infants

To characterize the clinical characteristics of infants with obstructive sleep apnea (OSA), define the resolution rate of infant OSA, and identify factors associated with OSA resolution. We identified infants diagnosed with OSA via retrospective chart review at less than one year of age at a tertiary care center. We identified patient comorbidities, flexible or rigid airway evaluations, surgical procedures, and oxygen/other respiratory support administration. We identified infants as having resolved OSA based on clinical or polysomnogram resolution. We compared the frequency of comorbid diagnoses and receipt of interventions in infants with resolved versus non-resolved OSA by χ2 analysis. 83 patients were included. Prematurity was found in 35/83 (42%), hypotonia-related diagnoses in 31/83 (37%), and craniofacial abnormalities in 34/83 (41%). Resolution was observed in 61/83 (74%), either clinically or by polysomnogram, during follow up. On χ2 analysis, surgical intervention was not associated with likelihood of resolution (73% versus 74% in those without surgical intervention, p=0.98). Patients with airway abnormalities on flexible or rigid evaluation were less likely to have OSA resolution than those without (63% versus 100%, p=0.010), as were patients with hypotonia-related diagnoses (58% versus 83%, p=0.014). In patients with laryngomalacia, there was no association of supraglottoplasty with increased resolution (88% with supraglottoplasty versus 80% without, p=1.00). We identified a group of infants with OSA with diverse comorbidities. There was a high rate of resolution. This data can assist with treatment planning and family counselling for infants with OSA. A prospective clinical trial is needed to better assess consequences of OSA in this age.

Respiratory indices during sleep in healthy infants: A prospective longitudinal study and meta-analysis

Study objectivesHealthy infants may have a greater apnea hypopnea index (AHI) than older children during the newborn period, but the trajectory of these sleep-related events beyond the first month of life is poorly understood. In this study, we evaluated the longitudinal changes in respiratory indices during sleep in healthy infants during the first six months of life. MethodsSingle-center prospective cohort study. Thirty healthy infants underwent overnight in-lab polysomnography at one and five months of age and findings were compared between assessments. Systematic review of studies evaluating infant polysomnography and meta-analysis was conducted. ResultsAt one month of age, total AHI, obstructive AHI, and central AHI model-adjusted means (95% confidence interval) were 16.9 events/hour (12.2, 21.5), 10.2 events/hour (7.4, 13.1), and 6.6 events/hour (4.2, 9.0), respectively. 16.8% of events were obstructive apneas and 36.1% central apneas. By five months of age, there were significant reductions in each index to 4.1 events/hour (3.2, 5.0), 1.9 events/hour (1.4, 2.4), and 2.2 events/hour (1.6, 2.9), respectively (p < 0.001 for each), and a lower proportion of events were obstructive apneas (8.6%, p = 0.007) and a greater proportion central apneas (52.3%, p = 0.002). Meta-analysis found high AHI in infants with significant heterogeneity. ConclusionsCentral AHI and obstructive AHI are greater in healthy newborns than older children. There is a significant spontaneous reduction in events and change in type of events in the first six months of life in this low-risk population. These findings may serve as a reference for clinicians evaluating for obstructive sleep apnea in infants.

Nocturnal pulse oximetry as a possible screening method for obstructive sleep apnea in infants with laryngomalacia

ObjectiveLaryngomalacia can be an important cause of obstructive sleep apnea (OSA) in infants. Nocturnal oximetry is a cheap and safe method in comparison to polysomnography for the detection of sleep-disordered breathing. The aim of this study is to evaluate the validity of nocturnal oximetry as a diagnostic tool for OSA in infants with laryngomalacia. MethodsThis retrospective study included infants with laryngomalacia and a clinical suspicion of OSA who underwent a polysomnography at the Antwerp University Hospital. The oximetry was rescored manually, blinded to the polysomnography results, according to four different scoring methods. An obstructive apnea–hypopnea index (oAHI) ≥ 2/h on polysomnography was used to define OSA. ResultsThis study included 53 patients with laryngomalacia (51% boys, mean age 3.72 ± 0.26 months). A diagnosis of OSA was established in 46 patients (87%) by polysomnography. Among the four different scoring methods, the scoring according to Brouillette et al., yielded the highest diagnostic accuracy with a sensitivity and specificity of 91% and 25% respectively and with a negative and positive predictive value of 25% and 91%, respectively. Correlations and the Bland–Altman plot showed a wide limit of agreement for laboratory polysomnography oAHI and nocturnal oximetry ODI. ConclusionOur data show that overnight pulse oximetry has a high sensitivity and PPV to diagnose OSA in infants with laryngomalacia. However, the low specificity and NPV indicate that PSG is still needed to exclude OSA in cases with normal oximetry.

Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants

IntroductionObstructive 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...

550 Laryngomalacia and obstructive sleep apnea in infants with PWS

Abstract Introduction Growth hormone (GH) improves tone, body composition, development, and growth in infants with Prader-Willi Syndrome (PWS). Concerns about sudden death following GH initiation and worsening obstructive sleep apnea (OSA) in children with PWS resulted in guidelines for polysomnography (PSG) evaluation before and after starting GH. We review novel evidence of laryngomalacia as a mechanism for this worsening of OSA and describe the incidence of laryngomalacia in this patient population. Methods A retrospective review of infants and children seen at the Seattle Children’s PWS clinic between October 2014 and May 2020 who had undergone polysomnography (PSG) before and after growth hormone initiation was performed. Findings on otolaryngology evaluation via flexible fiberoptic laryngoscopy (FFL) or drug-induced sleep endoscopy were reviewed to characterize obstruction, diagnosis of laryngomalacia, and response to surgical intervention. Results A total of 28 cases were identified. 12 (41%) were evaluated with FFL between ages 4 and 21 months old (median 5) for noisy breathing, worsening or persistent OSA, or dysphagia. Out of these, 9 (75% of FFL, 31% of total) were diagnosed with laryngomalacia. Children with laryngomalacia were more likely to have worsening of OSA after GH initiation. Surgical interventions including supraglottoplasty or adenotonsillectomy led to improvement in OSA in 86% of children who had worsening after GH initiation. Conclusion Worsening OSA after GH initiation is seen in 38% of patients with PWS. Laryngomalacia is a common comorbid condition and more frequent in those with worsening OSA after GH initiation that is amenable to targeted surgical intervention. Support (if any):

An intelligent detection and therapeutic device to support sleep apnea in infants

Among the numerous sleep-disorders breathing patterns encountered by babies, such as intermittent respiration, premature apnea, obstructive sleep apnea wa sconsidered a major cause of concern. Upper airway structure, pulmonary system mechanics, etc. are only a few reasons why the babies are vulnerable to obstructive sleep disorder. An imbalance in the viscoelastic properties of the pharynx, dilators and pressure can lead to airway collapse. Low level of oxygen in blood or hypoxemia is considered a characteristic in infants with severe Obstructive Sleep Apnea (OSA). Invasive treatments like nasopharyngeal tubes, continuous positive airway pressure (CPAP), or tracheostomy are found to be helpful in most cases where infants experience sleep apnea. This paper suggests an appropriate method for long-term monitoring of obstructive sleep apnea in infants and, if any abnormalities are observed, the tool provides continuous airway pressure treatment until the abnormality is stabilized. Resilient propagation algorithm is utilised to train the datasets and produce a relevant output.

High flow nasal cannula treatment for obstructive sleep apnea in infants and young children.

Continuous positive airway pressure (CPAP) is the nonsurgical treatment of choice for children with obstructive sleep apnea (OSA). However, CPAP limitations include difficulty with adherence and midface hypoplasia risk. We, therefore, sought to assess the effect of warm humidified air delivered via open nasal cannula (HFNC) on OSA in children in the sleep laboratory and at home. A retrospective review was performed among children recommended treatment of OSA with HFNC. Reasons for HFNC recommendation included poor surgical candidacy, residual OSA following surgery, and CPAP intolerance. Children underwent both diagnostic and HFNC titration sleep studies and were prescribed HFNC for home use. Standard sleep architecture, arousals, and apnea-hypopnea indices (AHI) were assessed with the evaluation of reported adherence and complications over 12 months of treatment. Twenty-two children (average 12.8 months, 95% confidence interval [95% CI: 7.0, 18.6]) with OSA (obstructive AHI [OAHI] range: 4.8-89.2 events/h) underwent HFNC titration with significant reduction in OAHI (28.9 events/h [17.6, 40.2] vs 2.6 [1.1, 4.0]; P < .001) (mean [95% CI]). Nineteen patients received home HFNC treatment. By 12 months, four patients were lost to follow-up and OSA resolved in three patients (16%). Of 12 remaining patients, 7 (58%) continued therapy while 5 (42%) discontinued due to intolerance. The most common treatment complication was cannula dislodgement. Additional complications included skin irritation, dry mucus membranes, restlessness, oxygen desaturation, and increased central apneas. HFNC offers a treatment alternative to CPAP in infants and young children with OSA and was well tolerated at home in our study.

Use of heated humidified high flow nasal cannula for obstructive sleep apnea in infants

ObjectiveHeated humidified high flow nasal cannula (HHHFNC) has gained popularity in the treatment of children with respiratory distress and bronchiolitis in the past decade. Its efficacy as a mode of non-invasive respiratory support has been demonstrated in both adults and children. However, reports on its use in the treatment of obstructive sleep apnea (OSA) in infants are limited. We aimed to evaluate the efficacy of HHHFNC therapy as treatment in infants with OSA. MethodsA retrospective analysis of OSA infants who had undergone polysomnographic titration between 2015 and 2017 was undertaken. Data about the age, gender, AHI, co-morbid conditions and flow used for each patient were retrieved. ResultsTen infants were included in this study (median age 34 weeks; IQR 27–38 weeks). The median optimal HHHFNC flow rate was 8.0 L/min (IQR 6.7–8.0 L/min). HHHFNC significantly reduced median obstructive apnea–hypopnea index (OAHI) from 9.1 (IQR 5.1–19.3) to 0.9 (IQR 0–1.6; P = 0.005) events/h; median obstructive apnea index (OAI) from 5.8 (IQR 1.1–13.4) to 0 (IQR 0–0.9; P = 0.021) events/h; median obstructive hypopnea index (OHI) from 4.1 (IQR 0.9–6.8) to 0.1 (0–0.9; P = 0.017) events/h; and median oxygen saturation (SpO2) nadir increased from 88% (IQR 83–94%) to 94% (IQR 93–96%; P = 0.040). ConclusionHHHFNC significantly reduced respiratory events and improved oxygenation in infants with OSA.

A Detection and Therapeutic Device to Overcome Sleep Apnea in Infants

Among the various sleep-disordered breathing patterns infant’s experience, like periodic breathing, premature apnea, obstructive sleep apnea, has been considered a major cause of concern. Upper airway structure, mechanics of the pulmonary system, etc., are a few reasons why the infants are vulnerable to obstructive sleep-disordered. An imbalance in the viscoelastic properties of the pharynx, dilators, and pressure can lead to airway collapse. A low level of oxygen in blood or hypoxemia is considered a characteristic in infants with severe OSA. Invasive treatments like nasopharyngeal tubes, continuous positive airway pressure (CPAP), or tracheostomy are found to be helpful in most cases where infants experience sleep apnea. This paper proposes an efficient system for monitoring obstructive sleep apnea in infants on a long-term basis, and if any anomaly is detected, the device provides Continuous Airway Pressure therapy until the abnormality is normalized.

Can overnight portable pulse oximetry be used to stratify obstructive sleep apnea risk in infants? A correlation analysis.

There is limited evidence on the accuracy of oximetry in the evaluation of infant obstructive sleep apnea (OSA). We aimed to determine the utility of overnight oximetry to stratify infants at risk for OSA, to determine urgency for definitive screening with an overnight in-laboratory polysomnogram (PSG). Retrospective single-institution cohort study of infants undergoing PSG and a separate overnight oximetry over an 8-year period. Correlations, using oximetry in both in-hospital (attended) or at-home (unattended) settings, for ODI410 (decrease in oxygen saturation ≥ 4% from baseline, duration ≥ 10 seconds) and ODI40 (duration > 0 second) with the obstructive apnea-hypopnea index (AHIo) were obtained. The area under the curve was calculated, and sensitivity and specificity values have been presented as receiver operating characteristic curves. Thirty-eight infants were included. The mean (SD) age (months) was 5.7 (3.9) at diagnostic PSG and 5.5 (3.7) at the time of oximetry. The mean AHIo for the entire cohort was 6.7 (6.2). The mean (SD) ODI40 was 8.6 (9.0) and the mean (SD) ODI410 was 5.4 (5.1).The correlation between ODI and AHIo was statistically significant for the cohort (ODI40 vs. AHIo [r = .59, P < .001] and ODI410 vs AHIo [r = .55, P = .0003]). Using an ODI40 cutoff of 3, the sensitivity, specificity, negative predictive value and positive predictive value for diagnosing OSA was: 86%, 40%, 50%, and 80% respectively for an AHIo greater than 2, and 100%, 35%, 100%, and 58% respectively for an AHIo greater than or equal to 5. There is a significant positive correlation between the ODI4 obtained from oximetry and the AHIo obtained from PSG in infants at risk for OSA. An ODI40 greater than 3 may be useful to stratify infants at risk for moderate to severe OSA when used in attended (in-hospital) or unattended (in-home) settings.

Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know.

Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know.

The spectrum of obstructive sleep apnea in infants and children with Down Syndrome

ObjectiveDescribe the spectrum of OSA across time in infants and children with Down syndrome. MethodsRetrospective records review of children who underwent formal polysomnography (PSG) in one of two Australian tertiary sleep centres over selected 3.5-year periods. 152 children were identified, then all sleep study and treatment records were retrieved for the lifetime of the child through 2018. Results3.8 ± 3.2 studies (range 1–17) were retrieved per child and 38.2% had mild disease at worst. Children having only 1 study were more likely to have a normal or mild result than those having ≥2 (chi-square 11.25, p-value 0.0008) Studies were more often severe in children age <2 compared to those ≥2 years, (chi-square 12.87, p = 0.005). After age 2 years, OSA severity increased with age. Amongst 91 (56.4%) children with ≥2 studies, 71 (78.0%) had moderate or severe disease at some time. Studies evaluating the effects of surgery (most often adenotonsillectomy) showed resolution of disease to mild or normal in 53.3%. Where ≥2 studies were evaluated, the last study polarised towards normal or mild disease 40 (44.0%), or treatment titrations 34 (37.4%) with moderate or severe disease in 17 (18.7%). ConclusionsIn a tertiary sleep unit, a full spectrum of sleep disordered breathing in Down syndrome was seen from infancy onwards. Children having only one study were more likely to have normal results. Children with multiple studies reflected disease surveillance, including follow-up after treatment interventions.

Current Practice Patterns in the Diagnosis and Management of Sleep-Disordered Breathing in Infants.

Currently, there are no universally accepted guidelines for diagnosis and management of sleep-disordered breathing (SDB) in infants. The purpose of this study was to survey pediatric sleep medicine providers regarding their current practice patterns for diagnosis and management of SDB in infants. An anonymous, web-based survey with 71 questions was distributed via the PEDSLEEP and Ped-Lung listserv, which serve as a hub of communication for pediatric sleep and pulmonary medicine providers worldwide. Fifty-four providers from eight countries completed the survey. Ninety-six percent of providers reported performing sleep studies in infants with 53% performing more than 30 studies per year. There was no consensus on the definition of obstructive sleep apnea (OSA) in infants when using an obstructive apnea-hypopnea index (AHIo) cutoff: AHIo > 1 (30%), AHIo > 2 (35%), AHIo > 5 (24%), AHIo > 10 (2%) and other (9.3%). Thirty-six percent did not use pediatric criteria to define severity of OSA in infants. Opinions regarding management of five typical SDB cases were solicited and the results varied among respondents. Most of the providers (89%) thought that more research is needed to gather normative sleep data in infants and that their practice would benefit from evidence- based guidelines for diagnosis and management of SDB in infants (98%). These results demonstrate substantial variability in practice patterns for diagnosis and management of SDB in infants. Further research and consensus guidelines are needed to ensure optimal care for infants with SDB.

Orthodontic plate for management of obstructive sleep apnoea in infants with Pierre Robin sequence: experience and protocol in Hong Kong.

To present the application of the pre-epiglottic baton plate (PEBP) in infants with Pierre Robin sequence (PRS) in the Southern Chinese population (Hong Kong) and to present the diagnosis and management protocol of these infants in our centre. Retrospective case series of three patients with PRS. Neonatal Intensive Care Unit in Kwong Wah Hospital and Craniofacial Orthodontic Centre in United Christian Hospital, Hong Kong. Three new-born infants (two girls, one boy) with PRS and upper airway obstruction due to glossoptosis. A protocol for the diagnosis and management of these infants in the Southern Chinese population (Hong Kong) was presented. The three patients received nasal high-flow oxygen and/or continuous positive airway pressure (CPAP) as first-line respiratory support, followed by PEBP for 3-5 months. A two-stage approach was undertaken to ensure accurate positioning of the PEBP. All three infants had improvement in clinical signs, symptoms and polysomnography upon discharge. PEBP and other respiratory aids were weaned off at 3-6 months. The PEBP, combined with other respiratory support, is a useful modality in the treatment of obstructive sleep apnoea in infants with PRS.

Evaluation of Obstructive Sleep Apnea in Prone Versus Nonprone Body Positioning With Polysomnography in Infants With Robin Sequence.

Management of obstructive sleep apnea in infants with Robin sequence (RS) includes prone positioning during sleep, which conflicts with safe infant sleep data. We examined changes in polysomnography (PSG) parameters for prone versus nonprone body positions in these infants. Pre-post interventional, nonblinded study. Infants with RS referred for PSG were recruited from craniofacial clinic and inpatient units at Children's Hospital Los Angeles, a tertiary pediatric center. Fourteen infants were recruited, and 12 studies were completed on both body positions; 11 studies were used in the analysis. The PSG was divided into nonprone and prone sleep, moving from their usual sleep position to the other position midway in the study. Data was collected in each position for obstructive apnea-hypopnea index (oAHI), central apnea index (CAI), sleep efficiency (SE), and arousal index (AI). Signed rank test was used to evaluate the change in body position. All infants were term except 1, age 7 to 218 days (mean: 55 days; standard deviation: 58 days), and 8 (57%) of 14 were female. From nonprone to prone sleep position, the median oAHI (16.0-14.0), CAI (2.9-1.0), and AI (28.0-19.9) decreased (P = .065); SE increased (67.4-85.2; P = .227). Prone positioning may benefit some infants with RS. However, even those with significant improvement in obstructive sleep apnea did not completely resolve their obstruction. The decision to use prone positioning as a therapy should be objectively evaluated in individual infants.

0722 Predictors of Severe Obstructive Sleep Apnea in Infants

0722 Predictors of Severe Obstructive Sleep Apnea in Infants