Micrognathia and cleft palate as a cause of obstructive sleep apnoea in infants

Aim: Obstructive sleep apnoea (OSA) is common in Robin sequence (RS). We investigated the significance of micrognathia, cleft palate and sleep positioning on OSA in infants. Methods: We analysed our 13-year national reference centre polysomnography (PSG) dataset. PSG was performed as daytime recordings (97%) in the supine-, side- and prone sleeping position at the median age of 5 weeks (interquartile range 3-8 weeks). Results: Our study included 113 infants with RS and cleft palate, 10 infants with RS but intact palate and 32 infants with cleft palate without micrognathia. The degree of OSA in infants with cleft palate without micrognathia was less severe than in infants with RS in terms of obstructive events (median OAHI 4 vs. 32 h(-1), respectively), SpO(2) desaturations (ODI(>= 3)OAH 0.4 vs. 3 h(-1)), transcutaneous pCO(2) levels (TcCO2P95, 41 vs. 46 mmHg) (p < 0.0001) and work of breathing (p = 0.01). In the RS group, OSA was sleep-position dependent, with fewer obstructive events apparent in the side (18 vs. 24 h(-1), p = 0.005) and prone (39 vs. 27 h(-1), p = 0.003) sleeping positions than when supine. Conclusions: The degree of OSA in RS infants is more dependent on micrognathia than on cleft palate.