Obstructive Sleep Apnea and Sleep Position: Does It Matter for Infants With a Cleft Palate?

Objective: To determine whether nonsupine sleep improves obstructive sleep apnea (OSA) in infants with cleft palate undergoing polysomnography (PSG). Design: Retrospective chart review. Setting: Tertiary care pediatric hospital. Patients: Twenty-seven infants (1 month to 1 year) with cleft palate with or without cleft lip (CP +/- L) undergoing PSG testing for suspected OSA were included. Main Outcome Measures: Polysomnography measures included obstructive apnea-hypopnea index (OAHI), central apnea-hypopnea index (CAHI), oxygen saturation (SpO(2)) nadir, SpO(2), and end-tidal carbon dioxide (ETCO2). Results: Twenty-three PSGs with at least 20 minutes of sleep in both the supine and the nonsupine positions were analyzed. The supine OAHI (mean: 16.8 events/hour; standard deviation [SD]: 18.5) and nonsupine OAHI (mean: 12.6 events/hour; SD: 12.6) did not differ significantly (P = .10). The supine CAHI (mean: 1.9 events/hour; SD: 2.7) and nonsupine CAHI (mean: 3.1 events/hour; SD: 3.7; P = .15), the supine SpO(2) nadir (mean: 81.2%; SD: 6.3) and nonsupine SpO(2) nadir (mean: 81.8%; SD: 5.3; P = .70), the supine mean SpO(2) (mean: 95.5%; SD: 1.9) and nonsupine mean SpO(2) saturation (mean: 95.3%; SD: 2.4; P = .34), and the supine ETCO2 (mean: 45.4 mm Hg; SD: 5.3) and nonsupine ETCO2 (mean: 42.5 mm Hg; SD: 10.1; P = .24) were also similar. Conclusions: There were no significant improvements in OSA metrics during nonsupine sleep in infants with CP +/- L. Prior to recommending nonsupine positioning which increases infant's exposure to sudden infant death syndrome risk, we advocate obtaining a PSG to verify an objective improvement in OSA.