LAUSR

Obstructive sleep apnea (OSA) in children is characterized by partial or complete upper airway obstruction during sleep, associated with gas exchange abnormalities and disrupted sleep with well-recognized neurobehavioral, neurocognitive, cardiovascular consequences. Positional obstructive sleep apnea (POSA) is defined as a lower AHI (by 50%) in the non-supine position than in the supine position. POSA has been well described in adults, affecting about 55% of adults with OSA. This occurs because airway collapse is maximal in the supine position compared to lateral or prone positions in this subset of patients with significant reduction in airway dimension occurring antero-posteriorly compared to circumferential reduction in airway dimension. However, POSA has not been well studied in children. In this single center retrospective study, data was collected from one hundred consecutive polysomnographic studies from children (6-18 years) with moderate and severe OSA. Mean age was 10.7 years with 50% males in our cohort. Regression analysis was performed to study the relationship of sleeping position with the following variables: Age, sex, BMI, neck circumference, AHI, and desaturation index (DI) in supine and non-supine positions. 60% of the patients in our study had significantly lower (by 50%) AHI and DI in non-supine position. This effect was seen in both moderate and severe OSA, though the effect was higher with increasing AHI and BMI. The effect of sleeping position persisted even when corrected for time spent in each position. Most of the children in our cohort showed significant reduction in OSA in non-supine sleeping position. Positional therapy (PT), being a low-cost and non-invasive intervention is a reasonable approach in patients who demonstrate differences in AHI, oxygenation, and ventilation. Identifying the OSA phenotype and the subset of OSA patients likely to benefit from non-supine position increases the success of PT. PT may be helpful in situations where adenotonsillectomy may not be indicated and CPAP may not be well tolerated, not desired by the patient, and/or not sufficient to improve OSA. We intend to perform further analysis to study the effect of position on gas exchange and identify the phenotype who may benefit from PT in a larger cohort.