Systematic Review of the Management of Infant Obstructive Sleep Apnea

Sunday, October 1, 2023

1:30 PM - 1:36 PM East Coast USA Time

Location: 207CD

Presenting Author(s)

JL

James A. Leonard, MD

Resident Physician
Georgetown University Hospital
Washington, DC, United States

Co-Author(s)

Daniel L. Blumenthal, MD

Resident Physician
Georgetown University Hospital
Washington, DC, United States
MA

Mohamad M. Almasri, B.S.

Georgetown University School of Medicine, USA

Senior Author(s)

Claire M. Lawlor, MD

Pediatric Otolaryngologist
Children's National Health Center
Washington, DC, United States

Disclosure(s):

James A. Leonard, MD: No relevant relationships to disclose.

Daniel L. Blumenthal, MD: No relevant relationships to disclose.

Claire M. Lawlor, MD: No relevant relationships to disclose.

Introduction: Unlike pediatric sleep apnea, infant sleep apnea lacks data on long-term outcomes of untreated obstructive sleep apnea and guidelines for management. For years, surgical and non-surgical treatment methods have reported diverse results with different end points. As a result, there is a gap in the literature surrounding many interventions and how to best measure successful treatment.

Methods: The PubMed, EMBASE, Web of Science, and Cochrane databases were queried for articles published between 1975 and 2021 on management of OSA. Articles were included if polysomnography (PSG) was performed before and after intervention. Articles were excluded if patients were greater than 12 months of age. There were 1,375 articles identified after removal of duplicates. These titles and abstracts were reviewed and 128 articles were selected for full review. Forty-seven articles were included for analysis.

Results: Interventions identified included positioning (5), continuous positive airway pressure (12), oral appliances (6), tongue lip adhesion or partial glossectomy (4), mandibular distraction (13) supraglottoplasty (7), tracheostomy (1), and floor of mouth release (1) . Significant reductions in PSG parameters were seen with prone positioning, positive pressure, oral appliance use primarily in children with Pierre Robin Syndrome (PRS), and supraglottoplasty in children with laryngomalacia, however measured variables were not uniformly reported and did not allow for meta-analysis. Outcomes of mandibular distraction osteogenesis for children with PRS were typically reported as pre and post operative apnea hypopnea index (AHI) with an average improvement in AHI by 28.19 (p < 0.001).

Conclusions: Despite the many publications surrounding infant sleep apnea, there is a paucity of data on interventions, the majority of which highlight a single management technique in a specific population. Delivering evidence based medicine in this population will require standardization of PSG reporting for infants.