Lisa M Walter1, Daranagama U N Dassanayake2, Aidan J Weichard3, Margot J Davey4, Gillian M Nixon5, Rosemary S C Horne6. 1. The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia. Electronic address: lisa.walter@hudson.org.au. 2. The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia. Electronic address: natalie.stepup@gmail.com. 3. The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia. Electronic address: aidan.weichard@hudson.org.au. 4. The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Australia. Electronic address: margot.davey@monashhealth.org. 5. The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Australia. Electronic address: gillian.nixon@monashhealth.org. 6. The Ritchie Centre, Hudson Institute of Medical Research and the Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia. Electronic address: rosemary.horne@monash.edu.
Abstract
BACKGROUND: In both adults and children, obstructive sleep apnea (OSA) has significant adverse cardiovascular consequences. In adults, sleeping position has a marked effect on the severity of OSA; however, the limited number of studies conducted in children have reported conflicting findings. We aimed to evaluate the effect of sleeping position on OSA severity and the cardiovascular consequences in preschool-aged children. METHODS: This was a retrospective analysis of children (3-5 years of age) diagnosed with OSA (n = 75) and nonsnoring controls (n = 25). Sleeping position was classified as supine, semi-supine, left lateral, right lateral, prone, and semi-prone by using video recordings during one night of attended polysomnography. OSA severity and cardiovascular parameters were compared between the positions. RESULTS: All children spent significantly more sleep time in the supine position than in any other position. The obstructive apnea-hypopnea index was higher in the supine position than in the other sleeping positions during NREM (p < 0.05), higher in the moderate/severe OSA group when sleeping in the supine position than when sleeping in the left and right lateral positions (p < 0.05 for both) and prone position (p = 0.007) during REM. Sympathovagal balance was decreased in children with OSA in the supine and lateral positions (p < 0.05). CONCLUSIONS: This study identified that preschool-aged children, whether nonsnoring controls or children with OSA, predominately sleep in the supine position, and OSA was more severe in the supine position. We suggest that to avoid the supine sleep position, positional therapy has the potential to ameliorate OSA severity, and the known cardiovascular consequences.
BACKGROUND: In both adults and children, obstructive sleep apnea (OSA) has significant adverse cardiovascular consequences. In adults, sleeping position has a marked effect on the severity of OSA; however, the limited number of studies conducted in children have reported conflicting findings. We aimed to evaluate the effect of sleeping position on OSA severity and the cardiovascular consequences in preschool-aged children. METHODS: This was a retrospective analysis of children (3-5 years of age) diagnosed with OSA (n = 75) and nonsnoring controls (n = 25). Sleeping position was classified as supine, semi-supine, left lateral, right lateral, prone, and semi-prone by using video recordings during one night of attended polysomnography. OSA severity and cardiovascular parameters were compared between the positions. RESULTS: All children spent significantly more sleep time in the supine position than in any other position. The obstructive apnea-hypopnea index was higher in the supine position than in the other sleeping positions during NREM (p < 0.05), higher in the moderate/severe OSA group when sleeping in the supine position than when sleeping in the left and right lateral positions (p < 0.05 for both) and prone position (p = 0.007) during REM. Sympathovagal balance was decreased in children with OSA in the supine and lateral positions (p < 0.05). CONCLUSIONS: This study identified that preschool-aged children, whether nonsnoring controls or children with OSA, predominately sleep in the supine position, and OSA was more severe in the supine position. We suggest that to avoid the supine sleep position, positional therapy has the potential to ameliorate OSA severity, and the known cardiovascular consequences.