title: Polysomnographic results of prone versus supine positioning in micrognathia.
abstract: BACKGROUND
  Children with micrognathia commonly present with upper airway symptoms and are at risk for developing obstructive sleep apnea (OSA). Prone positioning is widely used as first-line management for micrognathic children with obstructive symptoms. The aim of the present study was to document the effect of positioning on oxygenation and upper airway obstruction as measured by polysomnography (PSG).
  
  
  METHODS
  Three children with micrognathia from two institutions underwent PSG in both the prone and supine position.
  
  
  RESULTS
  Patient ages were 1 week, 3 months, and 7 months. Supine obstructive apnea-hypopnea indices (oAHI) were severe for all 3 children, with a mean of 21.9 events/hour (range 16.8 to 26.3). In the prone position, the oAHI significantly improved in 2 of 3 children, with a mean of 5.1 events/hour (range 0.3 to 10.3). The frequency of central apnea events increased in 1 child following supine positioning. Nadir oxygen saturation improved in 2 of 3 children and remained within normal limits in the third.
  
  
  CONCLUSIONS
  This is the first report of the effect of positioning on changes in PSG indices of micrognathic children. Improvement in obstructive PSG indices occurred with prone positioning, though OSA persisted in 2 of 3 children. The effect of positioning on central apnea was unclear. In light of these findings, we recommend that routine PSG be considered in micrognathic children undergoing prone positioning for definitive therapy of upper airway obstruction.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kimple
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States; Department of Pediatric Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, VA, United States.
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Baldassari
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Aliza P
authors.initials: AP
authors.lastname: Cohen
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: April
authors.initials: A
authors.lastname: Landry
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Pediatric Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: stacey.ishman@cchmc.org.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008844:Micrognathism / Q000150:complications*; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D056888:Patient Positioning; D017286:Polysomnography; D016684:Prone Position / Q000502:physiology; D012119:Respiration; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016683:Supine Position / Q000502:physiology
chemical_list: D010100:Oxygen
keywords: Micrognathia; Polysomnography; Positioning; Sleep apnea