title: Characteristics of sleep apnea in infants with Pierre-Robin sequence: Is there improvement with advancing age?
abstract: OBJECTIVE
  To investigate changes in obstructive sleep apnea (OSA) and central sleep apnea (CSA) in infants with Pierre-Robin sequence (PRS) with advancing age and after mandibular distraction osteogenesis (MDO).
  
  
  METHODS
  Charts from 141 infants with PRS that presented to our tertiary-care children's hospital between 2005 and 2015 were retrospectively reviewed. Forty-five patients received a polysomnogram (PSG) prior to surgical intervention. Linear regression was utilized to compare age at pre-operative PSG with apnea-hypopnea index (AHI), obstructive apnea-hypopnea index (OAHI), and central apnea index (CAI). We then analyzed a subset of 9 patients who underwent MDO with pre- and post-operative PSGs. Wilcoxon signed-rank test was utilized to examine differences in pre- and post-operative OSA and CSA scores.
  
  
  RESULTS
  Forty-five patients received pre-operative PSGs. Of these, 80.0% demonstrated severe sleep apnea (AHI≥10), 68.9% demonstrated severe obstructive sleep apnea (OAHI≥10), and 55.6% demonstrated central sleep apnea (CAI≥1). There was no significant pattern of decrease in AHI, OAHI, and CAI with increased age up to 1 year. Among the 9 patients who underwent MDO with pre- and post-operative PSGs, significant reductions in AHI, OAHI, CAI, and percentage of total sleep time with arterial oxygen saturation (SaO2) <90% and significant increases in SaO2 nadir were identified after MDO.
  
  
  CONCLUSIONS
  Contrary to previously examined literature in non-PRS patients, we did not find a decreased severity of central or obstructive sleep apnea with advancing age. Infants with PRS who underwent MDO demonstrated significant decreases in both obstructive and central apnea indices.
authors.affiliation: University of Pittsburgh School of Medicine, Department of Otolaryngology, 3550 Terrace St, Pittsburgh, PA 15261, United States.
authors.forename: Jake J
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Children's Hospital of Michigan, 3901 Beaubien St, Detroit, MI 48201, United States; Michigan Pediatric Ear, Nose & Throat Associates, 3901 Beaubien St, Detroit, MI 48201, United States.
authors.forename: Prasad J
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: Cleft-Craniofacial Center, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA, United States.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Ford
authors.affiliation: Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, United States. Electronic address: jabbourn@chp.edu.
authors.forename: Noel
authors.initials: N
authors.lastname: Jabbour
mesh_terms: D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008334:Mandible / Q000601:surgery*; D019857:Osteogenesis, Distraction; D010855:Pierre Robin Syndrome / Q000150:complications* / Q000601:surgery; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Airway obstruction; Central sleep apnea; Mandibular distraction osteogenesis; Obstructive sleep apnea; Pierre-Robin sequence; Polysomnogram