Orthodontic plate for management of obstructive sleep apnoea in infants with Pierre Robin sequence: experience and protocol in Hong Kong

Objective: To present the application of the pre-epiglottic baton plate (PEBP) in infants with Pierre Robin sequence (PRS) in the Southern Chinese population (Hong Kong) and to present the diagnosis and management protocol of these infants in our centre. Design: Retrospective case series of three patients with PRS. Setting: Neonatal Intensive Care Unit in Kwong Wah Hospital and Craniofacial Orthodontic Centre in United Christian Hospital, Hong Kong. Participants: Three new-born infants (two girls, one boy) with PRS and upper airway obstruction due to glossoptosis. Methods: A protocol for the diagnosis and management of these infants in the Southern Chinese population (Hong Kong) was presented. The three patients received nasal high-flow oxygen and/or continuous positive airway pressure (CPAP) as first-line respiratory support, followed by PEBP for 3–5 months. A two-stage approach was undertaken to ensure accurate positioning of the PEBP. Results: All three infants had improvement in clinical signs, symptoms and polysomnography upon discharge. PEBP and other respiratory aids were weaned off at 3–6 months. Conclusions: The PEBP, combined with other respiratory support, is a useful modality in the treatment of obstructive sleep apnoea in infants with PRS.

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Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320527 ◽

2021 ◽

pp. archdischild-2020-320527

Author(s):

Hanna-Leena Kristiina Kukkola ◽

Pia Vuola ◽

Maija Seppä-Moilanen ◽

Päivi Salminen ◽

Turkka Kirjavainen

Keyword(s):

Eye Movement ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Sleep Position ◽

Pierre Robin Sequence ◽

Rapid Eye Movement ◽

Obstructive Sleep ◽

Osa Treatment ◽

Sleep Positioning ◽

Pierre Robin

IntroductionObstructive sleep apnoea (OSA) and feeding difficulties are key problems for Pierre Robin sequence (PRS) infants. OSA management varies between treatment centres. Sleep positioning represents the traditional OSA treatment, although its effectiveness remains insufficiently evaluated.DesignTo complete a polysomnographic (PSG) evaluation of effect of sleep position on OSA in PRS infants less than 3 months of age. We analysed a 10-year national reference centre dataset of 76 PRS infants. PSG was performed as daytime recordings for 67 in the supine, side and prone sleeping position when possible. In most cases, recording included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in each position.ResultsOne-third of infants (9/76, 12%) had severe OSA needing treatment intervention prior to PSG. During PSG, OSA with an obstructive apnoea and hypopnoea index (OAHI) >5 per hour was noted in 82% (55/67) of infants. OSA was most severe in the supine and mildest in the side or in the prone positions. The median OAHI in the supine, side and prone positions were 31, 16 and 19 per hour of sleep (p=0.003). For 68% (52/67) of the infants, either no treatment or positional treatment alone was considered sufficient.ConclusionsThe incidence of OSA was 84% (64/76) including the nine infants with severe OSA diagnosed prior to PSG. For the most infants, the OSA was sleep position dependent. Our study results support the use of PSG in the evaluation of OSA and the use of sleep positioning as a part of OSA treatment.

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Tongue–lip adhesion and tongue repositioning for obstructive sleep apnoea in Pierre Robin sequence: A systematic review and meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215117000056 ◽

2017 ◽

Vol 131 (5) ◽

pp. 378-383 ◽

Cited By ~ 11

Author(s):

M Camacho ◽

M W Noller ◽

S Zaghi ◽

L K Reckley ◽

C Fernandez-Salvador ◽

...

Keyword(s):

Oxygen Saturation ◽

Obstructive Sleep Apnoea ◽

Meta Analysis ◽

Sleep Apnoea ◽

Pierre Robin Sequence ◽

Inclusion Criteria ◽

Robin Sequence ◽

Obstructive Sleep ◽

The Mean ◽

Pierre Robin

AbstractObjective:To search for studies on tongue–lip adhesion and tongue repositioning used as isolated treatments for obstructive sleep apnoea in children with Pierre Robin sequence.Methods:A systematic literature search of PubMed/Medline and three additional databases, from inception through to 8 July 2016, was performed by two authors.Results:Seven studies with 90 patients (59 tongue–lip adhesion and 31 tongue repositioning patients) met the inclusion criteria. Tongue–lip adhesion reduced the mean (± standard deviation) apnoea/hypopnoea index from 30.8 ± 22.3 to 15.4 ± 18.9 events per hour (50 per cent reduction). The apnoea/hypopnoea index mean difference for tongue–lip adhesion was −15.28 events per hour (95 per cent confidence interval = −30.70 to 0.15;p= 0.05). Tongue–lip adhesion improved the lowest oxygen saturation from 75.8 ± 6.8 to 84.4 ± 7.3 per cent. Tongue repositioning reduced the apnoea/hypopnoea index from 46.5 to 17.4 events per hour (62.6 per cent reduction). Tongue repositioning improved the mean oxygen saturation from 90.8 ± 1.2 to 95.0 ± 0.5 per cent.Conclusion:Tongue–lip adhesion and tongue repositioning can improve apnoea/hypopnoea index and oxygenation parameters in children with Pierre Robin sequence and obstructive sleep apnoea.

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Ambulatory models of care for obstructive sleep apnoea: Diagnosis and management

Respirology ◽

10.1111/resp.12071 ◽

2013 ◽

Vol 18 (4) ◽

pp. 605-615 ◽

Cited By ~ 19

Author(s):

Ching Li Chai-Coetzer ◽

Nick A. Antic ◽

R. Doug McEvoy

Keyword(s):

Obstructive Sleep Apnoea ◽

Models Of Care ◽

Sleep Apnoea ◽

Diagnosis And Management ◽

Obstructive Sleep

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Sleep disordered breathing

Emergencies in Respiratory Medicine ◽

10.1093/med/9780199202447.003.0041 ◽

2007 ◽

pp. 253-256

Keyword(s):

Obstructive Sleep Apnoea ◽

Sleep Disordered Breathing ◽

Face Mask ◽

Sleep Apnoea ◽

Respiratory Medicine ◽

Respiratory Support ◽

Obstructive Sleep ◽

Disordered Breathing

Sleep disordered breathing 254 Sleep disordered breathing is a relatively new area of respiratory medicine. It encompasses two broad and sometimes overlapping groups: the first and largest is obstructive sleep apnoea (OSA), and the second is the nocturnal hypoventilatory disorders. Both require nocturnal respiratory support, usually via a nasal or face mask, although sometimes via a tracheostomy. The on-call acute physician will be consulted about patients who have sleep disordered breathing and hence should be aware of the diagnoses and the therapies....

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