Longitudinal Sleep Outcomes in Neonates With Pierre Robin Sequence Treated Conservatively

Study Objectives: Although Pierre Robin sequence (PRS) is a major cause of neonatal obstructive sleep apnea (OSA), longitudinal studies reporting evolution with age are lacking. This study aimed to describe changes in sleep-related respiratory parameters and sleep architecture in neonates with PRS treated conservatively (defined for this paper as treatment without tracheostomy or mandibular distraction). Methods: A retrospective, 14-year, single-institution study of neonates with PRS who underwent diagnostic polysomnography (PSG) and at least one follow-up PSG. Those treated with surgery were excluded. Data were analyzed using a mixed-effects model with subject-specific random effect. Results: In a cohort of 21 infants, baseline PSG (mean age 0.9 +/- 0.7 months) showed a total apnea-hypopnea index (AHI) of 24.3 +/- 3.6 events/h, obstructive apnea-hypopnea index (OAHI) of 13.4 +/- 1.6 events/h, central apnea index of 10.2 +/- 3.2 events/h, and an arousal index of 28.3 +/- 1.3 events/h (variables reported as least square means +/- standard error of the mean). There was a significant reduction in AHI, OAHI, arousal index, and percentage of REM sleep with advancing age. Although 71% of infants achieved full oral feeds by one month of age, some infants remained underweight during infancy. Conclusions: These neonates with PRS and OSA, treated conservatively, had an improvement in OAHI with advancing age with the median age of OSA resolution at 15 months. Factors potentially responsible include craniofacial growth and maturational changes of respiratory control. Further studies are necessary to determine the long-term effects of conservative management on growth and neurodevelopmental outcomes in these infants.