Obstructive Sleep Apnea in 0- to 12-Month-Old Infants

Background: To investigate obstructive sleep apnea (OSA) prevalence, associated comorbidities, distribution of respiratory events in different sleep states, and body positions in infants. Methods: This was a single-center retrospective study that included infants aged 0 to 12 months who underwent polysomnogram (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1-4.9 events/h), moderate (5-9.9 events/h), and severe (≥10 events/h). Results: One hundred eighteen infants were included with a median age of 5 months (interquartile range, [IQR] 2.0-9.0) for the OSA group (73/118) and 7 months (IQR 6.0-9.0) for the non-OSA group (45/118) (P = .01). The most common indication for PSG was snoring (57.5%), followed by apneas (41.1%). OSA prevalence was 61.9% (53.4% mild, 17.8% moderate, and 28.8% severe). Gastroesophageal reflux disease (GERD; 32.9%) and 21.9% of craniofacial abnormalities were commonly associated comorbidities. Multivariate binominal regression analysis indicated that infants with a history of craniofacial abnormalities (P = .038) had higher odds of having OSA. There were no significant differences noted in sleep architecture medians, such as total sleep time, sleep efficiency, sleep latency, stage 1, 2, 3, and rapid eye movement (REM) sleep durations, between the OSA and the non-OSA group, except for the median arousal index, which was significantly higher in the OSA group (15.7 [11.9, 24.1] versus 10.6 [9.4, 16.3]; P < .001). Differences in respiratory parameters including apnea hypopnea index (AHI), OAHI, REM AHI, non-REM AHI, SpO₂ nadir and mean, and carbon dioxide mean and peak were significant. In 6-12-month-olds, 32 infants with OSA had REM AHI that was higher than non-REM (AHI: 17.0 [10.9, 33.8] versus 2.3 [0.6, 6.0]; P < .001). Similarly, supine AHI was higher (P < .001) when we compared it with each non-supine positions individually. Conclusions: In infants, OSA was highly prevalent in our cohort; a history of GERD and craniofacial abnormalities were commonly associated comorbidities. Obstructive events occurred predominantly in REM sleep and the supine position.