The challenge of assessing upper airway obstruction severity in infants with Robin Sequence

Abstract

Infants with Robin Sequence (PS) at high risk of upper airway obstruction (UAO). The aim of our study was to compare the severity of UAO evaluated on a 3-level clinical score, the mixed and obstructive apnea-hypopnea index (MOAHI), and the 3 % oxygen desaturation index (ODI) on a respiratory polygraphy (PG). The second aim was to compare the indication for a non-invasive respiratory support (NIRS), based on the severity of UAO using the same criteria. Severe clinical UAO was defined as a clinical score of 2 or 3, severe MOAHI as a value ≥ 10 events/hour and severe ODI as a value ≥ 10 events/hour. The data of 43 infants, mean age 2.3 ± 1.1 months, were analysed. Seventeen (40 %) and 10 (23 %) infants had a clinical severity score of 2 or 3, respectively. Eleven (26 %) infants had a MOAHI ≥ 10 events/hour and 22 (52 %) an ODI ≥ 10 events/hour. When analysing the correlation between these 3 parameters, only the MOAHI correlated with the ODI (r = 0.549, p < 0.001). Regarding NIRS initiation, no correlation was observed between any of the 3 parameters in the 18 infants who required a NIRS. In conclusion, this study shows the difficulty to assess the severity of UAO in infants with RS taking in account a clinical evaluation and two PG respiratory parameters. This pleads for the integration of body position and sleep/wake state, as well as other respiratory parameters, such as the hypoxic burden, for the assessment of UAO severity in infants with RS.