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Randomized Controlled Trial
. 2025 Jun 30;29(4):230.
doi: 10.1007/s11325-025-03393-1.

Supine position-related obstructive sleep apnea in children: insights from the Childhood Adenotonsillectomy Trial

Siyu Dai  1   2 , Ming Yang  1 , Chun Ting Au  3 , Nobel Tsz Kin Yuen  1 , Yuzheng Zhang  4 , Agatha Tang  1 , Michelle Wai Ling Yu  1 , Albert Martin Li  1   5   6 , Kate Ching Ching Chan  7   8   9
Affiliations
Randomized Controlled Trial

Supine position-related obstructive sleep apnea in children: insights from the Childhood Adenotonsillectomy Trial

Siyu Dai et al. Sleep Breath. .

Abstract

Purpose: This study aimed to examine the effectiveness of adenotonsillectomy (AT) among pediatric obstructive sleep apnea (OSA) patients with and without supine position-related OSA (POSA) and explore the stability of this subtype over time.

Methods: Data from the Childhood Adenotonsillectomy Trial (CHAT) were analyzed. Children with OSA were randomized to early AT (EAT) or watchful waiting with supportive care (WWSC). Polysomnographic and health outcomes were assessed at baseline and 7 months. POSA was defined as a supine obstructive apnea-hypopnea index (OAHI) ≥ 2× non-supine OAHI, with ≥ 30 min spent in each position.

Results: Among 354 patients (mean age: 6.97 ± 1.39 years; male: 48.1%), 47.2% had POSA at baseline. Compared to non-POSA, children with POSA exhibited lower baseline OAHI [3.77 (2.48, 7.71) vs. 5.42 (3.03, 9.47) events/h, p = 0.006], longer rapid eye movement (REM) sleep in the supine position (p = 0.05), shorter REM sleep in non-supine position (p = 0.005), and fewer allergic conditions (37.7% vs. 48.4%, p = 0.05). Generalized linear models showed AHI reduction was associated with randomization grouping (p < 0.001) but not POSA status (p = 0.10). Our restricted cubic splines further supported this finding. Notably, in the WWSC group, POSA classification changed for half of the patients over 7 months, with changes in non-supine OAHI as a significant indicator.

Conclusion: AT is effective in managing childhood OSA regardless of POSA status. The observed dynamic nature of POSA warrants future research into its pathophysiology and natural history.

Clinical trial registration: Childhood Adenotonsillectomy Study for Children with OSAS (CHAT), Clinical Trial Identifier NCT00560859.

Keywords: Adenotonsillectomy; Children; Natural history; Obstructive sleep apnea; Supine position.

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Conflict of interest statement

Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Joint Chinese University of Hong Kong-New Territories East Cluster Research Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For the current retrospective secondary study, formal consent is not required. Informed consent: Informed consent was obtained from all participating children or their guardians in the CHAT study. Competing interests: The authors have no conflicts of interests to declare.

Figures

Fig. 1
Fig. 1
Comparative analyses of AHI reduction over 7 months in children by POSA status. Notes: the restricted cubic spline (RCS) with 4 knots was used to assess the impacts of POSA status on AT treatment effectiveness and its interaction with RCT grouping in children; The shadow represents 95% confidence intervals
See this image and copyright information in PMC

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