Skip to main content
SpringerLink
Log in

Positional obstructive sleep apnea in children: prevalence and risk factors

  • Pediatrics • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Positional (supine dependent) obstructive sleep apnea (POSA) affects about 55% of adults with obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for POSA in children.

Methods

Cross-sectional analysis of data obtained in 171 children with moderate to severe OSA confirmed by polysomnography (PSG) performed over a 2-year period. POSA is defined by an obstructive apnea–hypopnea index (oAHI) in the supine position ≥ 2× oAHI in the non-supine position.

Results

The overall prevalence of POSA was 18.7%. Children with POSA were significantly older (p < 0.001), had a higher prevalence of obesity (p = 0.04), a lower tonsil score (p = 0.049), and less severe OSA (lower oAHI) (p = 0.02) compared to children without POSA, while age was the only significant independent predictor of POSA. The ratio AHI supine to AHI non-supine was not significantly higher during REM than during NREM sleep in children with POSA.

Conclusions

POSA is less common in children compared to adults and the prevalence of POSA increases with age. Although OSA worsens during REM sleep, this was not observed for POSA. Future studies should investigate the prevalence of POSA in specific subgroups and upper airway characteristics of POSA in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):714–755

    Article  Google Scholar 

  2. Bixler EO, Vgontzas AN, Lin HM, Liao D, Calhoun S, Vela-Bueno A, Fedok F, Vlasic V, Graff G (2009) Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 32(6):731–736

    Article  Google Scholar 

  3. Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7(2):110–114

    Article  CAS  Google Scholar 

  4. Joosten SA, O'Driscoll DM, Berger PJ, Hamilton GS (2014) Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev 18(1):7–17

    Article  Google Scholar 

  5. Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N (2006) The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 263(10):946–950

    Article  Google Scholar 

  6. Frank MH, Ravesloot MJ, van Maanen JP, Verhagen E, de Lange J, de Vries N (2015) Positional OSA part 1: towards a clinical classification system for position-dependent obstructive sleep apnoea. Sleep Breath 19(2):473–480

    Article  CAS  Google Scholar 

  7. Dayyat E, Maarafeya MM, Capdevila OS, Kheirandish-Gozal L, Montgomery-Downs HE, Gozal D (2007) Nocturnal body position in sleeping children with and without obstructive sleep apnea. Pediatr Pulmonol 42(4):374–379

    Article  Google Scholar 

  8. Cuhadaroglu C, Keles N, Erdamar B, Aydemir N, Yucel E, Oguz F, Deger K (2003) Body position and obstructive sleep apnea syndrome. Pediatr Pulmonol 36(4):335–338

    Article  Google Scholar 

  9. Zhang XW, Li Y, Zhou F, Guo CK, Huang ZT (2007) Association of body position with sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Acta Otolaryngol 127(12):1321–1326

    Article  Google Scholar 

  10. Goh DY, Galster P, Marcus CL (2000) Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med 162(2 Pt 1):682–686

    Article  CAS  Google Scholar 

  11. El-Kersh K, Cavallazzi R, Patel PM, Senthilvel E (2016) Effect of sleep state and position on obstructive respiratory events distribution in adolescent children. J Clin Sleep Med 12(4):513–517

    Article  Google Scholar 

  12. Must A, Anderson SE (2006) Body mass index in children and adolescents: considerations for population-based applications. Int J Obes 30(4):590–594. https://doi.org/10.1038/sj.ijo.0803300

    Article  CAS  Google Scholar 

  13. Flegal KM, Ogden CL (2011) Childhood obesity: are we all speaking the same language? Adv Nutr 2(2):159–166

    Article  Google Scholar 

  14. Brodsky L (1989) Modern assessment of tonsils and adenoids. Pediatr Clin N Am 36(6):1551–1569

    Article  CAS  Google Scholar 

  15. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep M (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619

    PubMed  PubMed Central  Google Scholar 

  16. Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47(1):69–94

    Article  Google Scholar 

  17. Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R, Paruthi S, Muzumdar H, Gozal D, Thomas NH, Ware J, Beebe D, Snyder K, Elden L, Sprecher RC, Willging P, Jones D, Bent JP, Hoban T, Chervin RD, Ellenberg SS, Redline S, Childhood Adenotonsillectomy T (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 368(25):2366–2376

    Article  CAS  Google Scholar 

  18. Fernandes do Prado LB, Li X, Thompson R, Marcus CL (2002) Body position and obstructive sleep apnea in children. Sleep 25(1):66–71

    Article  Google Scholar 

  19. Nisbet LC, Phillips NN, Hoban TF, O'Brien LM (2014) Effect of body position and sleep state on obstructive sleep apnea severity in children with Down syndrome. J Clin Sleep Med J 10(1):81–88

    Google Scholar 

  20. Omobomi O, Quan SF (2017) Positional therapy in the management of positional obstructive sleep apnea-a review of the current literature. Sleep Breath 22:297–304. https://doi.org/10.1007/s11325-017-1561-y

    Article  PubMed  Google Scholar 

  21. Kim HY, Dhong HJ, Lee JK, Chung SK, Jung SC (2011) Sleep quality and effects of position on sleep apnea in East Asian children. Auris Nasus Larynx 38(2):228–232

    Article  Google Scholar 

  22. Dayyat E, Kheirandish-Gozal L, Sans Capdevila O, Maarafeya MM, Gozal D (2009) Obstructive sleep apnea in children: relative contributions of body mass index and adenotonsillar hypertrophy. Chest 136(1):137–144

    Article  Google Scholar 

  23. Senthilvel E, Krishna J (2011) Body position and obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med 7(2):158–162

    PubMed  PubMed Central  Google Scholar 

  24. Walter LM, Dassanayake DUN, Weichard AJ, Davey MJ, Nixon GM, Horne RSC (2017) Back to sleep or not: the effect of the supine position on pediatric OSA: sleeping position in children with OSA. Sleep Med 37:151–159

    Article  Google Scholar 

  25. Lee SA, Paek JH, Chung YS, Kim WS (2017) Clinical features in patients with positional obstructive sleep apnea according to its subtypes. Sleep Breath 21(1):109–117

    Article  Google Scholar 

  26. Mador MJ, Choi Y, Bhat A, Dmochowski J, Braun M, Gottumukkala VA, Grant BJ (2010) Are the adverse effects of body position in patients with obstructive sleep apnea dependent on sleep stage? Sleep Breath 14(1):13–17

    Article  Google Scholar 

  27. Cartwright RD, Diaz F, Lloyd S (1991) The effects of sleep posture and sleep stage on apnea frequency. Sleep 14(4):351–353

    Article  CAS  Google Scholar 

  28. Victores AJ, Hamblin J, Gilbert J, Switzer C, Takashima M (2014) Usefulness of sleep endoscopy in predicting positional obstructive sleep apnea. Otolaryngol Head Neck Surg 150(3):487–493

    Article  Google Scholar 

  29. Boudewyns A, Abel F, Alexopoulos E, Evangelisti M, Kaditis A, Miano S, Villa MP, Verhulst SL (2017) Adenotonsillectomy to treat obstructive sleep apnea: is it enough? Pediatr Pulmonol 52(5):699–709

    Article  CAS  Google Scholar 

  30. Barnes H, Edwards BA, Joosten SA, Naughton MT, Hamilton GS, Dabscheck E (2017) Positional modification techniques for supine obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev 36:107–115

    Article  Google Scholar 

  31. Ravesloot MJL, White D, Heinzer R, Oksenberg A, Pepin JL (2017) Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med 13(6):813–824

    Article  Google Scholar 

  32. Beyers J, Dieltjens M, Kastoer C, Opdebeeck L, Boudewyns AN, De Volder I, Van Gastel A, Verbraecken JA, De Backer WA, Braem MJ, Van de Heyning PH, Vanderveken OM (2018) Evaluation of a trial period with a sleep position trainer in patients with positional sleep apnea. J Clin Sleep Med 14(4):575–583

    Article  Google Scholar 

  33. Tapia IE, Marcus CL (2013) Newer treatment modalities for pediatric obstructive sleep apnea. Paediatr Respir Rev 14(3):199–203

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Ir. Marc Willemen (sleep technician) and Mrs. Kristien Wouters (statistician) for their advice with the revised manuscript.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

    E. Verhelst, O. Vanderveken & A. Boudewyns

  2. Faculty of Medicine, University of Antwerp, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium

    I. Clinck & I. Deboutte

  3. Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

    S. Verhulst

Authors
  1. E. Verhelst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Clinck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Deboutte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Vanderveken
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Verhulst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Boudewyns
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Boudewyns.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the parents or legal caregivers for all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This paper was presented as poster at the European Society for Pediatric Otorhinolaryngology (ESPO) meeting in Stockholm, June 2–5, 2018.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Verhelst, E., Clinck, I., Deboutte, I. et al. Positional obstructive sleep apnea in children: prevalence and risk factors. Sleep Breath 23, 1323–1330 (2019). https://doi.org/10.1007/s11325-019-01853-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-019-01853-z

Keywords

Search

Navigation