Should obstructive hypopneas be included when analyzing sleep studies in infants with Robin Sequence?

Objective:We have used an obstructive apnea index of >= 3 as treatment indication for infants with Robin sequence (RS), while the obstructive apnea-hypopnea index (OAHI) and a threshold of >= 5 is often used internationally. We wanted to know whether these two result in similar indications, and what the interobserver variability is with either asessement. Methods:Twenty lab-based overnight sleep recordings from infants with isolated RS (median age: 7 days, range 2-38) were scored based on the 2020 American Academy of Sleep Medicine guidelines, including or excluding obstructive hypopneas. Results:Median obstructive apnea index (OAI) was 18 (interquartile range: 7.6-38) including only ap-neas, and 35 (18-54) if obstructive hypopneas were also considered as respiratory events (OAHI). Obstructive sleep apnea (OSA) severity was re-classified from moderate to severe for two infants when obstructive hypopneas were also considered, but this did not lead to a change in clinical treatment decisions for either infant. Median interobserver agreement was 0.86 (95% CI 0.70-0.94) for the OAI, and 0.60 (0.05-0.84) for the OAHI. Conclusion:Inclusion of obstructive hypopneas when assessing OSA severity in RS infants doubled the obstructive event rate, but impaired interobserver agreement and would not have changed clinical management. (c) 2022 Elsevier B.V. All rights reserved.