The role of sleep position in children with sleep-disordered breathing

Sleep-disordered breathing (SDB) in children encompasses a spectrum of alterations in respiratory patterns occurring during nocturnal rest, ranging from mild forms, such as habitual snoring, to more severe conditions, such as obstructive sleep apnea (OSA). In the pediatric population, the prevalence of OSA is estimated to range between 1% and 5.7%, with a peak incidence between 2 and 6 years of age—a developmental stage characterized by a relative disproportion between adenoidal and tonsillar volume and the caliber of the upper airways. In recent years, however, increasing attention has been directed toward SDB in other age groups as well, driven by factors such as the rising prevalence of childhood obesity and growing clinical awareness of sleep quality–related health issues 1-4. Pediatric OSA is characterized by recurrent episodes of partial or complete obstruction of the upper airways during sleep, leading to airflow limitation, oxygen desaturation, and sleep fragmentation 5-7. Clinically, affected children may present with habitual snoring, witnessed breathing pauses, restless sleep, nocturnal enuresis, and morning headaches, as well as daytime symptoms including excessive daytime sleepiness, irritability, attention deficits, or poor school performance 8-14. The Sleep Clinical Record (SCR), proposed by Villa et al. 15, is a combined clinical–anamnesis tool that integrates physical examination findings, nocturnal and daytime symptoms, and ADHD screening (via the SDAG scale). It assigns a total score, with values ≥ 6.25 considered positive and 4 correlating with higher AHI values. The SCR has a sensitivity of 96.05% and can help identify candidates for PSG, including those with mild OSAS. The diagnosis is confirmed through polysomnography, which allows for the quantification of disease severity using parameters such as the apnea–hypopnea index (AHI) 16-19. In recent years, the importance of identifying distinct clinical phenotypes within the spectrum of pediatric sleep-disordered breathing has become increasingly evident, particularly in relation to anatomical, functional, and neurobehavioral components. A particularly relevant yet still under-investigated aspect in the pediatric field concerns the influence of body position during sleep on the severity of the disorder. While the role of body position—especially the supine posture—is well established as an aggravating factor for apneas in adults, data in children remain limited 20 -21. The present work aims to investigate this specific aspect, with the objective of assessing the extent to which sleep position influences the severity of respiratory disturbances in children. A more detailed understanding of this relationship may provide an opportunity to individualize therapeutic approaches and introduce simple, non-invasive behavioral strategies that could be effective in improving both sleep quality and the overall health of the child.