Plastic Surgery Research Council

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Apnea-hypopnea Index Does Not Correlate With Weight Gain Or Failure To Thrive In Infants With Robin Sequence
Michael K. Boyajian, BA1, Pamela Tan, MD2, Erin Rada, MD2, Lauren Salinero, BS2, Gary Rogers, MD2, Albert Oh, MD2.
1Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Division of Plastic & Reconstructive Surgery at Children's National Medical Center, Washington, DC, USA.

Purpose:
Robin sequence (RS) is a condition characterized by the triad of micrognathia, glossoptosis, and airway obstruction. Obstruction of the airway can have serious immediate or chronic consequences. Proper diagnosis and treatment are critical, but surgical indications are still largely debated. The decision broadly hinges upon respiratory distress and, ultimately, failure to thrive (FTT), although to date the relationship between these parameters has not been analyzed. In this study we quantified airway obstruction using apnea-hypopnea index (AHI), and our aim was to investigate for correlations between AHI and FTT.
Methods:
This retrospective study reviewed all RS infants who were diagnosed and treated at our institution from the year 1994 until 2017. Study parameters included nonsyndromic patients who had baseline polysomnogram data as well as serial weight measurements prior to either surgical intervention or discharge. These patients were divided into 2 groups depending on weight gain. Patients in Group 1 (25 total patients) had failure to thrive (FTT, defined as weight gain <30 g/day after at least one week of conservative management), while those in Group 2 (6 total patients) demonstrated adequate weight gain. AHI scores were used to categorize the severity of sleep apnea.
Results:
Mean weight gain (g/day) for all infants was 19.3 +/- 8.9, and significant differences in weight gain were demonstrated between Group 1 vs. Group 2 (15.5 +/- 6.8 vs. 35.1 +/- 3.4; p<0.00001). Mean AHI for all patients was 51.1 +/- 35.4. However, no differences in AHI were demonstrated between Group 1 vs. Group 2 (49.5 +/- 36.3 vs. 79.6 +/- 30.6, respectively; p>0.05). Finally, there was no significant correlation between AHI and weight gain (r=0.25, p=0.17).
Conclusions:
Despite widespread use of AHI to quantify the severity of upper airway obstruction in infants with RS, this study failed to demonstrate any significant association between AHI and mean weight gain or FTT. Our results underscore the importance of comprehensive and individualized treatment plans for these challenging patients.


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