Prone Vs. Supine Sleep Position in Bronchiolitis: Effects on Apnoea and Oxygenation

Background: Despite its role as a risk factor for sudden infant death, the prone sleep position may have advantages in compromised infants. We aimed to study apnoeic pause frequency and oxygenation in the prone vs. the supine position in infants with bronchiolitis. Methods: 20 infants(median age 10 wk, range 2-28) admitted to hospital with bronchiolitis, who currently had no supplementary O₂ requirement (pulse oximeter saturations (SpO₂) >90%), underwent nap recordings of breathing movements, SpO₂ and pulse waveforms in both sleep positions. Recordings were analysed for breathing pattern, apnoeic pauses (≥4 s), desaturations(SpO₂≤80% for ≥4 s) and baseline values for SpO₂, and heart rate. Results: Median duration of sleep was 1 h in each position. Apnoeic pauses occurred significantly more frequently in the supine position (5.7 (0-31) vs. 8.6 (0-111)/h, p<0.05); no pause was > 12.5 s. Desaturations occurred in 1 infant while sleeping prone and in 5 when supine(median 0, range 0-0.9 vs. 0-4.8, p<0.05). Baseline SpO₂ was 94.2%(90-98) in the prone and 93.3% (88-99) in the supine position (n.s.). Heart rate was slightly higher in the prone position (135 (114-171) vs. 130/min.(114-168), p<0.05). Conclusion: In conditions such as bronchiolitis, the prone sleep position may be advantageous with regard to the stability of respiration. These data must not, however, imply that the prone position should be used at home in infants with bronchiolitis.