Oxygen therapy brings sweet comfort to infants with PWS sleep apnea
Small trial shows it prevents breathing disruptions better than medical air
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Supplemental oxygen is more effective at easing brain-related breathing disruptions during sleep for infants with Prader-Willi syndrome (PWS) than medical air, a small clinical trial has found.
The proof-of-concept study compared the two approaches in 10 infants with PWS who had central sleep apnea (CSA) — a condition in which the brain temporarily fails to signal the muscles to breathe during sleep. When receiving supplemental oxygen, the infants experienced about five times fewer breathing interruptions and had better blood oxygen levels than when they received medical air.
Because medical air is a gas mixture that closely mimics normal room air, these findings suggest that the benefits of oxygen therapy are driven by the oxygen itself rather than by the physical flow of gas through the delivery device.
“Supplemental oxygen produced a more consistent reduction in central apnea burden than medical air in infants with PWS,” researchers wrote.
The study, “A comparison of therapeutic oxygen versus medical air for the treatment of central sleep apnea in infants with Prader-Willi syndrome; A proof-of-concept randomized crossover trial,” was published in Sleep Medicine.
The danger of CSA in infants
PWS is a complex genetic disorder that causes a wide range of symptoms, including developmental delays, cognitive challenges, hyperphagia (an extreme, constant hunger), and sleep disturbances.
Sleep issues are common in PWS, particularly CSA, which affects up to 53% of babies younger than 2 years. Because the brain does not consistently signal the body to breathe, CSA can lead to dangerously low blood oxygen levels and other serious health complications.
While supplemental oxygen is a standard treatment to help maintain stable oxygen levels, scientists have not fully understood how it works in infants with PWS. Specifically, they wanted to know if the benefit comes from the extra oxygen or simply the sensory stimulation of gas flowing into the nose. If flow alone were the key, medical air would have produced the same positive results.
To answer this, a team of researchers in Canada studied 10 infants with PWS, who had a median age of 6 months. None of the infants had yet been treated with growth hormone, also known as somatropin (sold as Genotropin and Norditropin, with biosimilars available), which is often used to treat growth failure in PWS but can sometimes affect breathing patterns.
Before testing the therapies, the infants underwent an initial sleep study called a polysomnogram (PSG) to track their brain activity, heart rate, breathing, and oxygen levels. The results showed that while the infants generally slept well — with a median sleep time of seven hours and an 85% sleep efficiency — they experienced a median of nine CSA events per hour, each lasting an average of 5.9 seconds. These pauses were accompanied by 13.7 clinically meaningful drops in blood oxygen levels per hour.
Their median blood oxygen saturation, a proxy for blood oxygen levels, during sleep was 97.6%, with a median of the lowest recorded values of 83%.
About a month after the initial sleep study, the infants completed a “split-night” sleep study. During this test, the night was divided in half so that each infant could try both therapies. They were randomly assigned to receive either medical air first, followed by supplemental oxygen, or vice versa.
The results showed that infants experienced an adjusted average of 1.8 breathing pauses per hour while on oxygen therapy, compared to 9.4 pauses per hour when breathing medical air. This successful drop met the trial’s main goal, and the order in which the gases were given made no difference.
Supplemental oxygen also significantly increased blood oxygen levels compared to medical air, raising the lowest oxygen saturation by 8.2% and the average oxygen saturation by 2.1%. It also reduced the frequency of sudden drops in oxygen saturation by more than 12 events per hour.
Future steps for PWS sleep care
Overall, the study shows that supplemental oxygen provides a much more consistent benefit than medical air, suggesting that its benefits may not be attributable to flow alone.
While the researchers noted that these findings are specific to very young infants with PWS who have not yet started growth hormone therapy, they strongly support the use of supplemental oxygen as a safe and effective way to manage CSA in this high-risk group.
“Studies should aim to define evidence-based treatment algorithms for CSA in infants with PWS, clarifying when oxygen is sufficient, when escalation to other therapies is needed, and whether medical air or flow-based therapies have any adjunctive role in selected subgroups,” the team concluded.
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