SLUMBRS2

Comparing the effectiveness of side-lying sleep positioning to back-lying at reducing oxygen desaturation resulting from Obstructive Sleep Apnoea in infants with cleft palate.

Background

To reduce the numbers of babies dying from ‘cot death’ the government produced national guidelines advising that babies should sleep on their back - the ‘Back to Sleep’ campaign. We do not know if this is the best advice for babies with cleft palate.

Obstructive sleep apnoea

Babies with cleft palate have an increased risk of breathing problems whilst asleep, including obstructive sleep apnoea (OSA) due to problems with how their nose, mouth and throat have formed, meaning that they have a small airway to breathe through and their tongue falls backwards during sleep.

Some doctors and nurses caring for babies with cleft palate, feel from their experience that these babies are better sleeping on their side, rather than on their back.

Importance of oxygen

It is important that a baby’s heart, lungs and brain receive the right amount of oxygen to work normally whilst asleep. Regular blockage of a baby’s airway during sleep can cause problems with oxygen reaching the lungs and then the bloodstream and organs.

If the amount of oxygen in the blood regularly drops during sleep it can place a strain on the heart and lungs, which can cause problems with health, growth, brain development and learning at the time and in the future. Babies with cleft palate are particularly at risk of these problems as their airways are already small.

Safe sleeping position

Currently, doctors and nurses do not know the best advice to give parents regarding the safest sleeping position for a baby with cleft palate. We have published a feasibility study that has shown that parents and nurses think this is an important unanswered question, and the advice given to parents differs depending on where they live.

Study design

We will work with local cleft palate teams to ask parents of a large number of babies with cleft palate to take part in the three-year study. Parents will be asked to agree to their baby being randomly chosen to sleep on their back or side.

During one night of testing at one month of age, we will estimate blood oxygen levels during sleep using a sensor attached to the baby’s toe that records changes in the amount of oxygen in the blood. Recordings will be done at home by parents after they have been trained by the nurses to use the machine.

Stakeholder involvement

The Cleft Lip and Palate Association (CLAPA) will be a key partner in this study, supporting parents during the study, providing access to parents when we need to ask questions about the running of the study, and helping us to update their members on the progress and findings of the study.