Sleep Apnea throughout the First Two Years of Life: Assessment of the Effect of Pacifiers in Patients with ALTE

Luca Levrini*, Luana Nosetti, Riggi Letizia, Montericcio Laura, Massimo Agosti
Departemet of Surgery and Medicine, University of Insubria, Varese, Italy

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© 2019 Levrini et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Surgery and Medicine, University of Insubria, Varese, Italy; Tel: +39 0332/393606 & 278928; Fax; +39 0332/393280; E-mail:



Apparent Life-Threatening Event (ALTE), Obstructive Sleep Apnea syndrome (OSAs) and Sudden Infant Death Syndrome (SIDS) are strongly correlated and few studies analyze the role that pacifiers play in such conditions.


The aim of the study is to evaluate how pacifiers affect sleep apnea among children with a history of ALTE.


10 subjects between 1 month and 2 years of age with a history of idiopathic ALTE were non-selectively recruited. Patients were subjected to cardio-respiratory monitoring at home for two consecutive nights; during the first night, the pacifier was not used, whereas the second night, the pacifier was used by the child for at least four hours sleep. Parents were given an assessment questionnaire to evaluate and report any irritation due to the pacifier use. All obtained traces were blindly analyzed by a pediatric specialist in sleep disorders, more specifically: Peripheral oxygen saturation (SpO2), heart rate (FC), Electrocardiogram (ECG) and the presence of apneas and/or hypopneas were assessed. In order to evaluate the differences between the average values collected from the two groups, a t-test was performed.


The use of the pacifier resulted in a statistically significant reduction in the number of pathological apneas/night (-1.7%; p = 0,0024), an improvement in the average SpO2 (+ 0.8%; p = 0.3328) and an increase in the value of the minimum SpO2 detected (+ 2%; p = 0.2571).


The results show that the use of pacifiers improves the respiratory capacity of children that suffer from nocturnal apneas at night.

Keywords : Pacifiers, Polysomnography, Sudden infant death, Infant sleep, Interceptive orthodontics, Obstructive sleep apnea.