Polysomnographic findings in 320 infants evaluated for apneic events

Abstract

Apnea is a common problem that causes significant parental anxiety. The aim of this study was to describe polysomnographic findings in infants who were referred over a 4-year period for an apnea and/or cyanotic event. Our hypothesis was that most infants with apnea or cyanosis events will have normal polysomnography (PSG). In total, 320 patients younger than 2 years old were recruited sequentially and prospectively. Patients underwent a day or overnight PSG by computerized polysomnograph; 78% of studies were performed with pH probe in situ. Subjects' ages ranged from 10 days to 21 months (55% male and 84% full-term babies); 55% and 74% were younger than 3 and 6 months, respectively. The average total sleep time was 473.4 min (SD, 52.3), with mean sleep efficiency of 83.5%. The distribution of sleep stages was 56.5% active, 38.5%, quiet and 5.1% indeterminate sleep. Sixty-nine percent (n = 220) of PSG studies were done overnight. There were significant differences in average sleep efficiency (78.1% vs. 83.3%) and REM sleep time (63.6% vs. 59.1%) between PSGs done during the day and overnight (P < 0.05). In total, 34 patients with apneas were studied. The median apnea index for the whole study population was 1.01 (range, 0.1-9.1). In conclusion, our study showed a high prevalence of normal polysomnographic findings in infants referred because of apnea and/or cyanotic events. New clinical prospective studies should be conducted to evaluate whether there is a correlation between PSG findings and outcome at follow-up of infants with a history of apnea and cyanosis.

Sleep disordered breathing in bronchopulmonary dysplasia

“…In conclusion, we found that preterm children with BPD have a higher rate of SDB when compared to non-BPD non-premature populations. 52,63 While SDB improved with age, we found that standard SDB metrics by PSG were still abnormal in children with BPD when studied at four years of age. Severity of BPD, smoke exposure, and race modified the severity of SDB.…”

ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children

“…b) History of ALTEs has been associated with the presence or later development of OSAS and mild facial dysmorphia in studies of low methodological quality [23][24][25][26][27][28]. In contrast, a large retrospective study including infants with reported episodes of apnoea and/or cyanosis demonstrated normal polysomnographic findings in the majority of participants [29]. c) No consistent association has been found between gastro-oesophageal reflux and OSAS; prematurity as a risk factor for SDB in infancy has not been studied adequately, although there is evidence for its role in older children [3,[30][31][32][33].…”

Polysomnography for the diagnosis of sleep disordered breathing in children under 2 years of age

“…Apnea, periodic breathing, and oxygen desaturation during sleep are normal events in healthy infants in the first few weeks after birth. Decrease in respiratory events with increasing age reflects greater stability in the respiratory control system . Infants have more compliant upper airways and chest wall which increase the collapsibility of the upper airway and predisposes to paradoxical respirations .…”

“…16 After birth, variability continues to decrease such that a more stable pattern of both breathing and heart rate develops. Apnea, 17 periodic breathing, 18,19 and oxygen desaturation [20][21][22][23] during sleep are normal events in healthy infants in the first few weeks after birth. Decrease in respiratory events with increasing age reflects greater stability in the respiratory control system.…”

“…Decrease in respiratory events with increasing age reflects greater stability in the respiratory control system. 20,23 Infants have more compliant upper airways and chest wall which increase the collapsibility of the upper airway and predisposes to paradoxical respirations. [24][25][26] Finally, infant arousal responses are immature with greater variability in the arousal response to stimuli such as hypoxemia and changes in upper airway resistance.…”