Unexplained Significant Central Sleep Apnea in Infants: Clinical Presentation and Outcomes.
Pediatrics
Respiratory medicine
Sleep
Journal
Sleep & breathing = Schlaf & Atmung
ISSN: 1522-1709
Titre abrégé: Sleep Breath
Pays: Germany
ID NLM: 9804161
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
11
01
2022
accepted:
30
03
2022
revised:
07
03
2022
pubmed:
12
4
2022
medline:
10
3
2023
entrez:
11
4
2022
Statut:
ppublish
Résumé
Unexplained significant central sleep apnea in term infants presents as central apneas with associated oxygen desaturations requiring respiratory support and monitoring for prolonged periods. However, there is a paucity of literature describing idiopathic central sleep apnea (ICSA) in term or near-term infants. Our aim was to describe the clinical manifestations, polysomnography data, interventions, and trajectory of ICSA in infants. This is a retrospective study of infants (gestational age ≥ 35 weeks) who presented with significant central apneas and were subsequently diagnosed with ICSA following polysomnography and clinical investigations between January 2011 and April 2021 at a tertiary care hospital in Canada. Polysomnography data, clinical investigations, and treatments were documented. Eighteen infants (male, 78%; median gestational age 38 weeks) with ICSA were included. Initial polysomnograms were completed at a median (interquartile range [IQR]) age of 1.2 (0.6-1.6) months (n = 18) and follow-up polysomnograms at 12.4 (10.6-14.0) months (n = 13). Compared to baseline diagnostic polysomnograms, at follow-up there was a significant reduction in the median (IQR) central apnea-hypopnea index (26.1 [18.2-52.9] versus 4.2 [2.6-7.2] events/hour; p = 0.001), desaturation index (30.9 [12.2-57.4] versus 3.9 [3.0-7.9] events/hour; p = 0.002), average transcutaneous carbon dioxide (41.9 [40.1-47.3 versus 39.4 [37.5-42.7] mmHg; p = 0.025), and improved nadir oxygen saturation (79.8 [69.1-83.0] versus 85.5 [83.2-87.8]%; p = 0.033), respectively. Prescribed treatments included supplemental oxygen (14/18, 78%), caffeine (5/18, 28%), and noninvasive ventilation (1/18, 6%). Infants with significant unexplained ICSA have a favorable clinical trajectory over time. Further research is needed to understand the etiology of this rare disorder.
Identifiants
pubmed: 35399129
doi: 10.1007/s11325-022-02612-3
pii: 10.1007/s11325-022-02612-3
doi:
Substances chimiques
Carbon Dioxide
142M471B3J
Oxygen
S88TT14065
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
255-264Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
Références
Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL and Vaughn BV for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.6. www.aasmnet.org . Darien, Illinois: American Academy of Sleep Medicine, 2020.
Kritzinger FE, Al-Saleh S, Narang I (2011) Descriptive analysis of central sleep apnea in childhood at a single center: Central sleep apnea in childhood. Pediatr Pulmonol 46:1023–1030. https://doi.org/10.1002/ppul.21469
doi: 10.1002/ppul.21469
pubmed: 21520440
Felix O, Amaddeo A, Olmo Arroyo J, Zerah M, Puget S, Cormier-Daire V et al (2016) Central sleep apnea in children: experience at a single center. Sleep Med 25:24–28. https://doi.org/10.1016/j.sleep.2016.07.016
doi: 10.1016/j.sleep.2016.07.016
pubmed: 27823711
Ghirardo S, Amaddeo A, Griffon L, Khirani S, Fauroux B (2021) Central apnea and periodic breathing in children with underlying conditions. J Sleep Res 00:e13388. https://doi.org/10.1111/jsr.13388
doi: 10.1111/jsr.13388
Deschamp A, Daftary A (2017) A Newborn infant with oxygen desaturation during Sleep. Chest 151:e17-20. https://doi.org/10.1016/j.chest.2016.08.1435
doi: 10.1016/j.chest.2016.08.1435
pubmed: 28065256
American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.
Gurbani N, Verhulst SL, Tan C, Simakajornboon N (2017) Sleep complaints and sleep architecture in children with idiopathic central sleep apnea. J Clin Sleep Med 13:777–783. https://doi.org/10.5664/jcsm.6614
doi: 10.5664/jcsm.6614
pubmed: 28212689
pmcid: 5443738
McLaren AT, Bin-Hasan S, Narang I (2019) Diagnosis, management and pathophysiology of central sleep apnea in children. Paediatr Respir Rev 30:49–57. https://doi.org/10.1016/j.prrv.2018.07.005
doi: 10.1016/j.prrv.2018.07.005
pubmed: 30170958
Henderson-Smart DJ (1981) The effect of gestational age on the incidence and duration of recurrent apnoea in newborn babies. J Paediatr Child Health 17:273–276. https://doi.org/10.1111/j.1440-1754.1981.tb01957.x
doi: 10.1111/j.1440-1754.1981.tb01957.x
Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B et al (2016) Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics 137:e20160590. https://doi.org/10.1542/peds.2016-0590
doi: 10.1542/peds.2016-0590
pubmed: 27244835
Shi Y, Stornetta DS, Reklow RJ, Sahu A, Wabara Y, Nguyen A et al (2021) A brainstem peptide system activated at birth protects postnatal breathing. Nature 589:426–430. https://doi.org/10.1038/s41586-020-2991-4
doi: 10.1038/s41586-020-2991-4
pubmed: 33268898
Katz-Salamon M (2004) Delayed chemoreceptor responses in infants with apnoea. Arch Dis Child 89:261–266
doi: 10.1136/adc.2003.030957
pubmed: 14977706
pmcid: 1719836
Edwards BA, Sands SA, Berger PJ (2013) Postnatal maturation of breathing stability and loop gain: The role of carotid chemoreceptor development. Respir Physiol Neurobiol 185:144–155. https://doi.org/10.1016/j.resp.2012.06.003
doi: 10.1016/j.resp.2012.06.003
pubmed: 22705011
Eckert DJ, Jordan AS, Merchia P, Malhotra A (2007) Central Sleep Apnea. Chest 131:595–607. https://doi.org/10.1378/chest.06.2287
doi: 10.1378/chest.06.2287
pubmed: 17296668
Abu-Shaweesh JM, Martin RJ (2008) Neonatal Apnea: What’s New? Pediatr Pulmonol 43:937–944. https://doi.org/10.1002/ppul.20832
doi: 10.1002/ppul.20832
pubmed: 18780339
Rigatto H, Brady JP, de la Torre Verduzco R (1975) Chemoreceptor Reflexes in Preterm Infants 1. The Effect of Gestational and Postnatal Age on the Ventilatory Response to Inhalation of 100% and 15% Oxygen. Pediatrics 55:604–13
doi: 10.1542/peds.55.5.604
pubmed: 1128986
Nock ML, DiFiore JM, Arko MK, Martin RJ (2004) Relationship of the ventilatory response to hypoxia with neonatal apnea in preterm infants. J Pediatr 144:291–295. https://doi.org/10.1016/j.jpeds.2003.11.035
doi: 10.1016/j.jpeds.2003.11.035
pubmed: 15001929
Manning DJ, Stothers JK (1991) Sleep State, Hypoxia and Periodic Breathing in the Neonate. Acta Paediatr Scand 80:763–769. https://doi.org/10.1111/j.1651-2227.1991.tb11946.x
doi: 10.1111/j.1651-2227.1991.tb11946.x
pubmed: 1957593
Simakajornboon N, Beckerman RC, Mack C, Sharon D, Gozal D (2002) Effect of Supplemental Oxygen on Sleep Architecture and Cardiorespiratory Events in Preterm Infants. Pediatrics 110:884–888. https://doi.org/10.1542/peds.110.5.884
doi: 10.1542/peds.110.5.884
pubmed: 12415025
Weintraub Z, Alvaro R, Kwiatkowski K, Cates D, Rigatto H (1992) Effects of inhaled oxygen (up to 40%) on periodic breathing and apnea in preterm infants. J Appl Physiol 72:116–120. https://doi.org/10.1152/jappl.1992.72.1.116
doi: 10.1152/jappl.1992.72.1.116
pubmed: 1537704
Daftary AS, Jalou HE, Shively L, Slaven JE, Davis SD (2019) Polysomnography Reference Values in Healthy Newborns. J Clin Sleep Med 15:437–443. https://doi.org/10.5664/jcsm.7670
doi: 10.5664/jcsm.7670
pubmed: 30853051
pmcid: 6411184
Brockmann PE, Poets A, Poets CF (2013) Reference values for respiratory events in overnight polygraphy from infants aged 1 and 3 months. Sleep Med 14:1323–1327. https://doi.org/10.1016/j.sleep.2013.07.016
doi: 10.1016/j.sleep.2013.07.016
pubmed: 24211071
Seppä-Moilanen M, Andersson S, Kirjavainen T (2021) Caffeine is a respiratory stimulant without effect on sleep in the short-term in late-preterm infants. Pediatr Res. https://doi.org/10.1038/s41390-021-01794-y
doi: 10.1038/s41390-021-01794-y
pubmed: 34718352
pmcid: 9556325
Henderson-Smart DJ, De Paoli AG (2010) Methylxanthine treatment for apnoea in preterm infants.Cochrane Database of Systematic Reviews 12. Art. No.: CD000140. https://doi.org/10.1002/14651858.CD000140.pub2 .
Welborn L, Hannallah R, Fink R, Ruttimann U, Hicks J (1989) High-dose caffeine suppresses postoperative apnea in former preterm infants. Anesthesiology 71:347–349
doi: 10.1097/00000542-198909000-00005
pubmed: 2672899
Philippi H, Bieber I, Reitter B (2001) Acetazolamide Treatment for Infantile Central Sleep Apnea. J Child Neurol 16:600–603. https://doi.org/10.1177/088307380101600813
doi: 10.1177/088307380101600813
pubmed: 11510934
Zwillich CW, Weil JV (1982) Central Sleep Apnea: Improvement With Acetazolamide Therapy. Arch Intern Med 142:1816–1819
doi: 10.1001/archinte.1982.00340230056012
pubmed: 6812522
Ni Y-N, Yang H, Thomas RJ (2021) The role of acetazolamide in sleep apnea at sea level: a systematic review and meta-analysis. J Clin Sleep Med 17:1295–1304. https://doi.org/10.5664/jcsm.9116
doi: 10.5664/jcsm.9116
pubmed: 33538687
pmcid: 8314666