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Development of the control of breathing: implications for sleep-related breathing disorders in infants
1Service de Physiologie, INSERM CRI 9701, Hôpital Robert Debré, Paris, France. claude.gaultier@rdb.ap-hop-paris.fr
Insights
Abnormal breathing control in infants can lead to sleep-disordered breathing (SDB). Early detection of chemoreceptor dysfunction and appropriate treatment are crucial for healthy development and long-term respiratory health.
Area of Science:
- Pediatric Pulmonology
- Neuroscience
- Developmental Biology
Background:
- Sleep-disordered breathing (SDB) in infancy is linked to abnormal respiratory control development.
- Prenatal factors like nicotine exposure can increase SDB risk.
- Infants with SDB may have peripheral or central chemoreceptor dysfunction.
Purpose of the Study:
- To highlight the implications of abnormal breathing control in infant SDB.
- To emphasize the importance of investigating chemoreceptor function in at-risk infants.
- To underscore the necessity of optimal SDB treatment for neurodevelopment.
Main Methods:
- Assessing peripheral chemoreceptor function via hyperoxic or alternating breath tests.
- Evaluating central chemoreceptor function using the rebreathing test.
- Monitoring infants for SDB symptoms and risk factors.
Main Results:
- Abnormal respiratory control development is a key factor in infant SDB.
- Chemoreceptor dysfunction testing can identify infants needing intervention.
- Interventions like oxygen and ventilatory support mitigate hypoxemia and sleep disruption.
Conclusions:
- Preventing prenatal insults and early SDB detection are vital public health goals.
- Timely diagnosis and treatment of infant SDB are essential for neurocognitive outcomes.
- Developmental respiratory control alterations can have lasting effects, especially in genetically susceptible individuals.
Abstract:
Abnormal development of the control of breathing has implications for the occurrence and severity of SDB during infancy. Prevention of prenatal insults such as nicotine exposure should be included in public health programs. Infants at risk for SDB or with symptoms of SDB should be investigated for peripheral and central chemoreceptor dysfunction. Peripheral chemoreceptor function can be assessed using either the hyperoxic test or the alternating breath test, and central chemoreceptor function using the rebreathing test. Optimal treatment of SDB in the developing infant is of central importance for preserving normal behavior and neurocognitive development. Oxygen supplementation and/or ventilatory support during sleep prevent uncontrolled episodes of hypoxemia, sleep fragmentation, and REM sleep reduction. Finally, alterations in homeostatic responses during development may have long-term effects on breathing during sleep in childhood and adulthood. In genetically-predisposed subjects, environmental conditions during the period of development of respiratory control mechanisms may add to the intrinsic vulnerability to SDB.