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Behavioral arousal in newborn infants and its association with termination of apnea
C K Thoppil1, M A Belan, C P Cowen
1Department of Pediatrics, University of Texas Medical Branch, Galveston 77550.
Insights
Arousal is linked to resolving apnea in preterm infants, but it
Area of Science:
- Neonatal Physiology
- Sleep Medicine
- Pediatric Pulmonology
Background:
- Arousal is a known protective mechanism for obstructive sleep apnea in older individuals.
- The role of arousal in neonatal apnea, particularly in preterm infants, remains under-investigated.
Purpose of the Study:
- To investigate the role of spontaneous behavioral arousal in the termination of apnea in preterm infants.
- To compare arousal patterns in full-term, nonapneic preterm, and apneic preterm infants.
Main Methods:
- Utilized videorecording to identify spontaneous behavioral arousal.
- Conducted polygraphic monitoring of cardiorespiratory variables.
- Compared arousal rates during apneic and nonapneic sleep periods in preterm infants.
Main Results:
- Apneic preterm infants showed significantly higher arousal rates during apneic sleep (0.59/min) compared to nonapneic sleep (0.25/min).
- Arousal frequency correlated with apnea duration, type (mixed vs. central), and severity (severe vs. mild).
- Despite an association, a significant number of apneic episodes occurred without arousal, suggesting arousal is not essential for apnea termination.
Conclusions:
- Spontaneous arousal is associated with apnea resolution in preterm infants.
- Behavioral arousal is not a mandatory mechanism for terminating all apneic episodes in this population.
- Further research is needed to fully elucidate the mechanisms of apnea termination in preterm neonates.
Abstract:
Arousal is an important protective mechanism that aids in the resolution of obstructive sleep apnea in adults and children, but its role in neonatal apnea has not been investigated. The primary aim of the present study was to determine the role of arousal in the termination of apnea in preterm infants. Videorecording was used to identify spontaneous behavioral arousal in a group of healthy full-term (n = 7) and preterm (n = 10) infants before and during polygraphic monitoring of cardiorespiratory variables and in a group of preterm infants with apnea (n = 10) during similar polygraphic monitoring. Spontaneous arousal rates (mean +/- SE) in full-term infants before and during polygraphic monitoring were 0.18 +/- 0.03 and 0.23 +/- 0.07 episodes/min, respectively. Corresponding values in nonapneic preterm infants were 0.24 +/- 0.03 and 0.24 +/- 0.02 episodes/min. In apneic preterm infants, mean spontaneous arousal rate during polygraphic recording was 0.26 +/- 0.02, but it was considerably higher during apneic sleep periods (0.59 +/- 0.17) than during nonapneic sleep periods (0.25 +/- 0.01). The frequency of occurrence of arousal was significantly higher (P less than 0.005) in long vs. short apnea, mixed vs. central apnea, and severe vs. mild apnea. Although a clear association between arousal and apneic resolution was observed in preterm infants, lack of arousal responses in a large number of apneic episodes suggests that behavioral arousal is not essential for the termination of apnea in these infants.