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Polysomnography in preterm infants and children with chronic lung disease
Sharon A McGrath-Morrow1, Timothy Ryan, Brian M McGinley
1Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2533, USA. smcgrath@jhmi.edu
Insights
Overnight polysomnography (PSG) is more sensitive for assessing pulmonary reserve in preterm children with chronic lung disease (CLD) than standard clinical measures. Results show improved pulmonary function with age, indicating PSG
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Neonatology
Background:
- Chronic lung disease (CLD) is a significantcomorbidity in preterm infants.
- Assessing pulmonary reserve in young children with CLD is challenging.
- Overnight polysomnography (PSG) is a diagnostic tool for sleep-related breathing disorders.
Purpose of the Study:
- To evaluate the utility of overnight polysomnography (PSG) in assessing pulmonary reserve.
- To investigate pulmonary reserve in stable preterm children diagnosed with chronic lung disease (CLD).
- To compare PSG findings with outpatient clinical measures in this population.
Main Methods:
- Retrospective review of overnight polysomnograms (PSGs) and clinical data.
- Study included preterm infants/children (<3 years) with bronchopulmonary dysplasia.
- Data collected from Johns Hopkins CLD patient registry (2008-2010).
Main Results:
- Sixty-two stable patients underwent PSG, primarily for oxygen titration (71%).
- Mean respiratory disturbance index (RDI) was 8.2±10.1 events/hr; mean O2 saturation nadir was 86.2±5.7%.
- RDI significantly decreased with age (P<0.001) between serial PSGs, and outpatient measures did not predict PSG findings.
Conclusions:
- Mean RDI in stable preterm infants/children with CLD was higher than controls.
- Decreasing RDI with age suggests improving pulmonary reserve.
- Overnight PSG is more sensitive than outpatient clinical measures for assessing pulmonary reserve in this cohort.
Objective:
To determine the utility of overnight polysomnography (PSG) in assessing pulmonary reserve in stable preterm children with chronic lung disease (CLD).
Study Design:
A retrospective review and descriptive study of overnight PSGs and clinic visits of preterm infants/children less than 3 years of age who were diagnosed with bronchopulmonary dysplasia at discharge from the hospital and enrolled in the Johns Hopkins CLD patient registry between 2008 and 2010.
Results:
Sixty-two clinically stable patients underwent at least one overnight polysomnogram for clinical indications. The majority of patients were referred for oxygen titration (71%). PSGs from first studies revealed a mean respiratory disturbance index (RDI) of 8.2 ± 10.1 events/hr and a mean O(2) saturation (SaO(2) ) nadir of 86.2 ± 5.7%. In patients who underwent more than one PSG (n = 23), a significant decrease in RDI (P < 0.001) was found between the first study (mean age: 8.0 ± 3.3 months) and second study (mean age: 13.4 ± 5.2 months). Outpatient clinical measures of mean room air SaO(2) and respiratory rate were not predictive of PSG measures of RDI and SaO(2) nadir.
Conclusion:
Mean RDI was higher in stable preterm infants/children with CLD compared to previously published controls. RDI decreased with age in stable preterm infants/children with CLD suggesting improved pulmonary reserve with age. Outpatient clinical measures (respiratory rate and room air SaO(2) ) did not correlate with RDI and SaO(2) nadir indicating that overnight PSG is more sensitive in assessing pulmonary reserve than outpatient clinical measures.
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