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Obstructive sleep apnea in the formerly preterm infant: an overlooked diagnosis
Preeti B Sharma1, Fuad Baroody, David Gozal
1Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Comer Children's Hospital, University of Chicago Chicago, IL, USA.
Insights
Obstructive sleep apnea syndrome (OSAS) in premature infants, especially those with bronchopulmonary dysplasia (BPD), requires high clinical awareness. Snoring and difficulty weaning oxygen may signal OSAS, often persisting after surgery.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Neonatology
Background:
- Obstructive sleep apnea syndrome (OSAS) is common in children, but its characteristics in very young, premature infants with bronchopulmonary dysplasia (BPD) are not well-defined.
- Preterm infants with respiratory complications like BPD may present unique challenges in diagnosing and managing OSAS.
Purpose of the Study:
- To retrospectively review the clinical characteristics and outcomes of OSAS in a cohort of preterm infants.
- To identify key symptoms and diagnostic findings associated with OSAS in this vulnerable population.
Main Methods:
- Retrospective analysis of medical records of premature infants diagnosed with OSAS between 2004 and 2009.
- Inclusion criteria focused on infants with BPD followed in a Pediatric Pulmonary Clinic.
Main Results:
- Twelve preterm infants (mean gestational age 27 weeks) were diagnosed with OSAS.
- Common symptoms included inability to wean nighttime oxygen, need for re-oxygenation after illness, and snoring.
- Adenotonsillectomy did not resolve sleep-disordered breathing in any of the children.
- Apnea-hypopnea index ranged from 1-120/h, with SpO2 nadir as low as 50%.
Conclusions:
- In preterm infants, persistent snoring, poor weight gain, and difficulty weaning oxygen warrant investigation for OSAS.
- Airway structural changes and adenotonsillar hypertrophy may contribute to OSAS in former preterm infants.
- A high level of clinical suspicion is crucial for timely OSAS diagnosis in this population.
Background:
Obstructive sleep apnea syndrome (OSA) is a frequent disorder in children. The clinical characteristics of OSA in very young children under 2 years of age, and more particularly, in those born prematurely, and who have respiratory complications such as bronchopulmonary dysplasia (BPD), are not well defined. We therefore retrospectively reviewed our experience in a group of preterm infants with OSAS.
Methods:
The records of premature infants with BPD followed in the Pediatric Pulmonary Clinic at the University of Chicago who were diagnosed with OSA from 2004 to 2009 were reviewed and analyzed.
Results:
Twelve children, eight males, and four females with a mean gestational age of 27 weeks were found to have OSA. Mean age at diagnosis was 19 months. Inability to wean nighttime oxygen, the need to resume oxygen after intercurrent respiratory illness, and snoring were the most common presenting symptoms. The apnea-hypopnea index ranged from 1 to 120/h total sleep time (TST; mean: 29). SpO(2) nadir ranged from 50 to 91%. Despite adenotonsillectomy (AT), all children had persistent sleep disordered breathing.
Conclusion:
In preterm infants, while snoring is a frequent symptom, poor weight gain, and inability to wean nighttime oxygen may indicate the need for further investigation for OSA. In the former preterm infant structural changes in the airway may play an important role along with adenotonsillar hypertrophy. A high level of clinical awareness is required to identify OSA in the formerly preterm infant.
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