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Intermittent hypoxia and respiratory patterns during sleep of preterm infants aged 3 to 18 months residing at high
Elida Duenas-Meza1,2,3, María Isabel Escamilla-Gil1,2, María Angelica Bazurto-Zapata1,2
1Fundación Neumológica Colombiana, Sleep center, Bogotá, Colombia.
Insights
Preterm infants born at high altitudes experience more sleep-related breathing issues and oxygen desaturation than full-term infants. These respiratory disturbances persist, highlighting the need for ongoing monitoring and care for these vulnerable infants.
Area of Science:
- Pediatrics
- Neonatology
- Sleep Medicine
Background:
- High-altitude environments pose unique challenges for infant respiratory health.
- Preterm infants (PTIs) may be more susceptible to altitude-related respiratory issues than full-term infants (FTIs).
- Understanding sleep-disordered breathing and intermittent hypoxia in infants at high altitudes is crucial for developmental outcomes.
Purpose of the Study:
- To investigate the impact of apneas on oxygen saturation in preterm infants (PTIs) at high altitudes.
- To assess the presence and severity of intermittent hypoxia during sleep in PTIs compared to FTIs.
- To determine if respiratory disturbances during sleep resolve by 18 months of age in PTIs at high altitudes.
Main Methods:
- A comparative study included 127 PTIs and 175 FTIs aged 3 to 18 months.
- Infants were grouped by age (3-4, 6-7, 10-18 months) and underwent polysomnography.
- Apnea-hypopnea index (AHI), T90, oxygen desaturation index (ODI), and nadir SpO2 were evaluated.
Main Results:
- PTIs exhibited significantly higher total AHI across all age groups compared to FTIs.
- PTIs showed increased central and obstructive AHI, higher T90, and a greater ODI than FTIs.
- Lower nadir SpO2 levels were observed in PTIs, indicating more severe oxygen desaturation.
Conclusions:
- Preterm infants at high altitudes experience a higher incidence of respiratory events and oxygen desaturation during sleep.
- These sleep-related respiratory issues demonstrate delayed resolution in PTIs, persisting into the first 18 months of life.
- Continuous follow-up is recommended for PTIs at high altitudes to ensure timely diagnosis and management of sleep-disordered breathing.
Study Objectives:
The aim of this study was to determine the impact of apneas on oxygen saturation and the presence of intermittent hypoxia, during sleep of preterm infants (PTIs) born at high altitudes and compare with full-term infants (FTIs) at the same altitude.
Methods:
PTIs and FTIs from 3 to 18 months were included. They were divided into three age groups: 3-4 months (Group 1); 6-7 months (Group 2), and 10-18 months (Group 3). Polysomnography parameters and oxygenation indices were evaluated. Intermittent hypoxia was defined as brief, repetitive cycles of decreased oxygen saturation. Kruskal-Wallis test for multiple comparisons, t-test or Mann-Whitney U-test were used.
Results:
127 PTI and 175 FTI were included. Total apnea-hypopnea index (AHI) was higher in PTI that FTI in all age groups (Group 1: 33.5/h vs. 12.8/h, p = 0.042; Group 2: 27.0/h vs. 7.4/h, p < 0.001; and Group 3: 11.6/h vs. 3.1/h, p < 0.001). In Group 3, central-AHI (8.0/h vs. 2.3/h, p < 0.001) and obstructive-AHI (1.8/h vs. 0.6/h, p < 0.008) were higher in PTI than FTI. T90 (7.0% vs. 0.5, p < 0.001), oxygen desaturation index (39.8/h vs. 11.3, p < 0.001) were higher in PTI than FTI, nadir SpO2 (70.0% vs. 80.0, p<0.001) was lower in PTI.
Conclusion:
At high altitude, compared to FTI, PTI have a higher rate of respiratory events, greater desaturation, and a delayed resolution of these conditions, suggesting the persistence of intermittent hypoxia during the first 18 months of life. This indicates the need for follow-up of these infants for timely diagnosis and treatment of respiratory disturbances during sleep.
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