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Respiratory indices during sleep in healthy infants: A prospective longitudinal study and meta-analysis
Darko Stefanovski1, Ignacio E Tapia2, Janet Lioy3
1School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Insights
Healthy infants show a significant decrease in apnea hypopnea index (AHI) events and a shift from obstructive to central apneas by five months of age. This study tracks these respiratory changes in early infancy.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology in Infants
- Neonatal Health
Background:
- Infant sleep-related breathing events, like apnea hypopnea index (AHI), are higher in newborns than older children.
- The developmental trajectory of these respiratory events beyond the neonatal period is not well understood.
Purpose of the Study:
- To longitudinally evaluate changes in respiratory indices during sleep in healthy infants.
- To understand the natural progression of sleep-related breathing events in the first six months of life.
Main Methods:
- A prospective cohort study involving 30 healthy infants.
- Overnight polysomnography was conducted at one and five months of age.
- A systematic review and meta-analysis of infant polysomnography studies were performed.
Main Results:
- At one month, the mean total AHI was 16.9 events/hour, with 16.8% obstructive and 36.1% central apneas.
- By five months, total AHI significantly decreased to 4.1 events/hour (p < 0.001).
- The proportion of obstructive apneas decreased to 8.6% (p = 0.007), while central apneas increased to 52.3% (p = 0.002).
Conclusions:
- Healthy infants experience a significant spontaneous reduction in respiratory events within the first six months.
- There is a notable shift in the type of events, with a decrease in obstructive and an increase in central apneas.
- These findings provide a reference for clinicians assessing obstructive sleep apnea in infants.
Study Objectives:
Healthy infants may have a greater apnea hypopnea index (AHI) than older children during the newborn period, but the trajectory of these sleep-related events beyond the first month of life is poorly understood. In this study, we evaluated the longitudinal changes in respiratory indices during sleep in healthy infants during the first six months of life.
Methods:
Single-center prospective cohort study. Thirty healthy infants underwent overnight in-lab polysomnography at one and five months of age and findings were compared between assessments. Systematic review of studies evaluating infant polysomnography and meta-analysis was conducted.
Results:
At one month of age, total AHI, obstructive AHI, and central AHI model-adjusted means (95% confidence interval) were 16.9 events/hour (12.2, 21.5), 10.2 events/hour (7.4, 13.1), and 6.6 events/hour (4.2, 9.0), respectively. 16.8% of events were obstructive apneas and 36.1% central apneas. By five months of age, there were significant reductions in each index to 4.1 events/hour (3.2, 5.0), 1.9 events/hour (1.4, 2.4), and 2.2 events/hour (1.6, 2.9), respectively (p < 0.001 for each), and a lower proportion of events were obstructive apneas (8.6%, p = 0.007) and a greater proportion central apneas (52.3%, p = 0.002). Meta-analysis found high AHI in infants with significant heterogeneity.
Conclusions:
Central AHI and obstructive AHI are greater in healthy newborns than older children. There is a significant spontaneous reduction in events and change in type of events in the first six months of life in this low-risk population. These findings may serve as a reference for clinicians evaluating for obstructive sleep apnea in infants.
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