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The incidence of obstructive apneas in preterm infants with and without bronchopulmonary dysplasia
Insights
Preterm infants with bronchopulmonary dysplasia (BPD) experience more obstructive apneas than controls. This finding highlights the importance of clinical status in apnea incidence and suggests ventilatory patterns are not predictive of apnea type.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants.
- Infants with BPD are at increased risk for respiratory complications, including apnea.
- Understanding apnea patterns in BPD is crucial for improving infant outcomes.
Purpose of the Study:
- To investigate the incidence of obstructive apneas in preterm infants with BPD compared to controls.
- To determine if respiratory patterns during obstructive apneas are associated with hypoventilation.
- To explore the relationship between clinical status and apnea characteristics.
Main Methods:
- A comparative study involving 12 preterm infants with BPD and 12 matched control infants.
- Ventilation was measured using a flow-through system.
- Analysis of total apneas, differentiating between central and obstructive types, across sleep states and durations.
Main Results:
- Infants with BPD showed a significantly higher incidence of obstructive apneas (13%) compared to controls (4%).
- This increased incidence was observed in both quiet sleep (9.1% vs. 1.6%) and REM sleep (14.2% vs. 3.6%).
- No significant changes in ventilatory patterns were uniquely attributed to specific apnea types.
Conclusions:
- The clinical status of preterm infants, particularly BPD, is a significant factor influencing obstructive apnea incidence.
- Variability in reported obstructive apnea rates may be linked to differences in infant populations studied.
- Ventilatory pattern analysis is not a reliable predictor for identifying central or obstructive apneas in this population.
Abstract:
We tested the hypotheses that (1) preterm infants with bronchopulmonary dysplasia (BPD) have an increased incidence of obstructive apneas as compared to those without BPD (control) and (2) the respiratory pattern during obstructive apneas may be associated with more pronounced hypoventilation. Ventilation was measured with a flow-through system. We examined 2929 total apneas in 12 infants with BPD and 4366 apneas in 12 control infants matched for study weight (1.51 +/- 0.11 kg in the BPD group and 1.62 +/- 0.12 kg in the control group, P = 0.6) and for postconceptional age (33.3 +/- 0.8 weeks in the BPD group compared with 33.4 +/- 0.7 weeks in the control group, P = 0.6). The incidence of central apneas predominated in the BPD group (2551/2929, 87%) and in the control group (4188/4366, 96%). Obstructive apneas were more frequent in the BPD group (378/2929, 13%) than in the control group (178/4366, 4%, P = 0.004). The increased incidence of obstructive apneas in infants with BPD was observed in Quiet sleep (9.1 vs. 1.6%, P = 0.03) and in REM sleep (14.2 vs. 3.6%, P = 0.009). This increased incidence of obstructive apneas was applicable to short apneas (< 10 s, 10.9 vs. 2.7%, P = 0.003) and long apneas (> 10 s, 27.5 vs. 16.4%, P = 0.01). There were no significant changes in ventilatory pattern that could be uniquely attributed to one type of apnea. The findings suggest: (1) the great variability in the incidence of obstructive apneas reported in the literature relates, at least in part, to the clinical status of the infants and (2) ventilatory pattern is not a useful predictor of either type of apnea.