Ventilatory control instability as a predictor of persistent periodic breathing in preterm infants

The prevalence and characteristics of periodic breathing in preterm infants were measured by 24-hour impedance pneumograms in 66 preterm infants before discharge from the nursery. Four periodic breathing parameters (percentage of periodic breathing per quiet time, number of episodes of periodic breathing per 100 minutes of quiet time, mean duration of periodic breathing, and longest episode of periodic breathing) were compared to data available from healthy term infants and from term infants who subsequently died of sudden infant death syndrome (SIDS). Periodic breathing was found in all preterm infants studied and mean periodic breathing parameter values (12.0%, 8.6 episodes, 1.2 minutes, and 7.3 minutes, respectively) in our preterm population were substantially higher than values from healthy term infants and SIDS victims. Most periodic breathing parameters decreased significantly in infants studied at 39 to 41 weeks' postconceptional age compared with earlier postconceptional age groups. No relationship was found between central apneas of ≥15 seconds' duration and postconceptional age or any periodic breathing parameter. Periodic breathing is a common respiratory pattern in preterm infants that is usually not of pathologic significance. Associations between elevated levels of periodic breathing and respiratory dysfunction or SIDS should be made with caution.

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PERIODIC BREATHING AND APNEA IN PRETERM INFANTS. II. HYPOXIA AS A PRIMARY EVENT

PEDIATRICS ◽

10.1542/peds.50.2.219 ◽

1972 ◽

Vol 50 (2) ◽

pp. 219-228

Author(s):

Henrique Rigatto ◽

June P. Brady

Keyword(s):

Preterm Infants ◽

Oxygen Tension ◽

Minute Ventilation ◽

Arterial Oxygen Tension ◽

Blood Gases ◽

Periodic Breathing ◽

Capillary Blood ◽

Arterial Oxygen ◽

Primary Event ◽

The Relationship

We studied nine healthy preterm infants during the first 35 days of life to define the relationship between periodic breathing, apnea, and hypoxia. For this purpose we compared ventilation/apnea (V/A), minute ventilation, and alveolar and capillary blood gases during periodic breathing induced by hypoxia and during spontancous periodic breathing in room air. We induced periodic breathing by giving the baby in sequence 21, 19, 17, and 15% O2 to breathe for 5 minutes each, and also by giving 21, 15, and 21% O2. We measured ventilation with a nosepiece and a screen flowmeter. With a decrease in arterial oxygen tension, preterm infants (1) hypoventilated, (2) breathed periodically more frequently, and (3) showed a decrease in V/A due to an increase in the apneic interval. In one baby this led to apnea lasting 30 seconds. These findings support our hypothesis that preterm infants breathing periodically hypoventilate and suggest that hypoxia may be a primary event leading to periodic breathing and apnea.

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Reduction in Obstructive Breathing Events During Body Rocking: A Controlled Polygraphic Study in Preterm and Full-Term Infants

PEDIATRICS ◽

10.1542/peds.96.1.64 ◽

1995 ◽

Vol 96 (1) ◽

pp. 64-68

Author(s):

J. Groswasser ◽

M. Sottiaux ◽

E. Rebuffat ◽

T. Simon ◽

M. Vandeweyer ◽

...

Keyword(s):

Eye Movement ◽

Preterm Infants ◽

Upper Airway ◽

Periodic Breathing ◽

Full Term ◽

Rapid Eye Movement ◽

Term Infants ◽

Obstructive Sleep ◽

Significant Difference ◽

Obstructive Sleep Apneas

Objective. To investigate the effect of body rocking on infant respiratory behavior during sleep. Methods. Eighteen infants with documented obstructive sleep apneas were studied. There were eight premature infants with persistent bradycardias and 10 infants born full-term, admitted after an idiopathic apparent life-threatening event. No cause for the obstructive apneas was found. The infants were recorded with polygraphic techniques during two successive nights. They were randomly assigned to a rocking or a nonrocking mattress. The conditions were reversed the following night, in a crossover design. Results. In both groups of infants, no significant difference was seen between the two consecutive nights for most of the variables studied: total sleep time, the proportion of non-rapid-eye-movement and rapid-eye-movement sleep, the number of arousals, the number and maximal duration of central apneas, the frequency of periodic breathing, the level of oxygen saturation, and heart rate. During the nonrocking nights, all infants had repeated obstructive breathing events. In seven of the eight preterm infants and in nine of the 10 full-term subjects, body rocking was associated with a significant decrease in the frequency of obstructive events. During rocking, in the preterm infants the obstructions fell from a median of 2.5 to 1.8 episodes per hour (P = .034). In the full-term infants, rocking reduced the obstructive events from a median of 1.5 obstructions per hour to 0.7 (P = .005). No difference was seen for the duration of the obstructive episodes. Conclusion. In preterm and full-term infants prone to obstructive sleep apneas, gentle side-to-side body rocking is associated with a significant decrease in the frequency of upper-airway obstructions.

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Spectral analysis of the EMG and diaphragmatic muscle fatigue during periodic breathing in infants

Journal of Applied Physiology ◽

10.1152/jappl.1985.58.3.830 ◽

1985 ◽

Vol 58 (3) ◽

pp. 830-833 ◽

Cited By ~ 5

Author(s):

S. T. Nugent ◽

J. P. Finley

Keyword(s):

Spectral Analysis ◽

Muscle Fatigue ◽

Preterm Infants ◽

High Frequency ◽

Power Spectra ◽

Low Frequency ◽

Periodic Breathing ◽

Full Term ◽

Diaphragmatic Muscle ◽

Normal Breathing

Periodic breathing occurs commonly in full-term and preterm infants. The mechanisms which switch breathing on and off within a cycle of periodic breathing are not certain. Since immature infants may experience diaphragmatic muscle fatigue, one potential switching mechanism is fatigue. Power spectra of the electromyogram, uncontaminated by the electrocardiograph artifact, were studied for evidence of diaphragmatic muscle fatigue during spontaneous periodic breathing in infants. A fall in the high-frequency (103–600 Hz) power and an increase in the low-frequency (23–47 Hz) power during periodic as compared with normal breathing would indicate fatigue. This effect was not observed in any of the infants studied. Hence, there is no evidence that periodic breathing is the result of diaphragmatic muscle fatigue. This finding suggests that the effect of drugs such as theophylline in eliminating periodic breathing may be unrelated to the fact that they also reduce fatigue.

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Caffeine and supplemental oxygen effectively suppress periodic breathing with only minor effects during long episodes of apnoea in preterm infants

Acta Paediatrica ◽

10.1111/apa.14541 ◽

2018 ◽

Vol 108 (3) ◽

pp. 443-451 ◽

Cited By ~ 4

Author(s):

Maija Seppä-Moilanen ◽

Sture Andersson ◽

Krista Rantakari ◽

Kaija Mikkola ◽

Turkka Kirjavainen

Keyword(s):

Preterm Infants ◽

Periodic Breathing ◽

Supplemental Oxygen

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Reduction of Sleep Apnea and Bradycardia in Preterm Infants on Oscillating Water Beds: A Controlled Polygraphic Study

PEDIATRICS ◽

10.1542/peds.61.4.528 ◽

1978 ◽

Vol 61 (4) ◽

pp. 528-533

Author(s):

Anneliese F. Korner ◽

Christian Guilleminault ◽

Johanna Van den Hoed ◽

Roger B. Baldwin

Keyword(s):

Birth Weight ◽

Sleep Apnea ◽

Preterm Infants ◽

Premature Infants ◽

Gestational Age ◽

Periodic Breathing ◽

Quiet Sleep ◽

Severe Bradycardia

The sleep and respiratory patterns of eight apneic preterm infants were polygraphically recorded for 24 hours. This polygraphic study was designed to test and extend our previous finding that gently oscillating water beds reduce apnea in premature infants. The infants who ranged in gestational age from 27 to 32 weeks and in birth weight from 1,077 to 1,650 gm served as their own controls, off and on the water bed. The 24-hour recordings were divided into four time blocks with the infant being placed on the water bed during alternate six-hour periods. Apnea was significantly reduced while the infants were on the oscillating water beds, with the longest apneic periods and those associated with severe bradycardia being reduced the most. Reduction of apnea was most consistent during indeterminate sleep and most pronounced during quiet sleep. Short respiratory pauses and periodic breathing were not significantly reduced. Reductions of central, obstructive, and mixed apneas were approximately equal.

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Effect of baseline oxygenation on the ventilatory response to inhaled 100% oxygen in preterm infants

Journal of Applied Physiology ◽

10.1152/jappl.1995.79.6.2101 ◽

1995 ◽

Vol 79 (6) ◽

pp. 2101-2105 ◽

Cited By ~ 12

Author(s):

A. Z. Haider ◽

V. Rehan ◽

S. Al-Saedi ◽

R. Alvaro ◽

K. Kwiatkowski ◽

...

Keyword(s):

Preterm Infants ◽

Ventilatory Response ◽

Recovery Period ◽

Control Period ◽

Periodic Breathing ◽

Quiet Sleep ◽

Peripheral Chemoreceptor ◽

Lower Baseline ◽

O2 Concentration ◽

Flow Through

We tested the hypothesis that the immediate (< 1 min) ventilatory response to 100% O2 in preterm infants, a test of peripheral chemoreceptor activity characterized by a decrease in ventilation due to apnea, is more pronounced at lower baseline O2 concentrations. We studied 12 healthy preterm infants [birth weight 1,425 +/- 103 (SE) g; study weight 1,670 +/- 93 g; gestational age 30 +/- 1 wk; postnatal age 27 +/- 7 days] during quiet sleep. The infants inhaled 15, 21, 25, 30, 35, 40, and 45% O2 for 5 min in a randomized manner (control period), followed by 100% O2 for 2 min, and then the same initial O2 concentration again for 2 min (recovery period). A nose piece and a flow-through system were used to measure ventilation. The immediate decrease in ventilation with 100% O2 was 46% on 15% O2, 24% on 21% O2, 11% on 25% O2, 8% on 30% O2, 12% on 35% O2, and 8% on 40% O2; there was no decrease on 45% O2 (P < 0.01). The corresponding mean duration of apnea was 29 s during 15% O2, 18 s during 21% O2, 8 s during 25% O2, 9 s during 30 and 35% O2, and 3 s during 40% O2; only one infant developed a 5-s apnea during 45% O2 (P < 0.001). The findings suggest that 1) the ventilatory decrease in response to 100% O2 is dependent on the baseline oxygenation, being more pronounced the lower the baseline O2 concentration; and 2) this ventilatory decrease is entirely related to more prolonged apneas observed with lower baseline O2 concentrations. We speculate that the peripheral chemoreceptors, being so active in the small preterm infant with relatively low arterial PO2, are highly susceptible to changes in PO2, and this makes them prone to irregular or periodic breathing, especially during sleep.

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Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes

Journal of Applied Physiology ◽

10.1152/japplphysiol.90308.2008 ◽

2009 ◽

Vol 107 (3) ◽

pp. 696-706 ◽

Cited By ~ 20

Author(s):

Yoseph Mebrate ◽

Keith Willson ◽

Charlotte H. Manisty ◽

Resham Baruah ◽

Jamil Mayet ◽

...

Keyword(s):

Mathematical Model ◽

Sleep Apnea ◽

Time Window ◽

Central Sleep Apnea ◽

Periodic Breathing ◽

Optimal Time ◽

Optimal Timing ◽

Ventilatory Control ◽

Dynamic Therapy ◽

End Tidal

We examine the potential to treat unstable ventilatory control (seen in periodic breathing, Cheyne-Stokes respiration, and central sleep apnea) with carefully controlled dynamic administration of supplementary CO2, aiming to reduce ventilatory oscillations with minimum increment in mean CO2. We used a standard mathematical model to explore the consequences of phasic CO2 administration, with different timing and dosing algorithms. We found an optimal time window within the ventilation cycle (covering ∼1/6 of the cycle) during which CO2 delivery reduces ventilatory fluctuations by >95%. Outside that time, therapy is dramatically less effective: indeed, for more than two-thirds of the cycle, therapy increases ventilatory fluctuations >30%. Efficiency of stabilizing ventilation improved when the algorithm gave a graded increase in CO2 dose (by controlling its duration or concentration) for more severe periodic breathing. Combining gradations of duration and concentration further increased efficiency of therapy by 22%. The (undesirable) increment in mean end-tidal CO2 caused was 300 times smaller with dynamic therapy than with static therapy, to achieve the same degree of ventilatory stabilization (0.0005 vs. 0.1710 kPa). The increase in average ventilation was also much smaller with dynamic than static therapy (0.005 vs. 2.015 l/min). We conclude that, if administered dynamically, dramatically smaller quantities of CO2 could be used to reduce periodic breathing, with minimal adverse effects. Algorithms adjusting both duration and concentration in real time would achieve this most efficiently. If developed clinically as a therapy for periodic breathing, this would minimize excess acidosis, hyperventilation, and sympathetic overactivation, compared with static treatment.

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