Central apnea and periodic breathing in children with underlying conditions

Mother-infant bed sharing, compared with the solitary sleeping condition, has recently been associated with several physiological and behavioral effects. Because the physiological effects of bed sharing may also include respiratory changes, we compared the incidence of central and obstructive apneas and periodic breathing in bed-sharing and solitary sleeping infants. Twenty routinely bed-sharing mother-infant pairs and fifteen routinely solitary sleeping pairs slept for 3 nights in a sleep laboratory. After an initial adaptation night, each pair spent 1 night bed sharing and 1 night in solitary sleep in random order. Apnea and periodic breathing were scored from polysomnographic recordings. The frequency of central apnea was significantly increased on the bed-sharing night, compared with the solitary night, regardless of routine sleeping arrangement. There were significantly fewer obstructive apneas on the bed-sharing night than on the solitary night, but only in routinely solitary sleeping infants. In both groups, there was a significantly higher frequency of periodic breathing events on the bed-sharing night than on the solitary night. These findings demonstrate that the bed-sharing environment can have a significant impact on respiratory control in the infant. Evidence is also presented to suggest that routine bed sharing may result in subtle neurophysiological and/or developmental differences in infants.

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Effects of sleep deprivation on respiratory events during sleep in healthy infants

Journal of Applied Physiology ◽

10.1152/jappl.1989.66.3.1158 ◽

1989 ◽

Vol 66 (3) ◽

pp. 1158-1163 ◽

Cited By ~ 44

Author(s):

E. Canet ◽

C. Gaultier ◽

A. M. D'Allest ◽

M. Dehan

Keyword(s):

Sleep Deprivation ◽

Total Duration ◽

Periodic Breathing ◽

Central Apnea ◽

Quiet Sleep ◽

Term Infants ◽

Event Time ◽

Respiratory Events ◽

Healthy Infants ◽

Respiratory Event

This study was designed to determine the effects of sleep deprivation on respiratory events during sleep in healthy infants. Ten unsedated full-term infants (1–6 mo) were monitored polygraphically during “afternoon naps” on a control day and on the day after sleep deprivation. Respiratory events, i.e., central apnea, obstructive apnea and hypopnea, and periodic breathing were tabulated. Results for respiratory events were expressed as 1) indexes of the total number of respiratory events and of specific respiratory events per hour of total sleep (TST), “quiet” sleep (QS) and “active” sleep (AS) times; 2) total duration of total and specific respiratory events, expressed as a percentage of TST, QS, and AS times. After sleep deprivation, significant increases were observed for 1) respiratory event (P less than 0.001), central apnea (P less than 0.05), and obstructive respiratory event (P less than 0.01) indexes; 2) respiratory event time as a percentage of TST (P less than 0.002) and as a percentage of AS time (P less than 0.001); 3) obstructive respiratory event time as a percentage of TST (P less than 0.01), QS (P less than 0.05), and AS times (P less than 0.002). The present study shows that short-term sleep deprivation in healthy infants increases the number and timing of respiratory events, especially obstructive events in AS.

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Determinants of poststimulus potentiation in humans during NREM sleep

Journal of Applied Physiology ◽

10.1152/jappl.1992.73.5.1958 ◽

1992 ◽

Vol 73 (5) ◽

pp. 1958-1971 ◽

Cited By ~ 59

Author(s):

M. S. Badr ◽

J. B. Skatrud ◽

J. A. Dempsey

Keyword(s):

Eye Movement ◽

Control Period ◽

Periodic Breathing ◽

Nrem Sleep ◽

Normal Subjects ◽

Central Apnea ◽

Inhibitory Effects ◽

Arterial Pco2 ◽

End Tidal ◽

Sustained Hypoxia

To test whether active hyperventilation activates the “afterdischarge” mechanism during non-rapid-eye-movement (NREM) sleep, we investigated the effect of abrupt termination of active hypoxia-induced hyperventilation in normal subjects during NREM sleep. Hypoxia was induced for 15 s, 30 s, 1 min, and 5 min. The last two durations were studied under both isocapnic and hypocapnic conditions. Hypoxia was abruptly terminated with 100% inspiratory O2 fraction. Several room air-to-hyperoxia transitions were performed to establish a control period for hyperoxia after hypoxia transitions. Transient hyperoxia alone was associated with decreased expired ventilation (VE) to 90 +/- 7% of room air. Hyperoxic termination of 1 min of isocapnic hypoxia [end-tidal PO2 (PETO2) 63 +/- 3 Torr] was associated with VE persistently above the hyperoxic control for four to six breaths. In contrast, termination of 30 s or 1 min of hypocapnic hypoxia [PETO2 49 +/- 3 and 48 +/- 2 Torr, respectively; end-tidal PCO2 (PETCO2) decreased by 2.5 or 3.8 Torr, respectively] resulted in hypoventilation for 45 s and prolongation of expiratory duration (TE) for 18 s. Termination of 5 min of isocapnic hypoxia (PETO2 63 +/- 3 Torr) was associated with central apnea (longest TE 200% of room air); VE remained below the hyperoxic control for 49 s. Termination of 5 min of hypocapnic hypoxia (PETO2 64 +/- 4 Torr, PETCO2 decreased by 2.6 Torr) was also associated with central apnea (longest TE 500% of room air). VE remained below the hyperoxic control for 88 s. We conclude that 1) poststimulus hyperpnea occurs in NREM sleep as long as hypoxia is brief and arterial PCO2 is maintained, suggesting the activation of the afterdischarge mechanism; 2) transient hypocapnia overrides the potentiating effects of afterdischarge, resulting in hypoventilation; and 3) sustained hypoxia abolishes the potentiating effects of after-discharge, resulting in central apnea. These data suggest that the inhibitory effects of sustained hypoxia and hypocapnia may interact to cause periodic breathing.

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475 Automatic detection of self-similarity and prediction of CPAP failure

SLEEP ◽

10.1093/sleep/zsab072.474 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A187-A187

Author(s):

Eline Oppersma ◽

Wolfgang Ganglberger ◽

Haoqi Sun ◽

Robert Thomas ◽

Michael Westover

Keyword(s):

Sleep Apnea ◽

Significant Risk ◽

Periodic Breathing ◽

Driving Mechanism ◽

Central Apnea ◽

Loop Gain ◽

Breathing Patterns ◽

Self Similarity ◽

High Loop ◽

Cpap Failure

Abstract Introduction Sleep disordered breathing is a significant risk factor for cardiometabolic and neurodegenerative diseases. Tolerance and efficacy of continuous positive airway pressure (CPAP), the primary form of therapy for sleep apnea, is often poor. High loop gain (HLG) is a driving mechanism of central sleep apnea or periodic breathing. The current study aimed to develop a computational approach to detect HLG based on self-similarity in respiratory oscillations during sleep solely using breathing patterns, measured via Respiratory Inductance Plethysmography (RIP). To quantify the potential utility of the developed similarity metric, the presented algorithm was used to predict acute CPAP failure. Methods We developed an algorithm for detecting apneas as periods with reduced breathing effort, manifested in the RIP signal as low signal amplitude. Our algorithm calculates self-similarity in breathing patterns between consecutive periods of apnea or hypopnea. Working under the assumption that high loop gain induces self-similar respiratory oscillations and increases the risk of failure during CPAP, the full night similarity, computed during diagnostic non-CPAP polysomnography (PSG), was used to predict failure of CPAP, which we defined as titration central apnea index (CAI)>10. Central apnea labels are obtained both from manual scoring by sleep technologists, and from an automated algorithm developed for this study. The Massachusetts General Hospital (MGH) sleep database was used, including 2466 PSG pairs of diagnostic and CPAP titration PSG recordings. Results Diagnostic CAI based on technologist labels predicted failure of CPAP with an AUC of 0.82 ±0.03. Based on automatically generated labels, the combination of full night similarity and automatically generated CAI resulted in an AUC of 0.85 ±0.02. A subanalysis was performed on a population with technologist labeled diagnostic CAI>5. Full night similarity predicted failure with an AUC of 0.57 ±0.07 for manual and 0.65 ±0.06 for automated labels. Conclusion This study showed that central apnea labels can be derived in an automated way. The proposed self-similarity feature, as a surrogate estimate of expressed respiratory high loop gain and computed from easily accessible effort signals, can detect periodic breathing regardless of admixed obstructive features such as flow-limitation, and can aid prediction of CPAP failure or success. Support (if any):

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Description of central apnea and periodic breathing in children

10.1183/13993003.congress-2020.1226 ◽

2020 ◽

Author(s):

Sergio Ghirardo ◽

Alessandro Amaddeo ◽

Sonia Khirani ◽

Lucie Griffon ◽

Brigitte Fauroux

Keyword(s):

Periodic Breathing ◽

Central Apnea

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An Investigation into the Benefits of Resiting Nasoenteric Feeding Tubes

PEDIATRICS ◽

10.1542/peds.74.3.379 ◽

1984 ◽

Vol 74 (3) ◽

pp. 379-383

Author(s):

V. van Someren ◽

S. J. Linnett ◽

J. K. Stothers ◽

P. G. Sullivan

Keyword(s):

Preterm Infants ◽

Airway Resistance ◽

Periodic Breathing ◽

Feeding Tube ◽

Control Group ◽

Central Apnea ◽

Feeding Tubes ◽

The Third ◽

Transcutaneous Po2

Partial nasal obstruction in preterm infants increases the airway resistance. In spite of this, nasal feeding tubes are often used, if only because oral tubes are difficult to secure. A palatal appliance has been devised that maintains the position of oroenteric feeding tube(s) and is not associated with local complications. In order to assess the effects of resiting feeding tubes, two related studies were carried out. The first study, a trial, included respiratory monitoring of 29 infants on the third and/or seventh day after either the appliance and oroenteric tubes had been inserted, or, in the control group, after the nasoenteric tubes had been passed. After seven days, the infants using the palatal appliance had significantly less periodic breathing, central apnea, and movement than the control group. The second study showed that the removal of feeding tubes that had been in situ for several days reduced apnea rates and produced a significant increase in transcutaneous Po2.

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Cross-Correlation of Heart Rate and Oxygen Saturation in Very Low Birthweight Infants: Association with Apnea and Adverse Events

American Journal of Perinatology ◽

10.1055/s-0037-1608709 ◽

2017 ◽

Vol 35 (05) ◽

pp. 463-469 ◽

Cited By ~ 8

Author(s):

Douglas Lake ◽

Karen Fairchild

Keyword(s):

Heart Rate ◽

Adverse Events ◽

Oxygen Saturation ◽

Cross Correlation ◽

Low Birthweight ◽

Late Onset ◽

Periodic Breathing ◽

Central Apnea ◽

Very Low Birthweight ◽

Vlbw Infants

Background Analysis of subtle vital sign changes could facilitate earlier treatment of acute inflammatory illnesses. We previously showed that high cross-correlation of heart rate and oxygen saturation (XCorr-HR-SpO2) occurs in some very low birthweight (VLBW) infants with sepsis, and hypothesized that this corresponds to apnea. Methods In 629 VLBW infants, we analyzed XCorr-HR-SpO2 in relation to central apnea with bradycardia and desaturation (ABD), BD with or without central apnea (BD), and percent time in periodic breathing (PB) throughout the neonatal intensive care unit (NICU) stay (75 infant-years). We reviewed 100 days with extremely high XCorr-HR-SpO2 (>0.7) and control days for clinical associations. Next, we identified all cases of late-onset septicemia (LOS) and necrotizing enterocolitis (NEC) and analyzed change in XCorr-HR-SpO2 before diagnosis. Results Mean XCorr-HR-SpO2 was ∼0.10, and increasing XCorr-HR-SpO2 was associated with increasing ABD, BD, and PB (correlation coefficients >0.93). Days with maximum XCorr-HR-SpO2 >0.7 were more likely to have an adverse event than control days (49% versus 13%). In 93 cases of LOS or NEC, there was a 67% increase in XCorr-HR-SpO2 in the 24-hour period prior to diagnosis compared with the previous day (p < 0.01). Conclusion High XCorr-HR-SpO2 is associated with apnea and adverse events including LOS and NEC.

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Algorithm for automatic detection of self-similarity and prediction of residual central respiratory events during continuous positive airway pressure

SLEEP ◽

10.1093/sleep/zsaa215 ◽

2020 ◽

Author(s):

Eline Oppersma ◽

Wolfgang Ganglberger ◽

Haoqi Sun ◽

Robert J Thomas ◽

M Brandon Westover

Keyword(s):

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Significant Risk ◽

Periodic Breathing ◽

Driving Mechanism ◽

Central Apnea ◽

Self Similarity ◽

Respiratory Events ◽

High Loop

Abstract Study Objectives Sleep-disordered breathing is a significant risk factor for cardiometabolic and neurodegenerative diseases. High loop gain (HLG) is a driving mechanism of central sleep apnea or periodic breathing. This study presents a computational approach that identifies “expressed/manifest” HLG via a cyclical self-similarity feature in effort-based respiration signals. Methods Working under the assumption that HLG increases the risk of residual central respiratory events during continuous positive airway pressure (CPAP), the full night similarity, computed during diagnostic non-CPAP polysomnography (PSG), was used to predict residual central events during CPAP (REC), which we defined as central apnea index (CAI) higher than 10. Central apnea labels are obtained both from manual scoring by sleep technologists and from an automated algorithm developed for this study. The Massachusetts General Hospital sleep database was used, including 2466 PSG pairs of diagnostic and CPAP titration PSG recordings. Results Diagnostic CAI based on technologist labels predicted REC with an area under the curve (AUC) of 0.82 ± 0.03. Based on automatically generated labels, the combination of full night similarity and automatically generated CAI resulted in an AUC of 0.85 ± 0.02. A subanalysis was performed on a population with technologist-labeled diagnostic CAI higher than 5. Full night similarity predicted REC with an AUC of 0.57 ± 0.07 for manual and 0.65 ± 0.06 for automated labels. Conclusions The proposed self-similarity feature, as a surrogate estimate of expressed respiratory HLG and computed from easily accessible effort signals, can detect periodic breathing regardless of admixed obstructive features such as flow limitation and can aid the prediction of REC.

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