Periodic Apnea in the Full-Term Infant: Individual Consistency, Sex Differences, and State Specificity

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 79-86
Author(s):  
Stephen P. Waite ◽  
Evelyn B. Thoman
Keyword(s):  
Periodic Breathing ◽  
Term Infant ◽  
Full Term ◽  
Respiratory Pattern ◽  
Active Sleep ◽  
Sleep State ◽  
Quiet Sleep ◽  
Term Infants ◽  
The Mean ◽  
Individual Consistency

The occurrence of periodic apnea (apnea during periodic breathing) was studied in 27 normal, full-term infants during the first five weeks of life. The rate and mean length of apnea were analyzed both with respect to sleep state and with respect to respiratory pattern, ie, periodic vs nonperiodic breathing. The rate of apnea was found to vary according to sleep state and the pattern of breathing. The highest apnea rates were non-periodic apneas in active sleep. Periodic apnea rates were relatively low in both active and quiet sleep; however, this type of apnea was consistently observed from weeks 2 through 5. The proportion of apneas that are periodic is much higher in quiet sleep than in active sleep. Rates of periodic and nonperiodic apnea were more consistently correlated in active sleep than in quiet sleep. The mean length of periodic apnea was found to be significantly greater than the mean length of nonperiodic apnea in both sleep states, a difference that reflected a greater positive skew in the distribution of the nonperiodic apnea lengths. This variation in length between periodic and nonperiodic apnea explains, in part, the increased mean length in quiet sleep compared with active sleep. There were significant individual differences over weeks in both forms of apnea in active sleep and in quiet sleep. Female infants were observed to have higher rates of nonperiodic apnea than male infants in active sleep, although no significant differences in the distribution of lengths were obtained.

Polygraphic Studies of Normal Infants During the First Six Months of Life: III. Incidence of Apnea and Periodic Breathing

PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 418-425 ◽  
Author(s):  
Toke Hoppenbrouwers ◽  
Joan E. Hodgman ◽  
R. M. Harper ◽  
Elvira Hofmann ◽  
M. B. Sterman ◽  
...  
Keyword(s):  
Periodic Breathing ◽  
Term Infant ◽  
Full Term ◽  
Active Sleep ◽  
Quiet Sleep ◽  
Newborn Period ◽  
Term Infants ◽  
Waking State ◽  
Extreme Variability ◽  
Second Period

The incidence of apnea and periodic breathing was studied in full-term infants between birth and 6 months of age. Apnea was defined as a pause equal to or exceeding six seconds, periodic breathing as two cessations of breathing within a 20-second period, each equal to or longer than three seconds but less than six seconds. Sleep and cardiopulmonary variables were monitored. Apnea was common in the normal full-term infant. The incidence of apnea was highest in the newborn period and apneas exceeding 15 seconds were limited to this age. A reduction in apnea incidence occurred between birth and 3 months of age; thereafter, the incidence remained unchanged. The majority of apneas occurred during active sleep (AS). Few minutes were classified as indeterminate; the number of apneas during these minutes was comparable to those during AS. The incidence of apneas during quiet sleep was low. Periodic breathing remained stable across the ages, occurring primarily in AS. Apnea exceeding 15 seconds is rare in infancy. The tabulation of shorter apnea may be of limited value in identifying infants at risk for abnormal apnea due to extreme variability among infants. The sleep-waking state of the infants must be considered in order to evaluate apnea counts.

Effect of a single breath of 100% oxygen on respiration in neonates during sleep

1984 ◽  
Vol 57 (5) ◽  
pp. 1531-1535 ◽  
Author(s):  
T. Aizad ◽  
J. Bodani ◽  
D. Cates ◽  
L. Horvath ◽  
H. Rigatto
Keyword(s):  
Gestational Age ◽  
Minute Ventilation ◽  
Control Period ◽  
Full Term ◽  
Preterm Neonates ◽  
Sleep State ◽  
Quiet Sleep ◽  
Peripheral Chemoreceptor ◽  
Term Infants ◽  
Single Breath

To determine the effect of a single breath of 100% O2 on ventilation, 10 full-term [body wt 3,360 +/- 110 (SE) g, gestational age 39 +/- 0.4 wk, postnatal age 3 +/- 0.6 days] and 10 preterm neonates (body wt 2,020 +/- 60 g, gestational age 34 +/- 2 wk, postnatal age 9 +/- 2 days) were studied during active and quiet sleep states. The single-breath method was used to measure peripheral chemoreceptor response. To enhance response and standardize the control period for all infants, fractional inspired O2 concentration was adjusted to 16 +/- 0.6% for a control O2 saturation of 83 +/- 1%. After 1 min of control in each sleep state, each infant was given a single breath of O2 followed by 21% O2. Minute ventilation (VE), tidal volume (VT), breathing frequency (f), alveolar O2 and CO2 tension, O2 saturation (ear oximeter), and transcutaneous O2 tension were measured. VE always decreased with inhalation of O2 (P less than 0.01). In quiet sleep, the decrease in VE was less in full-term (14%) than in preterm (40%) infants (P less than 0.001). Decrease in VE was due primarily to a drop in VT in full-term infants as opposed to a fall in f and VT in preterm infants (P less than 0.05). Apnea, as part of the response, was more prevalent in preterm than in full-term infants. In active sleep the decrease in VE was similar both among full-term (19%) and preterm (21%) infants (P greater than 0.5). These results suggest greater peripheral chemoreceptor response in preterm than in full-term infants, reflected by a more pronounced decrease in VE with O2. The results are compatible with a more powerful peripheral chemoreceptor contribution to breathing in preterm than in full-term infants.

Sequential 22-Hour Profiles of Breathing Patterns and Heart Rate in 110 Full-Term Infants During Their First 6 Months of Life

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 763-777 ◽  
Author(s):  
J. M. Richards ◽  
J. R. Alexander ◽  
E. A. Shinebourne ◽  
M. de Swiet ◽  
A. J. Wilson ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Age Groups ◽  
Total Duration ◽  
Periodic Breathing ◽  
Full Term ◽  
Breathing Patterns ◽  
Term Infants ◽  
Wall Movement ◽  
The Mean

Sequential recordings (total number 365, mean duration 22 hours) of ECG and abdominal wall movement were obtained from 110 full-term infants up to 6 months of age. The longest pause in breathing movement per recording (maximum 21.6 seconds) decreased in duration over the first 2 weeks of life (P < .005). Pauses >18.0 seconds were not detected after seven days. The spread of values for pauses ≥3.6 seconds duration was widest during the first 2 weeks, and their number decreased with age (P < .001). Periodic breathing, detected in 69% to 80% of infants in all age groups, showed decreasing trends with age in total duration and maximum length of episode (P < .005 for both). The spread of values was widest during the first 2 weeks (range for total duration 0 to 4.7 hours) and decreased with age. The mean respiratory rate during regular breathing decreased after 4 weeks (P < .001). The spread of values was widest during the first 2 weeks and decreased with age. Birth weight was positively correlated with mean respiratory rate during the first three days of life (r = +.64, P < .001). The mean heart rate during regular breathing increased during the first 15 days (P < .001) and then decreased after 4 weeks (P < .001). Higher mean heart rates were found in male infants (P < .01).

Treatment of Apnea and Excessive Periodic Breathing in the Full-Term Infant

PEDIATRICS ◽  
1981 ◽  
Vol 68 (2) ◽  
pp. 183-186
Author(s):  
Dorothy H. Kelly ◽  
Daniel C. Shannon
Keyword(s):  
Serum Level ◽  
Periodic Breathing ◽  
Term Infant ◽  
Full Term ◽  
Average Dose ◽  
Term Infants ◽  
Full Term Infant ◽  
History Of ◽  
Average Serum

Twenty-two full-term infants, aged 0 to 6 weeks, with a history of unexplained apnea and respiratory abnormalities on pneumogram recordings, were treated with theophylline (average dose 7.5 mg/kg/day and average serum level 11 µg/ml). Subsequent recordings showed a significant decrease in the amount of periodic breathing (14.3% vs 0.7%) and apnea 10 to 14.9 seconds (12.8 vs 1.0/100 min) when compared to the initial pneumogram. It is concluded that theophylline therapy in this group of infants will result in a reduction of apnea and periodic breathing.

Influence of sleep state on frequency of swallowing, apnea, and arousal in human infants

2003 ◽  
Vol 94 (6) ◽  
pp. 2456-2464 ◽  
Author(s):  
Garrick W. Don ◽  
Karen A. Waters
Keyword(s):  
Sleep Stage ◽  
Respiratory Rhythm ◽  
Active Sleep ◽  
Sleep State ◽  
Quiet Sleep ◽  
Human Infants ◽  
The Mean ◽  
Swallowing Apnea

Apnea and arousal are modulated with sleep stage, and swallowing may interfere with respiratory rhythm in infants. We hypothesized that swallowing itself would display interaction with sleep state. Concurrent polysomnography and measurement of swallowing allowed time-matched analysis of 3,092 swallows, 482 apneas, and 771 arousals in 17 infants aged 1–34 wk. The mean rates of swallowing, apnea, and arousal were significantly different, being 23.3 ± 8.5, 9.4 ± 8.8, and 15.5 ± 10.6 h−1, respectively ( P < 0.001 ANOVA). Swallows occurred before 25.2 ± 7.9% and during 74.8 ± 6.3% of apneas and before 39.8 ± 6.0% and during 60.2 ± 6.0% of arousals. The frequencies of apneas and arousals were both strongly influenced by sleep state (active sleep > indeterminate > quiet sleep, P < 0.001), whether or not the events coincided with swallowing, but swallowing rate showed minimal independent interaction with sleep state. Interactions between swallowing and sleep state were predominantly influenced by the coincidence of swallowing with apnea or arousal.

Influence of chest wall distortion on esophageal pressure

1983 ◽  
Vol 55 (2) ◽  
pp. 353-358 ◽  
Author(s):  
P. N. LeSouef ◽  
J. M. Lopes ◽  
S. J. England ◽  
M. H. Bryan ◽  
A. C. Bryan
Keyword(s):  
Chest Wall ◽  
Preterm Infants ◽  
Face Mask ◽  
Esophageal Pressure ◽  
Term Infant ◽  
Full Term ◽  
Pleural Pressure ◽  
Quiet Sleep ◽  
Term Infants ◽  
Rib Cage

The caudocephalad profile of esophageal pressure swings was studied in 10 preterm and 5 full-term infants, and the effect of chest wall distortion on esophageal pressure swings was analyzed in 12 preterm infants. Esophageal pressure was measured with a fluid-filled catheter, tidal volume with a pneumotachograph, mouth pressure with a face mask and pressure transducer, and rib cage and abdominal motion with magnetometers. In preterm infants the profile of esophageal pressure swings fell very steeply in the caudocephalad direction. In full-term infants it was flat during quiet sleep and steep during rapid-eye-movement sleep. When breaths, standardized for pleural pressure, were compared between a period with maximal and a period with minimal chest wall distortion, esophageal pressure swings for both spontaneous and occluded breaths were higher in the former period. We conclude that the complaint preterm rib cage results in an uneven distribution of pleural pressure and that this distribution varies with changes in chest wall distortion. Esophageal pressure measurements are therefore an unreliable estimate of mean pleural pressure in the preterm infant and can be unreliable in the term infant.

Periodic Breathing in Preterm Infants: Incidence and Characteristics

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 785-792
Author(s):  
S. F. Glotzbach ◽  
R. B. Baldwin ◽  
N. E. Lederer ◽  
P. A. Tansey ◽  
R. L. Ariagno
Keyword(s):  
Preterm Infants ◽  
Age Groups ◽  
Periodic Breathing ◽  
Sudden Infant Death ◽  
Respiratory Pattern ◽  
Sudden Infant ◽  
Quiet Time ◽  
Term Infants ◽  
Respiratory Dysfunction ◽  
Postconceptional Age

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.

Neonatal Seizures, Intracerebral Hematoma, and Subarachnoid Hemorrhage in Full-Term Infants

PEDIATRICS ◽  
1979 ◽  
Vol 63 (5) ◽  
pp. 812-815
Author(s):  
Edward R. Chaplin ◽  
Gary W. Goldstein ◽  
David Norman
Keyword(s):  
Metabolic Disease ◽  
Subarachnoid Hemorrhage ◽  
Subarachnoid Space ◽  
Term Infant ◽  
Full Term ◽  
Spinal Fluid ◽  
Intracerebral Hematoma ◽  
Neonatal Seizures ◽  
Presumptive Diagnosis ◽  
Term Infants

During the first days of life intracranial hemorrhage is a frequent cause of convulsions in the full-term infant.1,2 If spinal fluid is bloody and there is no evidence of asphyxia, infection, or acute metabolic disease, then a presumptive diagnosis of primary subarachnoid hemorrhage is often made.1-3 These infants appear remarkably well in the interictal period, and their outcome is usually good.1,2 Since pathologic confirmation is not available, it has been assumed that bleeding occurs directly into the subarachnoid space and not as an extension of a subdural, intraventricular, or intracerebellar hemorrhage.1,3-5 During a 13-month period at our institution, only four full-term infants had seizures and bloody spinal fluid.

Round Table Discussion

PEDIATRICS ◽  
1951 ◽  
Vol 8 (3) ◽  
pp. 431-434
Author(s):  
HEYWORTH N. SANFORD ◽  
J. HAROLD ROOT ◽  
R. H. GRAHAM
Keyword(s):  
Premature Infant ◽  
Premature Infants ◽  
Death Rate ◽  
Round Table ◽  
Term Infant ◽  
Full Term ◽  
Round Table Discussion ◽  
Premature Births ◽  
Term Infants ◽  
Full Term Infant

Chairman Sanford: Dr. Herman N. Bundesen, Commissioner of Health of Chicago, organized 12 years ago the "Chicago Premature Plan." This consists in registering all premature infants with the City Health Department within a few hours after birth. The premature infant who is born at home, or in a hospital that does not have adequate premature care, is transported in an oxygenated incubator ambulance to a hospital which specializes in such care. From 1936 to 1947 premature infant deaths in Chicago have been lowered 6½%. The full term infant death rate during the same period has been lowered about 3%. Inasmuch as the premature death rate has been lowered about double that of the full term infant rate, we believe this procedure has been the cause of reduction. In 1936 there were 47,000 live births in Chicago. In 1947 there were 82,000, or an increase of 80%. In this number the full term infants increased from 45% to 60%, whereas the premature infants increased from 2000 to over 5000, or about 140% increase of premature infants born in Chicago during the last 10 years. This adds a considerable increase to the number of infants for our available premature infants beds. Where formerly we planned 5 premature births to each 100 full term births, we now find that prematures have increased to 8 per 100 full term infants. Causes of prematurity are multiple births, toxemia, heart disease, syphilis, tuberculosis, infections, accidents, premature separation of the placenta and abnormalities of the reproduction tract. It is generally understood that there is a tendency for more premature births among the Negro race than the white race.

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

PEDIATRICS ◽  
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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