Duration and Consequences of Periodic Breathing in Infants Born Preterm Before and After Hospital Discharge

Yee, Alicia; Siriwardhana, Leon S.; Nixon, Gillian M.; Walter, Lisa M.; Wong, Flora Y.; Horne, Rosemary Sylvia Claire

doi:10.1016/j.jpeds.2022.10.035

Cited by 5 publications

(15 citation statements)

References 26 publications

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“…However, we have previously shown that short apnoeas of 3-5 s in duration and periodic breathing are associated with falls in heart rate (median − 13.6%), peripheral (median − 8.9%) and cerebral oxygenation (median − 4.6%) in these infants 10,11 and this persists after hospital discharge. 10 This suggests that it may be the repetitive hypoxia which is driving the impairments in autonomic control as has been suggested from animal studies 7 and studies in infants with bronchopulmonary dysplasia. 8 Interestingly, these findings were only in AS, despite there being no difference between sleep states in the amount of sleep time spent with respiratory events.…”

Section: Discussionmentioning

confidence: 91%

“…Our study was unable to identify the direction of this association, as it could be that immature autonomic control predisposes infants to having increased apnoeas. However, we have previously shown that short apnoeas of 3–5 s in duration and periodic breathing are associated with falls in heart rate (median − 13.6%), peripheral (median − 8.9%) and cerebral oxygenation (median − 4.6%) in these infants 10,11 and this persists after hospital discharge 10 . This suggests that it may be the repetitive hypoxia which is driving the impairments in autonomic control as has been suggested from animal studies 7 and studies in infants with bronchopulmonary dysplasia 8 .…”

Section: Discussionmentioning

confidence: 93%

“…To further investigate how the amount of time spent having respiratory events affected HRV, infants were divided into two groups based on the % time spent with respiratory events above and below the median in AS and QS. 10,18 Further, One-Way ANCOVAs, covarying for heart rate and % time spent with respiratory events were used to determine differences in HRV parameters between the above and below the median groups during total sleep and stable sleep. All p values are two-tailed, with significance taken at p < 0.05.…”

Section: Discussionmentioning

confidence: 99%

“…One‐Way Analysis of Covariance (ANCOVA), covarying for HR and % time spent with respiratory events in an analysis of equal slopes model with post hoc Bonferroni t ‐tests was used to determine sleep state differences in HRV parameters (Total power, LF power, HF power and LF/HF) during total sleep (including respiratory events) and stable sleep (excluding respiratory events) and to compare HRV parameters between total sleep and stable sleep. To further investigate how the amount of time spent having respiratory events affected HRV, infants were divided into two groups based on the % time spent with respiratory events above and below the median in AS and QS 10,18 . Further, One‐Way ANCOVAs, covarying for heart rate and % time spent with respiratory events were used to determine differences in HRV parameters between the above and below the median groups during total sleep and stable sleep.…”

Section: Methodsmentioning

confidence: 99%

“…Infants who continued to require ventilatory support or oxygen therapy until 36 weeks PMA, infants with intrauterine growth restriction, a major congenital abnormality, major intracranial abnormality, significant intraventricular haemorrhage (Grade III or IV) or a haemodynamically significant patent ductus arteriosus were not recruited. Results of the risk factors for periodic breathing and the effects on cerebral oxygenation in this cohort of infants have been published previously 10,11 …”

Section: Methodsmentioning

confidence: 99%

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Autonomic cardiovascular control is altered by intermittent hypoxia in preterm infants

Yee,

Shetty,

Siriwardhana

et al. 2023

Acta Paediatrica

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AimPreterm infants frequently experience short apnoeas and periodic breathing. Animal studies have shown that repetitive hypoxia associated with periodic breathing can alter autonomic control. We aimed to elucidate if apnoea and periodic breathing were associated with changes in autonomic control assessed using heart rate variability, thus exacerbating the consequences of respiratory disturbance.MethodsForty very preterm infants (15 M/25 F) were studied at 34.3 weeks post‐menstrual age with daytime polysomnography. Total power, low frequency (LF, sympathetic+parasympathetic activity) high frequency (HF, parasympathetic activity) and LF/HF (sympathovagal balance) were calculated.ResultsInfants were divided into those with above and below the median total sleep time spent with respiratory events: Active sleep (AS) 13%, Quiet sleep (QS) 10%. In AS, including respiratory events, Total power (p < 0.05) and HF power (p < 0.05) were higher in the above median group. During AS excluding respiratory events, Total power (p < 0.05) and HF power (p = 0.061) were higher and LF power (p < 0.01) and LF/HF (p < 0.05) were lower in the above median group. There were no differences in HRV parameters in QS.ConclusionThis study provides new evidence that short apnoeas, particularly periodic breathing, which is currently not detected or treated in the neonatal unit can affect autonomic cardiovascular control.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Autonomic cardiovascular control is altered by intermittent hypoxia in preterm infants

Yee,

Shetty,

Siriwardhana

et al. 2023

Acta Paediatrica

Self Cite

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Effects of vanilla odor on hypoxia-related periodic breathing in premature newborns: A pilot study

Bergeron,

Champoux-Ouellet,

Samson

et al. 2024

Archives de Pédiatrie

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Developmental consequences of short apneas and periodic breathing in preterm infants

Yee,

Siriwardhana,

Nixson

et al. 2023

J Perinatol

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Objective We investigated the relationship between respiratory events experienced before and after hospital discharge and developmental outcomes at 6 months corrected age (CA). Study design Preterm infants born between 28–32 weeks gestational age (GA) were studied at 32–36 weeks postmenstrual age (PMA), 36–40 weeks PMA, 3- and 6-months CA. Percentage total sleep time (%TST) with respiratory events (isolated apneas, sequential apneas and periodic breathing (PB)) at each study was calculated. Stepwise multiple linear regressions determined significant predictors of developmental outcomes at 6 months. Result %TST with respiratory events at term were significant predictors of language (R2 = 0.165, β = −0.416) and motor (R2 = 0.180, β = −0.485) composite scores of the Bayley Scales of Infant Development at 6 months, independent of GA, birth weight and sex. Conclusions In clinically stable very preterm infants at term equivalent age, time spent having respiratory events, was related to a reduction in language and motor outcomes at 6 months.

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Duration and Consequences of Periodic Breathing in Infants Born Preterm Before and After Hospital Discharge

Cited by 5 publications

References 26 publications

Autonomic cardiovascular control is altered by intermittent hypoxia in preterm infants

Autonomic cardiovascular control is altered by intermittent hypoxia in preterm infants

Effects of vanilla odor on hypoxia-related periodic breathing in premature newborns: A pilot study

Developmental consequences of short apneas and periodic breathing in preterm infants

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