Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Abstract

Study Objectives: Neurocognitive deficits have been shown in school-aged children with sleep apnea. The effect of obstructive sleep apnea (OSA) on the neurodevelopmental outcome of preterm infants is unknown. Methods: A retrospective chart review was performed for all preterm infants (< 37 weeks) who had neonatal polysomnography (PSG) and completed neurodevelopmental assessment with the Bayley Scales of Infant and Toddler Development, 3rd Edition, between 2006 to 2015 at Riley Hospital. Exclusion criteria included grade IV intraventricular hemorrhage, tracheostomy, cyanotic heart disease, severe retinopathy of prematurity, craniofacial anomalies, or central and mixed apnea on PSG. Sleep apnea was defined as an apnea-hypopnea index (AHI) > 1 event/h. Regression analyses were performed to find a relationship between PSG parameters and cognitive, language, and motor scores. Results: Fifteen patients (males: n = 10) were eligible for the study. Median postmenstrual age at the time of the PSG was 41 weeks (37-46). Median AHI for the cohort was 17.4 events/h (2.2-41.3). Median cognitive, language, and motor scores were 90 (65-125), 89 (65-121), and 91 (61-112), respectively. Mean end-tidal CO2 (median 47 mm Hg ) negatively correlated with cognitive scores (P = .01) but did not significantly correlate with language or motor scores. AHI was not associated with cognitive, language, or motor scores. Conclusions: The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO2, independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA. Commentary: A commentary on this article appears in this issue on page 1233. Keywords: obstructive sleep apnea, polysomnography, infant, newborn Citation: Bandyopadhyay A, Harmon H, Slaven JE, Daftary AS. Neurodevelopmental outcomes at two years of age for premature infants diagnosed with neonatal obstructive sleep apnea.

Phenotypical Characterization of Obstructive Sleep Apnea in Premature Infants using Polysomnography

“…14 In 2017, Bandyopadhyay et al reported a median AHI in their cohort of 15 premature infants was 17.4 e/h, similar to the elevated AHI found in our premature cohort as well. 15 A 2021 study by Jaleel et al evaluated the polysomnogram characteristics between children born preterm and term, confirming prematurity led to a 2.97x risk of severe OSA (21.3%) and AHI elevation (6.5 e/h) compared with non-premature children for severe OSA (12.0%) and AHI elevation (4.6 e/h). 3 There are many theories as to why preterm infants are predisposed for OSA.…”

Airway management in infants with Robin sequence in the United Kingdom and Ireland: a prospective population-based study

“…Protracted hospital admissions in early childhood, as are often endured by infants with RS, are a further recognized risk factor for NDD 40 . Additionally, uncontrolled sleep-disordered breathing leading to oxygen desaturation, arousals, and sleep fragmentation is a known risk factor for cognitive and behavioral problems 41 . In our cohort, NDD was significantly associated with surgical airway intervention despite adjusting for the presence of non-isolated RS, which may reflect the impact of a protracted hospital admission or early severe UAO on neurodevelopment.…”

Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know

“…Table 3 summarizes the publications on neurocognitive outcomes in infants with OSA. Three studies [54][55][56] have analyzed a relationship between AHI and neurodevelopmental scores in the infant population. These studies did not find any correlation between the two.…”