Polysomnography in preterm infants and children with chronic lung disease

Abstract

Summary Objective To determine the utility of overnight polysomnography (PSG) in assessing pulmonary reserve in stable preterm children with chronic lung disease (CLD). Study design: A retrospective review and descriptive study of overnight PSGs and clinic visits of preterm infants/children less than 3 years of age who were diagnosed with bronchopulmonary dysplasia at discharge from the hospital and enrolled in the Johns Hopkins CLD patient registry between 2008 and 2010. Results Sixty-two clinically stable patients underwent at least one overnight polysomnogram for clinical indications. The majority of patients were referred for oxygen titration (71%). PSGs from first studies revealed a mean respiratory disturbance index (RDI) of 8.2 ± 10.1 events/hr and a mean O2 saturation (SaO2) nadir of 86.2 ± 5.7%. In patients who underwent more than one PSG (n = 23), a significant decrease in RDI (P < 0.001) was found between the first study (mean age: 8.0 ± 3.3 months) and second study (mean age: 13.4 ± 5.2 months). Outpatient clinical measures of mean room air SaO2 and respiratory rate were not predictive of PSG measures of RDI and SaO2 nadir. Conclusion Mean RDI was higher in stable preterm infants/children with CLD compared to previously published controls. RDI decreased with age in stable preterm infants/children with CLD suggesting improved pulmonary reserve with age. Outpatient clinical measures (respiratory rate and room air SaO2) did not correlate with RDI and SaO2 nadir indicating that overnight PSG is more sensitive in assessing pulmonary reserve than outpatient clinical measures.

Sleep disordered breathing in bronchopulmonary dysplasia

“…Using cross‐sectional data we found an association between age and RDI, with improvement in RDI with increasing age, which is consistent with our prior work which did use longitudinal data of a subset of subjects from the same database . Improvement in RDI with age may be due to a maturation in control of breathing, growth of the upper airway, and post‐natal alveolar development resulting in better pulmonary reserve.…”

“…There are limited data on the prevalence of SDB in children with a history of BPD. Studies evaluating polysomnograms (PSGs) performed on infants with BPD have found a higher rate of respiratory events compared to non‐BPD infants . During sleep, there is a reduction in airway muscle activity and ventilatory effort.…”

Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia

“…98 Polysomnography is more sensitive than clinic-based assessments for weaning support and may be useful in determining levels or types of respiratory support and determining optimal timing for weaning off of home ventilation. 104 When polysomnography is not available, alternative approaches, such as pulse oximetry and end tidal CO 2 monitoring, should be considered. In some cases, inpatient observation may be required for ventilator weaning, escalation of support, or capping of tracheostomies for safety purposes.…”

Using continuous overnight pulse oximetry to guide home oxygen therapy in chronic neonatal lung disease

“…Ideas and suggestions were deliberated, including criteria for establishing home oxygen, weaning regimes and performing polysomnography. All 25 quiz questions were also scored against criteria for abnormal overnight oximetry studies published by the TSANZ (mean SpO 2 < 93–95%), the BTS (mean SpO 2 < 93%), the ATS (≥ 5% of study time with SpO 2 ≤ 93%) and BTS (≥ 5% of study time with SpO 2 ≤ 90%) . Using the consensus answers as a gold standard, sensitivity and specificity were calculated using each criterion.…”

“…Although PSG is the gold standard for diagnosing sleep disordered breathing and gas exchange abnormalities, it is not routinely used to guide home oxygen therapy in CNLD because it is expensive, labour intensive and not readily accessible . An alternative is performing overnight oximetry as modern pulse oximeters, calibrated to the lowest averaging time, can accurately monitor continuous arterial oxygen saturations using software algorithms to account for low perfusion and motion artefact .…”