Retrospective analysis of inpatient polysomnogram characteristics and discharge outcomes in infants with bronchopulmonary dysplasia requiring home oxygen therapy

BackgroundPolysomnography (PSG) is the gold standard for the diagnosis of pediatric sleep‐disordered breathing (SDB). However, the literature characterizing the indications for inpatient PSGs and the impact on clinical decision‐making is limited.ObjectiveTo determine the indications, results, and outcomes for children undergoing inpatient PSGs at our institution.MethodsWe performed a retrospective review of children aged 0–18 years who underwent inpatient diagnostic PSGs between July 2018 and July 2021 at SickKids, Toronto, Canada. Baseline characteristics, indications, and management were reviewed and characterized by descriptive statistics.ResultsEighty‐eight inpatient PSGs were performed in 75 children (male 62.7%). Median (interquartile range) age and body mass index z‐score were 1.5 (0.2, 10.8) years and 0.27 (−1.58, 2.66), respectively. The most common indication for inpatient PSG was initiation and titration of ventilation (n = 34/75, 45.3%). Of the 75 children, 48 (64%) had multiple complex chronic conditions (CCCs). Sixty children (80%) underwent a baseline PSG for either the entire night or a portion of the night. Of these studies, 54 (90%) had clinically significant SDB of which isolated obstructive sleep apnea (OSA; 17/60, 28.3%) was the most common. The following management was undertaken for the 54 patients with SDB; respiratory technology (88.9%), surgical intervention (31.5%), positional therapy (1.9%), intranasal steroids (3.7%), and no further intervention (5.6%), respectively.ConclusionsOur study highlights that inpatient PSG was an important diagnostic tool resulting in directed medical and surgical management. Future multicenter studies are needed to compare indications for inpatient PSGs across institutions to develop evidence‐based clinical practice guidelines.

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 82%

Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center

Sunkonkit

Alzaid

Xiao

et al. 2023

“…The high prevalence of nocturnal hypoxemia on recorded home oximetry suggests a potential benefit of objective monitoring of oxyhemoglobin saturation when weaning supplemental oxygen consistent with the published guideline from the American Thoracic Society. 4 There is a known increase in sleep disordered breathing in premature infants with BPD, including OSA, central sleep apnea, hypoventilation, and nonapneic hypoxemia, 21 which could explain the increased frequency of desaturation events in this cohort. It has also been reported that the severity of BPD could augment the severity of sleep disordered breathing, implying that those infants who are discharged on home supplemental oxygen therapy would be at the highest risk for clinically significant sleep disordered breathing.…”

Section: Discussionmentioning

confidence: 91%

“…There is a known increase in sleep disordered breathing in premature infants with BPD, including OSA, central sleep apnea, hypoventilation, and nonapneic hypoxemia, 21 which could explain the increased frequency of desaturation events in this cohort. It has also been reported that the severity of BPD could augment the severity of sleep disordered breathing, implying that those infants who are discharged on home supplemental oxygen therapy would be at the highest risk for clinically significant sleep disordered breathing 22 .…”

Section: Discussionmentioning

confidence: 93%

Frequent hypoxemia found in infants with bronchopulmonary dysplasia after weaning home oxygen

House

Klein

Parham

et al. 2022

Objective Parental reports and brief clinical examinations are the primary information used to assist clinicians in weaning home supplemental oxygen in infants with bronchopulmonary dysplasia (BPD). Recorded nocturnal oximetry provides an objective assessment of hypoxemia; however, it is unknown if it identifies clinically undetected hypoxemia in the home setting. Our objective was to determine if nocturnal oximetry can identify unreported hypoxemia in infants with BPD who appear ready to wean from supplemental oxygen. Study Design We conducted a retrospective chart review of infants born <32 weeks gestation with BPD who were discharged to home receiving supplemental oxygen and completed recorded nocturnal oximetry in room air during an 18‐month period. Abnormal oximetry was defined as >5 min with SpO2 < 90% and/or an oxyhemoglobin desaturation index (ODI4) >5. Comparative analysis of patients with normal and abnormal overnight oximetry was performed using Fisher Exact and Wilcoxon signed‐rank test. Results Thirty‐five former premature infants completed nocturnal oximetry at 5.8 (3.4−8.3) months corrected age. Nocturnal oximetry was abnormal as defined in 67% of the cohort (n = 21). Five percent of patients were hypoxemic, 52% had frequent desaturation events, and 43% had both. No significant differences existed in neonatal characteristics between patients with normal and abnormal studies. Conclusions Nocturnal oximetry was abnormal in the majority of infants with BPD who were otherwise clinically ready to wean from oxygen support, suggesting that recorded home oximetry could be a feasible and useful tool to evaluate for otherwise clinically unapparent nocturnal hypoxemia in patients with BPD.

“…A recent study suggested obtaining a PSG before NICU discharge for infants with severe BPD 22 . Infants with severe BPD were often found to be hypoventilated with higher CO 2 values greater than 50 mmHg during sleep times.…”

Section: Discussionmentioning

confidence: 99%

Does recorded oximetry utilizing a consensus‐based algorithm compare to polysomnography in discontinuing home oxygen therapy in premature infants?

White

Sobelman

Kremer

et al. 2021

Background Approximately a third of all extremely preterm infants diagnosed with bronchopulmonary dysplasia will require home oxygen therapy (HOT). Lack of consensus‐based guidelines has led to significant variability in outpatient HOT management in the United States. A common assessment performed before discontinuing oxygen is a formal polysomnogram (PSG). PSGs are potentially undesirable due to cost, lack of convenient access, and parental stress, so alternative testing to determine the optimal timing of safe oxygen discontinuation are needed. Methods We compared nocturnal recorded home oximetry (RHO) with PSG data in a cohort of patients from the RHO trial for patients who had recordings performed simultaneously to or within 24 h of their PSG. The RHO trial was a randomized, unblinded, multi‐center trial comparing two oxygen management strategies. Parameters of oxygenation were compared between PSG and RHO, and nonoximegtry findings from the PSG that changed clinical management were identified. Results A total of 53 infants randomized to obtain a PSG as part of the RHO trial (55%) completed a PSG, and of those, 32 (64%) completed both a PSG with comparison RHO. There were more white infants in both groups than other races and ethnicities. Bland–Altman analysis showed a strong agreement of oxygen saturation time below 90% SpO2 between PSG and RHO results (slope = 1.014, p = 0.24). Results agreed in 96% of cases. Conclusion RHO is a safe and effective alternative to PSG to assist in determination of discontinuing HOT in infants with BPD without other risks for sleep‐disordered breathing.