Sleep disordered breathing in bronchopulmonary dysplasia

Abstract

BACKGROUND There are limited data on the effect of bronchopulmonary dysplasia (BPD) on sleep disordered breathing (SDB). We hypothesized that both the severity of prematurity and BPD would increase the likelihood of SDB in early childhood. Our secondary aim was to evaluate the association of demographic factors on the development of SDB. METHODS This is a retrospective study of patient factors and overnight polysomnogram (PSG) data of children enrolled in our BPD registry between 2008 and 2015. Association between PSG results and studied variables was assessed using multiple linear regression analysis. RESULTS One-hundred-forty children underwent at least one sleep study on room air. The mean respiratory disturbance index (RDI) was elevated at 9.9 events/hr (SD: 10.1). The mean obstructive apnea-hypopnea index (OAHI) was 6.5 (9.1) events/hr and the mean central event rate of 3.0 (3.7) events/hr. RDI had decreased by 22% or 1.5 events/hour (95% CI: 0.6, 1.9) with each year of age (p=0.005). Subjects with more severe respiratory disease had 38% more central events (p=0.02). Infants exposed to secondhand smoke had 2.4% lower (p=0.04) oxygen saturation nadirs and a pattern for more desaturation events. Non-white subjects were found to have 33% higher OAHI (p=0.05), while white subjects had a 61% higher rate of central events (p<0.001). CONCLUSIONS RDI was elevated in a selected BPD population compared to norms for non-preterm children. BPD severity, smoke exposure, and race may augment the severity of SDB. RDI improved with age but was still elevated by age 4, suggesting that this population is at risk for the sequelae of SDB.

The role of polysomnography in tracheostomy decannulation of children with bronchopulmonary dysplasia

“…Premature infants are predisposed to upper airway obstruction due to a combination of decreased upper airway muscle tone, smaller caliber upper airway that allows for easier collapse as well as increased compliance of the chest wall . For these reasons, preterm children with BPD have a higher rate of sleep disordered breathing when compared with non‐BPD and non‐premature populations …”

“…6,7 For these reasons, preterm children with BPD have a higher rate of sleep disordered breathing when compared with non-BPD and non-premature populations. [8][9][10] Tracheostomy decannulation is a shared goal of patient, family, and providers. Despite its known benefits, tracheostomy is associated with increased morbidity and mortality.…”

2017 pediatric pulmonology year in review part 2—neonatology

“…The decrements in oxygen saturation they observed may also be attributable in part to sleep‐disordered breathing, which was observed by Ortiz and colleagues who conducted sleep studies in a subset of their BPD clinic patients . These studies were conducted in patients with suspected obstructive sleep apnea (41%) or to determine suitability of weaning off supplemental oxygen (50%).…”

Non-invasive Ventilation for Children With Chronic Lung Disease

“…Furthermore, in BPD, central apneas and abnormal ventilatory responses to hypoxic and hypercarbic states due to the immaturity of respiratory drive and sleep fragmentation are common. In addition to the immaturity of respiratory drive, upper airway obstruction is also increased during sleep as a result of a smaller caliber upper airway and increased compliance of the chest wall ( 12 , 13 ).…”