RESUMEN
OBJECTIVE: To investigate the amount of time spent in periodic breathing and its consequences in infants born preterm before and after hospital discharge. METHODS: Infants born preterm between 28-32 weeks of gestational age were studied during daytime sleep in the supine position at 32-36 weeks of postmenstrual age (PMA), 36-40 weeks of PMA, and 3 months and 6 months of corrected age. The percentage of total sleep time spent in periodic breathing (% total sleep time periodic breathing) was calculated and infants were grouped into below and above the median (8.5% total sleep time periodic breathing) at 32-36 weeks and compared with 36-40 weeks, 3 and 6 months. RESULTS: Percent total sleep time periodic breathing was not different between 32-36 weeks of PMA (8.5%; 1.5, 15.0) (median, IQR) and 36-40 weeks of PMA (6.6%; 0.9, 15.1) but decreased at 3 (0.4%; 0.0, 2.0) and 6 months of corrected age 0% (0.0, 1.1). Infants who spent above the median % total sleep time periodic breathing at 32-36 weeks of PMA spent more % total sleep time periodic breathing at 36-40 weeks of PMA (18.1%; 7.7, 23.9 vs 2.1%; 0.6, 6.4) and 6 months of corrected age 0.9% (0.0, 3.3) vs 0.0% (0.0, 0.0). CONCLUSIONS: Percentage sleep time spent in periodic breathing did not decrease as infants born preterm approached term corrected age, when they were to be discharged home. High amounts of periodic breathing at 32-36 weeks of PMA was associated with high amounts of periodic breathing at term corrected age (36-40 weeks of PMA), and persistence of periodic breathing at 6 months of corrected age.
Asunto(s)
Recien Nacido Prematuro , Alta del Paciente , Recién Nacido , Humanos , Lactante , Sueño , Edad Gestacional , HospitalesRESUMEN
BACKGROUND: To assess if the effects of sleep disordered breathing (SDB) on heart rate (HR) and HR variability, as a measure of autonomic control, were more severe in a group of children born preterm compared with a group of children born at term referred to our sleep laboratory for assessment of SDB. STUDY DESIGN: Children (3-12 years of age) referred for polysomnographic assessment of SDB were recruited; 50 born preterm (<37 weeks of gestation) and 50 at term, matched for age and SDB severity. The mean HR and HR variability using power spectral analysis were calculated for each child for wake and sleep, and stages N1, N2, N3, and rapid eye movement sleep. RESULTS: Ex-preterm children were born between 23 and 35 weeks of gestational age (29.3 ± 3.6; mean ± SEM). There were no differences in the demographic, sleep, or respiratory characteristics between the groups. High-frequency power (reflecting parasympathetic activity) was greater in the ex-preterm children in both N2 and N3 (P < .05 for both) and total power was greater in N3 (P < .05). When the children were divided by SDB severity, these effects were most marked in those preterm born children with moderate to severe disease. CONCLUSIONS: Preterm born children matched for age and SDB severity with children born at term showed no differences in sleep characteristics; however, they did exhibit increased parasympathetic tone during non-rapid eye movement sleep.
Asunto(s)
Sistema Nervioso Autónomo , Enfermedades Cardiovasculares/fisiopatología , Recien Nacido Prematuro , Síndromes de la Apnea del Sueño/fisiopatología , Sueño , Presión Sanguínea , Sistema Cardiovascular/fisiopatología , Estudios de Casos y Controles , Niño , Preescolar , Estudios Transversales , Femenino , Frecuencia Cardíaca , Humanos , Recién Nacido , Masculino , Polisomnografía , Estudios Retrospectivos , Sueño REMRESUMEN
OBJECTIVE: To measure sleep patterns and quality, objectively and subjectively, in clinically stable children with cystic fibrosis (CF) and healthy control children, and to examine the relationship between sleep quality and disease severity. STUDY DESIGN: Clinically stable children with CF and healthy control children (7-18 years of age) were recruited. Sleep patterns and quality were measured at home with actigraphy (14 days). Overnight peripheral capillary oxygen saturation was measured via the use of pulse oximetry. Daytime sleepiness was evaluated by the Pediatric Daytime Sleepiness Scale (PDSS) and subjective sleep quality by the Sleep Disturbance Scale for Children and Obstructive Sleep Apnea-18. RESULTS: A total of 87 children with CF and 55 control children were recruited with no differences in age or sex. Children with CF had significantly lower total sleep time and sleep efficiency than control children due to frequent awakenings and more wake after sleep onset. In children with CF, forced expiratory volume in 1 second and overnight peripheral capillary oxygen saturation nadir correlated positively with total sleep time and sleep efficiency and negatively with frequency of awakenings and wake after sleep onset. Patients with CF had significantly greater Sleep Disturbance Scale for Children (45 vs 35; P < .001), Obstructive Sleep Apnea-18 (35 vs 24; P < .001), and PDSS scores (14 vs 11; P < .001). There was a negative correlation between PDSS and forced expiratory volume in 1 second (r = -0.23; P < .05). CONCLUSIONS: Even in periods of clinical stability, children with CF get less sleep than their peers due to more time in wakefulness during the night rather than less time spent in bed. Objective measures of sleep disturbance and subjective daytime sleepiness were related to disease severity. In contrast, parents of children with CF report high levels of sleep disturbance unrelated to disease severity.
Asunto(s)
Fibrosis Quística/complicaciones , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/etiología , Encuestas y Cuestionarios , Actigrafía/métodos , Adolescente , Distribución por Edad , Australia , Estudios de Casos y Controles , Niño , Fibrosis Quística/diagnóstico , Femenino , Volumen Espiratorio Forzado , Humanos , Incidencia , Masculino , Oximetría/métodos , Polisomnografía/métodos , Pronóstico , Intercambio Gaseoso Pulmonar , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Trastornos del Sueño-Vigilia/diagnóstico , Estadísticas no Paramétricas , Centros de Atención TerciariaRESUMEN
OBJECTIVE: To determine whether sustained resolution of sleep disordered breathing (SDB) in young children, either because of treatment or spontaneous recovery, predicted long-term improvements in quality of life, family functioning, and parental stress. STUDY DESIGN: Children diagnosed with primary snoring (n = 16), mild obstructive sleep apnea (OSA, n = 11), moderate-severe (MS) OSA (n = 8), and healthy nonsnoring controls (n = 25) at ages 3-5 years underwent repeat polysomnography at 6-8 years. Parents completed quality of life and parental stress questionnaires at both time points. Resolution of SDB was determined as obstructive apnea hypopnea index (OAHI) ≤1 event/hour, or absence of snoring during polysomnography or on parent report. Linear mixed-model analyses determined the effects of resolution on psychosocial morbidity. OAHI was used to determine the predictive value of changes in SDB severity on psychosocial outcomes. RESULTS: Fifty percent of primary snoring, 45% mild OSA, and 63% MS OSA resolved, of which 67% received treatment. Children originally diagnosed with SDB continued to show significant psychosocial impairments compared with nonsnoring controls, irrespective of resolution. A reduction in OAHI predicted improvements in physical symptoms, school functioning, family worry and family relationships, and stress related to a difficult child. CONCLUSIONS: Treatment was more likely to result in resolution of SDB if original symptoms were MS. Children originally diagnosed with SDB, irrespective of resolution, continued to experience psychosocial dysfunction suggesting additional interventions are required.