Gastro-oesophageal reflux and apnoeic pauses during sleep in infancy —no direct relation
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We studied the relation of gastro-oesophageal reflux with apnoea during sleep in 24 infants with antecedent respiratory abnormalities and/or proven gastro-oesophageal reflux (GOR), by combined lower oesophageal pH and polygraphic monitoring. GOR, indicated by pH<4, was confirmed in 24 infants. There were no episodes of prolonged (>20s) central apnoea (CA). Fifty-six mixed or obstructive breathing episodes were identified in 12 infants (14 studies), of which 28 lasted between 3 and 6s. Bradycardia (heart rate less than <80 beats/min for 10s was not observed. There were 80 falls in transcutaneous oxygen (PtcO2>5 mmHg) but only 6 exceeded 10 mmHg and one 20 mmHg. There was no relationship between GOR and obstructive episodes in terms of frequency, duration or temporal occurrence, except in one infant. There were 1276 gross body movements, mainly during active or indeterminate sleep and, of these, 7% were associated with decreases in pH to <4. Movements occurred during the 60s period preceding 83% of pH decreases >1 pH unit compared to only 30% in the 60s succeeding a pH drop. We conclude that, while GOR and obstructive episodes may co-exist in the patient groups studied, decreases in pH in the lower oesophagus do not usually induce either central or obstructive apnoea, and vice versa. Of the variables monitored, only gross body movements were temporally associated with pH drops, and usually preceded them.
Key wordsGastro-oesophageal reflux Apnoea Gross body movements Sleep Infants
apparent life-threatening event
transcutaneous oxygen tension
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