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Sleep-disordered breathing symptoms and their association with structural and functional pulmonary changes in children born extremely preterm

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Abstract

This study aimed to evaluate symptoms of sleep-disordered breathing (SDB) among children born extremely preterm, with and without a history of bronchopulmonary dysplasia (BPD), including associations between sleep and respiratory symptoms, physical activity, pulmonary function, and pulmonary magnetic resonance imaging (MRI). This multi-center cross-sectional study enrolled children aged 7–9 years born extremely preterm with and without BPD. Participants completed the Pediatric Sleep Questionnaire (PSQ), the modified Epworth sleepiness scale, a respiratory symptom questionnaire, pedometer measurements, pulmonary function testing, and pulmonary MRI. Spearman’s correlations and univariate and multivariable linear regression modelling were performed. Twenty-eight of 45 children included had a history of moderate-to-severe BPD. The prevalence of sleep-related symptoms was low, with the exception of hyperactivity and inattention. There were no differences in mean (SD) scores on sleep questionnaires in children with and without BPD (PSQ: 0.21 (0.13) vs 0.16 (0.14), p = 0.3; modified Epworth: 2.4 (2.4) vs 1.8 (2.8), p = 0.4). Multiple regression analyses examining difference in sleep scores between groups, adjusting for gestational age and intraventricular hemorrhage, found no statistical difference (p > 0.05). Greater daytime sleepiness was moderately correlated with FEV1%-predicted (r =  − 0.52); no other moderate-strong associations were identified.

  Conclusions: There was no evidence of clinically important differences in sleep symptoms between children with and without BPD, suggesting that sleep symptoms may be related to prematurity-related factors other than a BPD diagnosis, including airflow limitation. Further research is necessary to explore the relationship between sleep symptoms, airway obstruction, and neurobehavioral symptoms among premature-born children.

  Trial registration: NCT02921308. Date of registration: October 3, 2016.

What is Known:

• Presence of bronchopulmonary dysplasia (BPD) may further contribute to the development of SDB, though its impact is not well-studied.

• Premature-born children have a greater risk of lung structural and functional differences, including sleep-disordered breathing (SDB).

What is New:

• There was no difference in sleep symptoms between children with and without BPD, suggesting that sleep symptoms are related to other prematurity-related factors, such as airflow limitation.

• Greater daytime sleepiness was correlated with lower FEV1 in our population, which reflects greater airflow limitation.

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Abbreviations

ADHD:

Attention deficit hyperactivity disorder

BPD:

Bronchopulmonary dysplasia

FEV1:

Forced expiratory volume in 1 s

FRC + 1L:

Functional residual capacity plus 1 L of room air

FVC:

Forced vital capacity

LCI:

Lung clearance index

MRI:

Magnetic resonance imaging

MVPA:

Moderate-to-vigorous physical activity

OSA:

Obstructive sleep apnea

PFT:

Pulmonary function testing

PICTURE:

Pulmonary magnetic resonance imaging of ex-preterm children with and without bronchopulmonary dysplasia to understand risk of emphysematous changes

PSG:

Polysomnography

PSQ:

Pediatric sleep questionnaire

SD:

Standard deviation

SDB:

Sleep-disordered breathing

SRBD:

Sleep-related breathing disorder

TLC:

Total lung capacity

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Acknowledgements

We would like to thank the children and families who participated in this study as well as our entire study team.

Funding

This work was funded by the Ontario Lung Association Grant in Aid Award.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada

    Victoria Griffiths, Bernard Thébaud & Sherri L. Katz

  2. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

    Henrietta Blinder, Lamia Hayawi, Nicholas Barrowman, Bernard Thébaud & Sherri L. Katz

  3. Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada

    Thuy Mai Luu & Anne-Monique Nuyt

  4. Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Theo J. Moraes & Giles Santyr

  5. Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada

    Theo J. Moraes & Giles Santyr

  6. Department of Medical Biophysics, Western University, London, ON, Canada

    Grace Parraga

  7. Robarts Research Institute, London, ON, Canada

    Grace Parraga

  8. Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada

    Giles Santyr

  9. Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Bernard Thébaud

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  1. Victoria Griffiths
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Contributions

This study was conceptualized by Dr. Katz, and designed by Drs. Katz and Barrowman. Recruitment and acquisition of sleep questionnaires, pulmonary function tests, and pedometer data were conducted by Drs. Katz, Luu, Nuyt, Thebaud, Moraes, Tse, and Ben Fadel. Drs. Santyr, Abdeen, and Deschenes contributed to MRI data acquisition and interpretation. Dr. Parraga was responsible for the MRI data analysis and interpretation. Ms. Blinder was the project coordinator and responsible for acquisition and validation of study data. Statistical analysis was performed by Dr. Barrowman and Ms. Hayawi. Dr. Griffiths wrote the initial manuscript draft. All authors contributed to data interpretation and revision of the manuscript, and approved the final version being submitted.

Corresponding author

Correspondence to Sherri L. Katz.

Ethics declarations

Ethics approval

This study was approved by the local ethics board at each participating site (Children’s Hospital of Eastern Ontario Research Ethics Board (REB) #16/31E; The Hospital for Sick Children REB # 1000055745; and Centre hospitalier universitaire Sainte-Justine #2017–1486).

Consent to participate

Written informed consent and/or assent was obtained from all children and their parents included in this study.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Griffiths, V., Blinder, H., Hayawi, L. et al. Sleep-disordered breathing symptoms and their association with structural and functional pulmonary changes in children born extremely preterm. Eur J Pediatr 182, 155–163 (2023). https://doi.org/10.1007/s00431-022-04651-0

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  • DOI: https://doi.org/10.1007/s00431-022-04651-0

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