Polysomnography in Preterm Infants with Bronchopulmonary Dysplasia for Monitoring Sleep-Disordered Breathing and Pulmonary Reserve
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Purpose of Review
Bronchopulmonary dysplasia (BPD) has progressed over time into a syndrome with multifactorial aetiology and complex pathophysiology characterised by a developmental arrest of the alveolar and pulmonary vasculature compartments. BPD remains common in extremely preterm and very low birth weight infants. Maintaining appropriate oxygen blood levels in BPD infants may promote growth, reduce the risk of sudden infant death syndrome, and lower pulmonary artery pressures. There is no agreed approach on how to best titrate and wean home oxygen treatment in BPD infants.
In BPD infants on home oxygen therapy, sleep-disordered breathing is common and appears to be central in origin. However, obstructive apnoea events are also more common in BPD infants. The increased frequency of central apnoea events during sleep in BPD infants has been shown to decline on low-flow oxygen treatment to levels observed in healthy infants. It is hypothesised that brief respiratory pauses in sleep could result in significant oxygen desaturations in BPD infants who have a decreased pulmonary reserve. Those events are scored as central apnoea in polysomnography and are prevented by oxygen treatment. Central apnoea events may also represent disrupted control of breathing secondary to altered chemosensitivity.
Polysomnography may be of clinical value to monitor sleep-disordered breathing, assess pulmonary reserves, and titrate and wean oxygen in BPD infants. Considering the increasing number of extremely preterm and very low birth weight infants with BPD, we recommend prioritising the performance of well-designed studies to gather high-level evidence into the potential role of polysomnography in the management of prematurity- and BPD-associated long-term sequelae.
KeywordsBronchopulmonary dysplasia Sleep apnoea Oxygen treatment Polysomnography in infants Sleep study in infants Pulmonary reserve
Compliance with Ethical Standards
Conflict of Interest
Joerg Mattes, Tanya Gulliver, Jodi Hilton, Adam Collison, and Bruce Whitehead each declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 2.Workshop on bronchopulmonary dysplasia. Sponsored by the division of lung diseases. National Heart, Lung, and Blood Institute, National Institutes of Health. J Pediatr 1979;95(5 Pt 2):1–9, 815–920.Google Scholar
- 7.Bhatt AJ, Pryhuber GS, Huyck H, Watkins RH, Metlay LA, Maniscalco WM. Disrupted pulmonary vasculature and decreased vascular endothelial growth factor, Flt-1, and TIE-2 in human infants dying with bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;164(10 Pt 1):1971–80.CrossRefGoogle Scholar
- 11.Rane S, Bathula S, Thomas RL, Natarajan G. Outcomes of tracheostomy in the neonatal intensive care unit: is there an optimal time? The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet 2014;27(12):1257–1261.Google Scholar
- 14.Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics. 1988;82(4):527–32.Google Scholar
- 18.•• Lodha A, Ediger K, Rabi Y, Lodha S, Tang S, Bhandari A, et al. Does chronic oxygen dependency in preterm infants with bronchopulmonary dysplasia at NICU discharge predict respiratory outcomes at 3 years of age? J Perinatol: official journal of the California Perinatal Association. 2015;35(7):530–6 This study provides follow-up data on respiratory outcomes in 1030 preterm infants and identifies those with BPD on home oxygen at greater risk for chronic lung disease at 3 years of age. CrossRefGoogle Scholar
- 23.Moyer-Mileur LJ, Nielson DW, Pfeffer KD, Witte MK, Chapman DL. Eliminating sleep-associated hypoxemia improves growth in infants with bronchopulmonary dysplasia. Pediatrics. 1996;98(4 Pt 1):779–83.Google Scholar
- 25.Thoracic Society of A, New Z, Fitzgerald DA, Massie RJ, Nixon GM, Jaffe A, et al. Infants with chronic neonatal lung disease: recommendations for the use of home oxygen therapy. Med J Aust. 2008;189(10):578–82.Google Scholar
- 26.•• Hayes D Jr, Wilson KC, Krivchenia K, Hawkins SMM, Balfour-Lynn IM, Gozal D, et al. Home oxygen therapy for children. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019;199(3):e5–e23 This document provides some guidance on the use of home oxygen in infants with BPD.CrossRefGoogle Scholar
- 34.•• Ortiz LE, McGrath-Morrow SA, Sterni LM, Collaco JM. Sleep disordered breathing in bronchopulmonary dysplasia. Pediatr Pulmonol. 2017;52(12):1583–91 This study provides evidence for an increased risk for sleep-disordered breathing in children diagnosed with BPD in infancy at 4 years of age.CrossRefGoogle Scholar
- 39.•• Kulkarni G, de Waal K, Grahame S, Collison A, Roddick L, Hilton J, et al. Polysomnography for the management of oxygen supplementation therapy in infants with chronic lung disease of prematurity. J Matern-Fetal Neonatal Med. 2018:1–7. This study describes polysomnogram indices from 41 infants with BPD and home oxygen studied on room air and supplemental oxygen.Google Scholar