Current Sleep Medicine Reports

, Volume 5, Issue 2, pp 56–60 | Cite as

Polysomnography in Preterm Infants with Bronchopulmonary Dysplasia for Monitoring Sleep-Disordered Breathing and Pulmonary Reserve

  • Joerg MattesEmail author
  • Tanya Gulliver
  • Jodi Hilton
  • Adam Collison
  • Bruce Whitehead
Sleep and Sleep Apnea at the Extremes (D Gozal, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sleep and Sleep Apnea at the Extremes


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.

Recent Findings

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.


Bronchopulmonary 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.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967;276(7):357–68.CrossRefGoogle Scholar
  2. 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
  3. 3.
    Rojas MA, Gonzalez A, Bancalari E, Claure N, Poole C, Silva-Neto G. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr. 1995;126(4):605–10.CrossRefGoogle Scholar
  4. 4.
    Charafeddine L, D’Angio CT, Phelps DL. Atypical chronic lung disease patterns in neonates. Pediatrics. 1999;103(4 Pt 1):759–65.CrossRefGoogle Scholar
  5. 5.
    Husain AN, Siddiqui NH, Stocker JT. Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia. Hum Pathol. 1998;29(7):710–7.CrossRefGoogle Scholar
  6. 6.
    Coalson JJ. Pathology of new bronchopulmonary dysplasia. Semin Neonatol. 2003;8(1):73–81.CrossRefGoogle Scholar
  7. 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
  8. 8.
    Jobe AJ. The new BPD: an arrest of lung development. Pediatr Res. 1999;46(6):641–3.CrossRefGoogle Scholar
  9. 9.
    Day CL, Ryan RM. Bronchopulmonary dysplasia: new becomes old again! Pediatr Res. 2017;81(1–2):210–3.CrossRefGoogle Scholar
  10. 10.
    Guaman MC, Gien J, Baker CD, Zhang H, Austin ED, Collaco JM. Point prevalence, clinical characteristics, and treatment variation for infants with severe bronchopulmonary dysplasia. Am J Perinatol. 2015;32(10):960–7.CrossRefGoogle Scholar
  11. 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
  12. 12.
    Arjaans S, Zwart EAH, Ploegstra MJ, Bos AF, Kooi EMW, Hillege HL, et al. Identification of gaps in the current knowledge on pulmonary hypertension in extremely preterm infants: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2018;32(3):258–67.CrossRefGoogle Scholar
  13. 13.
    Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163(7):1723–9.CrossRefGoogle Scholar
  14. 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
  15. 15.
    Gomez Pomar E, Concina VA, Samide A, Westgate PM, Bada HS. Bronchopulmonary dysplasia: comparison between the two most used diagnostic criteria. Front Pediatr. 2018;6:397.CrossRefGoogle Scholar
  16. 16.
    Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005;116(6):1353–60.CrossRefGoogle Scholar
  17. 17.
    Jeng SF, Hsu CH, Tsao PN, Chou HC, Lee WT, Kao HA, et al. Bronchopulmonary dysplasia predicts adverse developmental and clinical outcomes in very-low-birthweight infants. Dev Med Child Neurol. 2008;50(1):51–7.CrossRefGoogle Scholar
  18. 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
  19. 19.
    Stroustrup A, Trasande L. Epidemiological characteristics and resource use in neonates with bronchopulmonary dysplasia: 1993-2006. Pediatrics. 2010;126(2):291–7.CrossRefGoogle Scholar
  20. 20.
    Johnson TJ, Patel AL, Jegier BJ, Engstrom JL, Meier PP. Cost of morbidities in very low birth weight infants. J Pediatr. 2013;162(2):243–9 e1.CrossRefGoogle Scholar
  21. 21.
    Ellsbury DL, Acarregui MJ, McGuinness GA, Eastman DL, Klein JM. Controversy surrounding the use of home oxygen for premature infants with bronchopulmonary dysplasia. J Perinatol: official journal of the California Perinatal Association. 2004;24(1):36–40.CrossRefGoogle Scholar
  22. 22.
    Fleming PJ, Blair PS. Sudden unexpected deaths after discharge from the neonatal intensive care unit. Semin Neonatol. 2003;8(2):159–67.CrossRefGoogle Scholar
  23. 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
  24. 24.
    Kotecha S, Allen J. Oxygen therapy for infants with chronic lung disease. Arch Dis Child Fetal Neonatal Ed. 2002;87(1):F11–4.CrossRefGoogle Scholar
  25. 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. 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
  27. 27.
    Katz-Salamon M. Delayed chemoreceptor responses in infants with apnoea. Arch Dis Child. 2004;89(3):261–6.CrossRefGoogle Scholar
  28. 28.
    Darnall RA. The role of CO(2) and central chemoreception in the control of breathing in the fetus and the neonate. Respir Physiol Neurobiol. 2010;173(3):201–12.CrossRefGoogle Scholar
  29. 29.
    Joosten K, de Goederen R, Pijpers A, Allegaert K. Sleep related breathing disorders and indications for polysomnography in preterm infants. Early Hum Dev. 2017;113:114–9.CrossRefGoogle Scholar
  30. 30.
    Sharma PB, Baroody F, Gozal D, Lester LA. Obstructive sleep apnea in the formerly preterm infant: an overlooked diagnosis. Front Neurol. 2011;2:73.CrossRefGoogle Scholar
  31. 31.
    Montgomery-Downs HE, Young ME, Ross MA, Polak MJ, Ritchie SK, Lynch SK. Sleep-disordered breathing symptoms frequency and growth among prematurely born infants. Sleep Med. 2010;11(3):263–7.CrossRefGoogle Scholar
  32. 32.
    Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):242–52.CrossRefGoogle Scholar
  33. 33.
    Fajardo C, Alvarez J, Wong A, Kwiatkowski K, Rigatto H. The incidence of obstructive apneas in preterm infants with and without bronchopulmonary dysplasia. Early Hum Dev. 1993;32(2–3):197–206.CrossRefGoogle Scholar
  34. 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
  35. 35.
    Huang YS, Paiva T, Hsu JF, Kuo MC, Guilleminault C. Sleep and breathing in premature infants at 6 months post-natal age. BMC Pediatr. 2014;14:303.CrossRefGoogle Scholar
  36. 36.
    Kahn A, Groswasser J, Sottiaux M, Rebuffat E, Franco P. Mechanisms of obstructive sleep apneas in infants. Biol Neonate. 1994;65(3–4):235–9.CrossRefGoogle Scholar
  37. 37.
    Leiberman A, Tal A, Brama I, Sofer S. Obstructive sleep apnea in young infants. Int J Pediatr Otorhinolaryngol. 1988;16(1):39–44.CrossRefGoogle Scholar
  38. 38.
    McGowan FX, Kenna MA, Fleming JA, O’Connor T. Adenotonsillectomy for upper airway obstruction carries increased risk in children with a history of prematurity. Pediatr Pulmonol. 1992;13(4):222–6.CrossRefGoogle Scholar
  39. 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
  40. 40.
    Sekar KC, Duke JC. Sleep apnea and hypoxemia in recently weaned premature infants with and without bronchopulmonary dysplasia. Pediatr Pulmonol. 1991;10(2):112–6.CrossRefGoogle Scholar
  41. 41.
    •• McGrath-Morrow SA, Ryan T, McGinley BM, Okelo SO, Sterni LM, Collaco JM. Polysomnography in preterm infants and children with chronic lung disease. Pediatr Pulmonol. 2012;47(2):172–9 This study describes polysomnogram indices from 62 infants with BPD.CrossRefGoogle Scholar
  42. 42.
    Sands SA, Edwards BA, Kelly VJ, Davidson MR, Wilkinson MH, Berger PJ. A model analysis of arterial oxygen desaturation during apnea in preterm infants. PLoS Comput Biol. 2009;5(12):e1000588.CrossRefGoogle Scholar
  43. 43.
    Brockmann PE, Poets A, Poets CF. Reference values for respiratory events in overnight polygraphy from infants aged 1 and 3months. Sleep Med. 2013;14(12):1323–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Joerg Mattes
    • 1
    • 2
    Email author
  • Tanya Gulliver
    • 2
  • Jodi Hilton
    • 2
  • Adam Collison
    • 1
  • Bruce Whitehead
    • 2
  1. 1.Priority Research Centre GrowUpWell®, Experimental and Translational Respiratory Medicine Group, School of Medicine and Public HealthUniversity of Newcastle and Hunter Medical Research InstituteNew LambtonAustralia
  2. 2.Paediatric Respiratory and Sleep Medicine DepartmentJohn Hunter Children’s HospitalNewcastleAustralia

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