Decima Pauline F F, Fyfe Karinna L, Odoi Alexsandria, Wong Flora Y, Horne Rosemary S C
The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia; Laboratoire PériTox, UMR-I 01 INERIS, Faculté de Médecine, Université de Picardie Jules Verne, Amiens, France.
The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
Sleep Med. 2015 Jun;16(6):729-35. doi: 10.1016/j.sleep.2015.02.537. Epub 2015 Mar 14.
Periodic breathing is common in preterm infants, but is thought to be benign. The aim of our study was to assess the incidence and impact of periodic breathing on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI) over the first six months after term-equivalent age.
Twenty-four preterm infants (27-36 weeks gestational age) were studied with daytime polysomnography in quiet sleep (QS) and active sleep (AS) and in both the prone and supine positions at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age. HR, SpO2, and TOI (NIRO-200 spectrophotometer) were recorded. Periodic breathing episodes were defined as greater than or equal to three sequential apneas each lasting ≥3 s.
A total 164 individual episodes of periodic breathing were recorded in 19 infants at 2-4 weeks, 62 in 12 infants at 2-3 months, and 35 in 10 infants at 5-6 months. There was no effect of gestational age on periodic breathing frequency or duration. Falls in HR (-21.9 ± 2.7%) and TOI (-13.1 ± 1.5%) were significantly greater at 2-3 months of age compared to 2-4 weeks of age.
The majority of preterm infants discharged home without clinical respiratory problems had persistent periodic breathing. Although in most infants periodic breathing was not associated with significant falls in SpO2 or TOI, several infants had significant desaturations and reduced cerebral oxygenation especially during AS. The clinical significance of this on neurodevelopmental outcome is unknown and warrants further investigations.
周期性呼吸在早产儿中很常见，但被认为是良性的。我们研究的目的是评估在足月等效年龄后的前六个月内，周期性呼吸对心率（HR）、血氧饱和度（SpO2）和脑组织氧合指数（TOI）的发生率及影响。
对24名早产儿（胎龄27 - 36周）在矫正年龄2 - 4周、2 - 3个月和5 - 6个月时，于安静睡眠（QS）和主动睡眠（AS）状态下，分别在俯卧位和仰卧位进行日间多导睡眠监测。记录HR、SpO2和TOI（NIRO - 200分光光度计）。周期性呼吸发作被定义为连续三次或三次以上呼吸暂停，每次持续≥3秒。
在19名婴儿矫正年龄2 - 4周时共记录到164次周期性呼吸发作，12名婴儿矫正年龄2 - 3个月时记录到62次，10名婴儿矫正年龄5 - 6个月时记录到35次。胎龄对周期性呼吸频率或持续时间没有影响。与矫正年龄2 - 4周相比，矫正年龄2 - 3个月时HR（-21.9±2.7%）和TOI（-13.1±1.5%）的下降幅度显著更大。
大多数无临床呼吸问题出院回家的早产儿存在持续性周期性呼吸。虽然大多数婴儿的周期性呼吸与SpO2或TOI的显著下降无关，但有几名婴儿出现了明显的血氧饱和度降低和脑氧合减少，尤其是在主动睡眠期间。这对神经发育结局的临床意义尚不清楚，值得进一步研究。
