Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
J Clin Sleep Med. 2017 Nov 15;13(11):1311-1317. doi: 10.5664/jcsm.6804.
Neurocognitive deficits have been shown in school-aged children with sleep apnea. The effect of obstructive sleep apnea (OSA) on the neurodevelopmental outcome of preterm infants is unknown.
A retrospective chart review was performed for all preterm infants (< 37 weeks) who had neonatal polysomnography (PSG) and completed neurodevelopmental assessment with the Bayley Scales of Infant and Toddler Development, 3rd Edition, between 2006 to 2015 at Riley Hospital. Exclusion criteria included grade IV intraventricular hemorrhage, tracheostomy, cyanotic heart disease, severe retinopathy of prematurity, craniofacial anomalies, or central and mixed apnea on PSG. Sleep apnea was defined as an apnea-hypopnea index (AHI) > 1 event/h. Regression analyses were performed to find a relationship between PSG parameters and cognitive, language, and motor scores.
Fifteen patients (males: n = 10) were eligible for the study. Median postmenstrual age at the time of the PSG was 41 weeks (37-46). Median AHI for the cohort was 17.4 events/h (2.2-41.3). Median cognitive, language, and motor scores were 90 (65-125), 89 (65-121), and 91 (61-112), respectively. Mean end-tidal CO (median 47 mm Hg [25-60]) negatively correlated with cognitive scores ( = .01) but did not significantly correlate with language or motor scores. AHI was not associated with cognitive, language, or motor scores.
The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO, independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA.
A commentary on this article appears in this issue on page 1233.
有研究表明，睡眠呼吸暂停的学龄儿童存在神经认知缺陷。阻塞性睡眠呼吸暂停（OSA）对早产儿神经发育结局的影响尚不清楚。
对 2006 年至 2015 年期间在莱利医院接受过新生儿多导睡眠图（PSG）检查并完成了贝利婴幼儿发育量表第 3 版神经发育评估的所有（<37 周）早产儿进行了回顾性图表审查。排除标准包括 IV 级脑室内出血、气管造口术、紫绀型心脏病、严重早产儿视网膜病变、颅面畸形或 PSG 上的中枢性和混合性呼吸暂停。睡眠呼吸暂停定义为呼吸暂停-低通气指数（AHI）>1 次/小时。进行回归分析以发现 PSG 参数与认知、语言和运动评分之间的关系。
15 名患者（男性：n=10）符合研究条件。PSG 时的中位校正胎龄为 41 周（37-46）。该队列的中位 AHI 为 17.4 次/小时（2.2-41.3）。中位认知、语言和运动评分分别为 90（65-125）、89（65-121）和 91（61-112）。呼气末 CO 均值（中位数 47mmHg[25-60]）与认知评分呈负相关（r=0.01），但与语言或运动评分无显著相关性。AHI 与认知、语言或运动评分无关。
患有新生儿 OSA 的早产儿的认知、语言和运动评分的中位数均在公布的正常范围内的一个标准差内。独立于 AHI 的呼气末 CO 均值可能成为预测患有新生儿 OSA 的早产儿认知结局不良的生物标志物。
本文的一篇评论文章见本期第 1233 页。
