Department of Pediatrics, Division of Pediatric Pulmonology, Children's Hospital Los Angeles, Los Angeles, California.
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Loma Linda University Medical Center, Loma Linda, California.
Pediatr Pulmonol. 2020 Jun;55(6):1495-1502. doi: 10.1002/ppul.24770. Epub 2020 Apr 14.
To date there are limited data in the literature to guide the initial evaluation for etiologies of apnea in full-term infants born at greater than or equal to 37 weeks conceptional age (apnea of infancy [AOI]). Pediatricians and pediatric pulmonologists are left to pursue a broad, rather than targeted and a stepwise approach to begin diagnostic evaluation.
We performed a retrospective chart review of 101 symptomatic full-term infants (age under 12 months) diagnosed with apnea with an inpatient multichannel pneumogram (six channels) or a fully attended overnight pediatric polysomnogram in our outpatient sleep center accredited by American Academy of Sleep Medicine (AASM), scored using the standards set forth by the AASM. The infant was diagnosed as having AOI if the apnea hypopnea index (AHI) was greater than 1 (AHI is defined as the number of apnea and hypopnea events per hour of sleep). The final diagnosis/etiology was determined based on physician clinical assessment and work up. We then determined the frequency for each diagnosis.
We found that the three most common etiologies were gastroesophageal reflux disease (GERD) (48/101), upper airway abnormalities/obstruction (37/101), and neurological diseases (19/101). There were significant numbers of infants with multiple etiologies for AOI.
Based on the frequencies obtained, pediatric practitioners caring for full-term infants with apnea of unknown etiology are advised to begin with evaluation of more likely causes such as GERD and upper airway abnormalities/obstruction before evaluating for less common causes.
迄今为止，文献中仅有有限的数据可用于指导胎龄大于或等于 37 周的足月儿（婴儿呼吸暂停[AOI]）的病因初始评估。儿科医生和儿科肺科医生只能采用广泛而非针对性和逐步的方法来开始诊断评估。
我们对 101 例有症状的足月儿（年龄在 12 个月以下）进行了回顾性图表审查，这些婴儿被诊断为伴有住院多导睡眠图（6 个通道）或在我们的经美国睡眠医学学会（AASM）认证的门诊睡眠中心进行的全夜小儿多导睡眠图的呼吸暂停，使用 AASM 规定的标准进行评分。如果呼吸暂停低通气指数（AHI）大于 1（AHI 定义为每小时睡眠中呼吸暂停和低通气事件的次数），则婴儿被诊断为 AOI。最终诊断/病因是基于医生的临床评估和检查确定的。然后，我们确定了每种诊断的频率。
我们发现最常见的三种病因是胃食管反流病（GERD）（48/101）、上呼吸道异常/阻塞（37/101）和神经系统疾病（19/101）。有相当数量的婴儿有多种 AOI 病因。
根据获得的频率，建议为不明原因呼吸暂停的足月婴儿提供治疗的儿科医生，在评估不太常见的病因之前，应首先评估更可能的病因，如 GERD 和上呼吸道异常/阻塞。
