van Leuteren Ruud W, Arts Lieke A P, Blom Fabio A, de Jongh Frans H, van Kaam Anton H, Hutten G Jeroen
Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Amsterdam Reproduction & Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
BMJ Paediatr Open. 2025 Sep 1;9(1):e003702. doi: 10.1136/bmjpo-2025-003702.
To assess the activity of the diaphragm using electromyography (dEMG) prior and during apnoea-induced intermittent hypoxaemia (IH) events in preterm infants DESIGN: A single-centre observational study.
Neonatal intensive care unit.
Preterm infants (<32 weeks of gestation) experiencing IH events with a frequency of >1/hour METHODS: Heart rate, oxygen saturation (SpO) and dEMG were measured for 24 hours. dEMG data were processed for all IH events resulting in a SpO<80%. Events were scored by two reviewers as central, obstructive or mixed. Subsequently, minimum (dEMG) and maximum (dEMG) diaphragmatic activity were calculated in three time periods (5-1 min prior, 1 min prior and during the desaturation) for each event. The dEMG activity over time was also compared between the different apnoea types.
20 infants (gestational age 27.6±1.3 weeks) were included. A total of 591 IH events were used for analysis of which 88 (14.9%), 239 (40.4%) and 264 (44.7%) were scored as central, obstructive and mixed, respectively. In the 1 min before the actual IH, dEMG and dEMG dropped for central and increased for obstructive events. Central and obstructive events also differed during the actual event (dEMG 6.1 vs 8.4 µV and dEMG 9.4 vs 13.3 µV, both p<0.001 for central vs obstructive events). Mixed events did not show a distinct dEMG pattern.
dEMG can detect and characterise central and obstructive apnoea before the IH event occurs, which supports development of automated detection and classification of apnoea events.
在早产儿呼吸暂停诱发间歇性低氧血症（IH）事件之前及期间，使用肌电图（dEMG）评估膈肌活动。设计：单中心观察性研究。
新生儿重症监护病房。
胎龄<32周且IH事件频率>1次/小时的早产儿。方法：连续24小时测量心率、血氧饱和度（SpO）和dEMG。对所有导致SpO<80%的IH事件的dEMG数据进行处理。两名评估者将事件分为中枢性、阻塞性或混合性。随后，针对每个事件，在三个时间段（低氧血症前5 - 1分钟、前1分钟和低氧血症期间）计算最小（dEMG）和最大（dEMG）膈肌活动。还比较了不同类型呼吸暂停时dEMG活动随时间的变化。
纳入20例婴儿（胎龄27.6±1.3周）。共591次IH事件用于分析，其中88次（14.9%）、239次（40.4%）和264次（44.7%）分别被评为中枢性、阻塞性和混合性。在实际发生IH前1分钟，中枢性事件的dEMG和dEMG下降，阻塞性事件则升高。中枢性和阻塞性事件在实际事件期间也存在差异（dEMG分别为6.1与8.4 μV，dEMG分别为9.4与13.3 μV，中枢性与阻塞性事件比较，两者p<0.001）。混合性事件未表现出明显的dEMG模式。
dEMG可在IH事件发生前检测并区分中枢性和阻塞性呼吸暂停，这有助于呼吸暂停事件自动检测与分类的发展研究。
