Hoppenbrouwers T, Hodgman J E, Cabal L
Department of Pediatrics, University of Southern California School of Medicine, Los Angeles.
Pediatr Pulmonol. 1993 Jan;15(1):1-12. doi: 10.1002/ppul.1950150102.
Repetitive polysomnograms were recorded between 40 weeks post-conceptional age and 6 months in a total of 49 infants, 19 healthy preterm infants, 14 normal term infants, and 16 subsequent siblings of infants who died of sudden infant death syndrome (SIDS). These nighttime recordings lasted 2-4 hours, except at 3 months when an overnight 12-hour recording was performed. Obstructive apneas (OA) > 3 seconds were divided into 3 categories: 1) clear obstructive, 2) mixed and 3) unclear because of movement artifacts. More than half belonged in category 3 and were excluded from further analysis unless accompanied by a transient episode of bradycardia (TEB), defined as heart rate < or = 100 beats per minute. Each OA with TEB was also examined for changes in transcutaneous oxygen tension (PtcO2). Most pauses were brief (median, 4 seconds), the longest (27 seconds) seen only once in the youngest premature infant. The majority of OA were accompanied by heart rate accelerations. The number of clear obstructive and mixed apneas was similar. The scores were combined to calculate a density (number per 100 minutes of recording). OA were not common: Their density decreased from 2 in 100 minutes at 40 weeks in the preterm to once every 300 minutes (5 hours) in the 6-month-old term infant. Ten percent of the OA were accompanied by TEB. Of these, 10% were accompanied by a PtcO2 decrease of > 10 mm Hg. OA with TEB followed a nonmonotonic curve, the highest percentage of infants showing this pattern at the age of highest risk for SIDS. Minor differences among study groups were confined to less movements with OA in subsequent siblings and an earlier peak incidence of OA with TEB in prematures, compared to normal term infants. OA were seen in all study groups, were self-limited, and apparently were devoid of pathological consequences.
对49名婴儿在孕龄40周和6个月之间进行了重复多导睡眠图记录，其中包括19名健康早产儿、14名足月正常婴儿以及16名因婴儿猝死综合征（SIDS）死亡婴儿的同胞手足。这些夜间记录持续2 - 4小时，但在3个月时进行了一次为期12小时的通宵记录。持续时间超过3秒的阻塞性呼吸暂停（OA）分为3类：1）明确的阻塞性；2）混合性；3）因运动伪影而不明确。超过一半属于第3类，除非伴有心动过缓短暂发作（TEB）（定义为心率≤100次/分钟），否则将被排除在进一步分析之外。对每例伴有TEB的OA，还检查了经皮氧分压（PtcO2）的变化。大多数呼吸暂停持续时间较短（中位数为4秒），最长的（27秒）仅在最年幼的早产儿中出现过一次。大多数OA伴有心率加快。明确的阻塞性呼吸暂停和混合性呼吸暂停的数量相似。将这些分数合并以计算密度（每100分钟记录中的数量）。OA并不常见：其密度从早产儿40周时每100分钟2次降至6个月大足月婴儿时每300分钟1次（5小时）。10%的OA伴有TEB。其中，10%伴有PtcO2下降>10 mmHg。伴有TEB的OA呈现非单调曲线，在SIDS风险最高的年龄，显示这种模式的婴儿比例最高。与足月正常婴儿相比，研究组之间的微小差异仅限于SIDS死亡婴儿的同胞手足中OA相关的运动较少，以及早产儿中伴有TEB的OA的发病高峰出现得更早。所有研究组中均可见OA，其具有自限性，且显然没有病理后果。
