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PEDIATRICS Vol. 110 No. 5 November 2002, pp. 884-888

Effect of Supplemental Oxygen on Sleep Architecture and Cardiorespiratory Events in Preterm Infants

Narong Simakajornboon, MD^*,, Robert C. Beckerman, MD^*,, Cindy Mack, RPSGT, Denise Sharon, MD, PhD, David Gozal, MD

^* Constance S. Kaufman Pediatric Pulmonary Research Laboratory, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
Comprehensive Sleep Medicine Center, Tulane University Hospital and Clinics, New Orleans, Louisiana
Kosair Children’s Hospital Research Institute and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky

--> Objective. To investigate the effect of low-flow supplemental oxygen (SupOx) on sleep architecture and cardiorespiratory events in asymptomatic preterm infants.

Methods. An overnight polysomnographic evaluation was conducted prospectively in 23 premature infants who were born at 30.0 ± 3.2 (standard deviation) weeks’ gestational age and studied at 38.1 ± 4.4 weeks’ postconceptional age. Infants were free of any adverse events, including cardiorespiratory monitor alarms in the nursery for at least 1 week before the study. Infants received room air (RA) or SupOx via nasal cannula at 0.25 L/min.

Results. Quiet sleep density was increased during SupOx (33.3 ± 10.8% vs 26.6 ± 10.0% total sleep time [TST] in RA), and a reciprocal decrease in active sleep density was observed (61.5 ± 11.1% vs 68.4 ± 9.9% TST in RA). No differences in sleep efficiency emerged (69.7 ± 10.6% SupOx vs 69.7 ± 8.8% RA). SupOx elicited significant decreases in apnea index (3.8 ± 2.4 events/h vs 11.1 ± 6.4 events/h in RA) and in the percentage of time spent in periodic breathing (1.8 ± 2.9% vs 6.7 ± 8.9% in RA). In addition, SupOx decreased the frequency of bradycardic events (0.3 ± 0.8 events vs 2.5 ± 0.03 events in RA) and improved overall oxygen saturation (98.7 ± 1.1% vs 96.4 ± 2.2%). No changes in alveolar ventilation, as derived from end-tidal CO₂ measurements, was detected (38.6 ± 5.8 mm Hg in SupOx vs 38.4 ± 5.4 mm Hg in RA).

Conclusions. Asymptomatic preterm infants exhibit frequent and potentially clinically adverse cardiorespiratory events when assessed in the sleep laboratory. Administration of SupOx to these infants is associated with an increase in the overall duration and percentage TST spent in quiet sleep with reciprocal changes in active sleep. In addition, improvement in respiratory stability is observed with the use of low-flow SupOx, as evidenced by a decrease in apnea, periodic breathing, and bradycardia, without adverse effects on alveolar ventilation.

Key Words: apnea of prematurity • supplemental oxygen • infant sleep • bradycardia • prematurity

Abbreviations: SupOx, supplemental oxygen • CNLD, chronic neonatal lung disease • REM, rapid eye movement • FIO₂, fraction of inspired oxygen • RA, room air • AS, active sleep • QS, quiet sleep • IS, indeterminate sleep • TST, total sleep time • AI, apnea index • ROP, retinopathy of prematurity

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Received for publication Nov 27, 2001; Accepted Apr 3, 2002.

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