Long Term Developmental Consequences of Short Apneas and Periodic Breathing in Preterm Infants

Abstract

Objective: Preterm infants frequently experience short apneas which can occur in isolation or in a repetitive pattern termed periodic breathing. We assessed the consequences of the amount of time spent with short apneas on developmental outcomes at 2 years of age.

Methods: Preterm infants (N = 23) born between 28 and 32 weeks gestational age were studied during daytime sleep in the supine position at 32-36 weeks post menstrual age (PMA), 36-40 weeks PMA, 3 months and 6 months corrected age. The percentage of total sleep time (TST) spent with apneas at each study was calculated. Infants were divided into those below and above the median cumulative time spent with apneas over the 4 studies (28.4% TST) and developmental assessments (Bayley Scales of Infant Development III, Early Childhood Behavior Questionnaire, Child Behavior Check List) at 2 years of age were compared with ANCOVA.

Results: The above median group tended to have lower unadjusted scores for motor composite, social emotional composite and adaptive behavior composite on the Bayley's. After adjusting for confounders and %TST spent with apneas, the motor composite score was significantly lower in the above median group (p < 0.05). Perceptual Sensitivity was lower in the above median group (p < 0.05).

Conclusions: In clinically stable very preterm infants, who had been discharged home with no concerns of respiratory instability, those infants who spent more time with short apneas, particularly periodic breathing, had reduced motor outcomes at 2 years of age. Our findings add to a growing literature suggesting that short apneas and periodic breathing are not benign.

Keywords: developmental outcomes; periodic breathing; preterm infant; sleep.

Figure 1

Percent total sleep time (TST) spent with all apneas combined at Study 1 (32‐26 weeks PMA), Study 2 (36‐40 weeks PMA), Study 3 (3 months CA) and Study 4 (6 months CA) in the Above and Below median groups.

Figure 2

Raw composite scores for Bayley Scales of Infant Development assessments at 2 years of age in the below and above cumulative median % TST spent with apnea.

Figure 3

Scores adjusted for gestational age at birth, birth weight, sex, SRI, IRSAD and cumulative %TST spent with apnea for Bayley Scales of Infant Development assessments at 2 years of age.

Figure 4

Scores adjusted for gestational age at birth, birth weight, sex, SRI, IRSAD and cumulative %TST spent with apnea for Child Behavior Checklist assessments at 2 years of age.