Abstract Introduction Sleep disordered breathing (SDB) is common among infants in the neonatal intensive care unit (NICU). Airway immaturity, respiratory control instability, craniofacial anomalies, neurologic disorders, increased time in REM sleep and prematurity may contribute to its pathophysiology. The natural progression of SDB including obstructive sleep apnea and central sleep apnea across in NICU infants remains undefined. This study aims to describe the longitudinal course of SDB in this population. Methods This was a retrospective study in NICU patients from 2005-2025 who had ≥ 2 polysomnograms (PSGs) within the first 24 months of life. The median and IQ range were calculated for AHI, obstructive AHI (OAHI), central apnea index (CAI), REM% and NREM% across four age groups: 0-3, 3-6, 6-12 and 12 months. Longitudinal changes in SDB indices over age were modeled using generalized linear mixed model with random intercept. Results A total of 930 infants with corresponding 2690 PSGs met the criteria for analysis. Of these infants, 57.9% (n=539) were male; mean gestational age 36.4±3.7 weeks and mean birthweight 2.76±0.88 kg. Comorbidities included genetic syndromes and craniofacial abnormalities (n=355), airway abnormalities (n=388), neuromuscular or neurological (n=136), cardiopulmonary conditions (n=296). The median AHI significantly decreased with increasing age (35 0-3 months vs 18.4 3-6 months vs 13.5 6-12 months vs 11.2 12 months; P 0.001]. Similarly, the median OAHI significantly declined with increasing age (28.5 0- 3 months vs 14.7 3-6 months vs 8.6 6-12 months vs 6.8 12months; P 0.001). The median CAI decreased between 0-3 and 3-6 months (P 0.003) with no further changes afterwards. Increasing age was associated with decreasing REM (P 0.001) and corresponding increasing NREM (P 0.001). Conclusion In this large cohort of former NICU infants, SDB severity decreased with age with a consistent reduction in AHI and OAHI in the first 2 years and a decrease in CAI in the first 6 months. Expected maturation changes of REM and NREM were noted in this cohort. Developmental changes of central respiratory control and airway growth may contribute to trajectory changes of SDB in this population. Support (if any) Cincinnati Children’s Research Foundation
Larrain et al. (Fri,) studied this question.