Airway closure during mixed apneas in preterm infants: Is respiratory effort necessary?☆,☆☆,★,★★
Section snippets
Subjects
This study consisted of reviewing all apneas in infants who were previously studied in our apnea laboratory located near the intermediate care nursery. These infants were referred to us to clarify their type of apnea and to recommend appropriate management. A total of 33 tracings corresponding to 33 preterm infants (birth weight, 1.4 ± 0.1 kg [mean ± SEM; range, 0.5 to 2.9]; study weight, 1.7 ± 0.1 kg [range, 0.8 to 3.6]; gestational age, 29 ± 1 weeks [range, 24 to 35];
General Observations
Each study lasted for an average of 171 ± 7.2 minutes (range, 132 to 253 minutes).
Apneas
There were 4484 episodes of apnea. Of these, 4241 were central, 45 were “obstructive,” and 198 were mixed according to our new classification. Of these, 20 (10%) were <5 seconds, 78 (39%) were 5 to <10 seconds, 45 (23%) 10 to <15 seconds, 27 (14%) 15 to <20 seconds, and 28 (14%) were ≥20 seconds. The great majority of these apneas (88%) had a central, followed by an obstructive, component. Of the 198 apneas, 151
Discussion
We found that the majority of mixed apneas (76%) are not associated with respiratory efforts, and a few of them (2%) have the respiratory efforts occurring after the occlusion of the airway. Only in 22% of the apneas did the respiratory efforts coincide with the occlusion of the airway. These findings suggest that respiratory efforts are not needed to occlude the airway in mixed apneas and the simultaneous occurrence of respiratory efforts and airway closure may reflect a contributory role for
Acknowledgements
We thank Marie Meunier for assistance in the preparation of this manuscript.
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2021, Computer Methods and Programs in BiomedicineCitation Excerpt :This results in cessation of breathing due to lack of movement of the respiratory muscles in chest and abdomen. Obstructive apneas occur due to airflow obstruction at the pharyngeal level [8,9]. The cause of obstruction can be due to a primary mechanical event, e.g., head and neck positional changes, or neural event, e.g., loss of neural drive to the pharyngeal and laryngeal dilator muscles.
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2015, ChestCitation Excerpt :In addition, postnatal developmental changes in respiratory control may further enhance the stability and robustness of the respiratory system and, thus, prevent or dampen oscillatory behaviors in respiratory patterning (eg, reduced frequency of PB).34,50,51 We should note that although less likely, we cannot exclude the possibility that the progressive attenuation of the respiratory and hypoxemic event frequencies with age could also reflect the well-known acclimatization to high-altitude hypoxia.52,53 To further place our current study within the context of previously published information, we review some salient reports of Spo2 levels in infants at high altitude.
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Inflammation in the carotid body during development and its contribution to apnea of prematurity
2013, Respiratory Physiology and NeurobiologyCitation Excerpt :Central apnea is the total cessation of inspiratory efforts with no evidence of upper airway obstruction. Obstructive apnea is the absence of airflow associated with respiratory movements against a closed larynx or pharynx (Idiong et al., 1998; Miller et al., 1988; Milner et al., 1980; Ruggins and Milner, 1991). Mixed apnea consists of obstructed respiratory efforts, usually following central pauses.
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From the Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba R3E 0L8, Canada.
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Supported by the Children’s Hospital of Winnipeg Research Foundation and The Manitoba Lung Association.
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Reprint requests: Henrique Rigatto, MD, University of Manitoba, Department of Pediatrics, WR125 Women’s Hospital, 735 Notre Dame Ave, Winnipeg, Manitoba, R3E 0L8 Canada.
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0022-3476/98/$5.00 + 0 9/21/92860