Assessing ventilatory instability using the response to spontaneous sighs during sleep in preterm infants

Bradley A. Edwards, Leonardo Nava-Guerra, James S. Kemp, John L. Carroll, Michael C. Khoo, Scott A. Sands, Philip I. Terrill, Shane A. Landry, Raouf S. Amin

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Study Objectives: Periodic breathing (PB) is common in newborns and is an obvious manifestation of ventilatory control instability. However, many infants without PB may still have important underlying ventilatory control instabilities that go unnoticed using standard clinical monitoring. Methods to detect infants with "subclinical" ventilatory control instability are therefore required. The current study aimed to assess the degree of ventilatory control instability using simple bedside recordings in preterm infants. Methods: Respiratory inductance plethysmography (RIP) recordings were analyzed from ~20 minutes of quiet sleep in 20 preterm infants at 36 weeks post-menstrual age (median [range]: 36 [34-40]). The percentage time spent in PB was also calculated for each infant (%PB). Spontaneous sighs were identified and breath-by-breath measurements of (uncalibrated) ventilation were derived from RIP traces. Loop gain (LG, a measure of ventilatory control instability) was calculated by fitting a simple ventilatory control model (gain, time-constant, delay) to the post-sigh ventilatory pattern. For comparison, periodic inter-breath variability was also quantified using power spectral analysis (ventilatory oscillation magnitude index [VOMI]). Results: %PB was strongly associated with LG (r2 = 0.77, p < 0.001) and moderately with the VOMI (r2 = 0.21, p = 0.047). LG (0.52 ± 0.05 vs. 0.30 ± 0.03; p = 0.0025) and the VOMI (-8.2 ± 1.1 dB vs. -11.8 ± 0.9 dB; p = 0.026) were both significantly higher in infants that displayed PB vs. those without. Conclusions: LG and VOMI determined from the ventilatory responses to spontaneous sighs can provide a practical approach to assessing ventilatory control instability in preterm infants. Such simple techniques may help identify infants at particular risk for ventilatory instabilities with concomitant hypoxemia and its associated consequences.

Original languageEnglish
Article numberzsy161
Number of pages8
JournalSleep
Volume41
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

Keywords

  • breathing control
  • breathing physiology
  • pediatrics-breathing control
  • pediatris-infants
  • periodic breathing
  • loop gain
  • neonates

Cite this

Edwards, B. A., Nava-Guerra, L., Kemp, J. S., Carroll, J. L., Khoo, M. C., Sands, S. A., ... Amin, R. S. (2018). Assessing ventilatory instability using the response to spontaneous sighs during sleep in preterm infants. Sleep, 41(11), [zsy161]. https://doi.org/10.1093/sleep/zsy161
Edwards, Bradley A. ; Nava-Guerra, Leonardo ; Kemp, James S. ; Carroll, John L. ; Khoo, Michael C. ; Sands, Scott A. ; Terrill, Philip I. ; Landry, Shane A. ; Amin, Raouf S. / Assessing ventilatory instability using the response to spontaneous sighs during sleep in preterm infants. In: Sleep. 2018 ; Vol. 41, No. 11.
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title = "Assessing ventilatory instability using the response to spontaneous sighs during sleep in preterm infants",
abstract = "Study Objectives: Periodic breathing (PB) is common in newborns and is an obvious manifestation of ventilatory control instability. However, many infants without PB may still have important underlying ventilatory control instabilities that go unnoticed using standard clinical monitoring. Methods to detect infants with {"}subclinical{"} ventilatory control instability are therefore required. The current study aimed to assess the degree of ventilatory control instability using simple bedside recordings in preterm infants. Methods: Respiratory inductance plethysmography (RIP) recordings were analyzed from ~20 minutes of quiet sleep in 20 preterm infants at 36 weeks post-menstrual age (median [range]: 36 [34-40]). The percentage time spent in PB was also calculated for each infant ({\%}PB). Spontaneous sighs were identified and breath-by-breath measurements of (uncalibrated) ventilation were derived from RIP traces. Loop gain (LG, a measure of ventilatory control instability) was calculated by fitting a simple ventilatory control model (gain, time-constant, delay) to the post-sigh ventilatory pattern. For comparison, periodic inter-breath variability was also quantified using power spectral analysis (ventilatory oscillation magnitude index [VOMI]). Results: {\%}PB was strongly associated with LG (r2 = 0.77, p < 0.001) and moderately with the VOMI (r2 = 0.21, p = 0.047). LG (0.52 ± 0.05 vs. 0.30 ± 0.03; p = 0.0025) and the VOMI (-8.2 ± 1.1 dB vs. -11.8 ± 0.9 dB; p = 0.026) were both significantly higher in infants that displayed PB vs. those without. Conclusions: LG and VOMI determined from the ventilatory responses to spontaneous sighs can provide a practical approach to assessing ventilatory control instability in preterm infants. Such simple techniques may help identify infants at particular risk for ventilatory instabilities with concomitant hypoxemia and its associated consequences.",
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author = "Edwards, {Bradley A.} and Leonardo Nava-Guerra and Kemp, {James S.} and Carroll, {John L.} and Khoo, {Michael C.} and Sands, {Scott A.} and Terrill, {Philip I.} and Landry, {Shane A.} and Amin, {Raouf S.}",
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Edwards, BA, Nava-Guerra, L, Kemp, JS, Carroll, JL, Khoo, MC, Sands, SA, Terrill, PI, Landry, SA & Amin, RS 2018, 'Assessing ventilatory instability using the response to spontaneous sighs during sleep in preterm infants' Sleep, vol. 41, no. 11, zsy161. https://doi.org/10.1093/sleep/zsy161

Assessing ventilatory instability using the response to spontaneous sighs during sleep in preterm infants. / Edwards, Bradley A.; Nava-Guerra, Leonardo; Kemp, James S.; Carroll, John L.; Khoo, Michael C.; Sands, Scott A.; Terrill, Philip I.; Landry, Shane A.; Amin, Raouf S.

In: Sleep, Vol. 41, No. 11, zsy161, 01.11.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Assessing ventilatory instability using the response to spontaneous sighs during sleep in preterm infants

AU - Edwards, Bradley A.

AU - Nava-Guerra, Leonardo

AU - Kemp, James S.

AU - Carroll, John L.

AU - Khoo, Michael C.

AU - Sands, Scott A.

AU - Terrill, Philip I.

AU - Landry, Shane A.

AU - Amin, Raouf S.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Study Objectives: Periodic breathing (PB) is common in newborns and is an obvious manifestation of ventilatory control instability. However, many infants without PB may still have important underlying ventilatory control instabilities that go unnoticed using standard clinical monitoring. Methods to detect infants with "subclinical" ventilatory control instability are therefore required. The current study aimed to assess the degree of ventilatory control instability using simple bedside recordings in preterm infants. Methods: Respiratory inductance plethysmography (RIP) recordings were analyzed from ~20 minutes of quiet sleep in 20 preterm infants at 36 weeks post-menstrual age (median [range]: 36 [34-40]). The percentage time spent in PB was also calculated for each infant (%PB). Spontaneous sighs were identified and breath-by-breath measurements of (uncalibrated) ventilation were derived from RIP traces. Loop gain (LG, a measure of ventilatory control instability) was calculated by fitting a simple ventilatory control model (gain, time-constant, delay) to the post-sigh ventilatory pattern. For comparison, periodic inter-breath variability was also quantified using power spectral analysis (ventilatory oscillation magnitude index [VOMI]). Results: %PB was strongly associated with LG (r2 = 0.77, p < 0.001) and moderately with the VOMI (r2 = 0.21, p = 0.047). LG (0.52 ± 0.05 vs. 0.30 ± 0.03; p = 0.0025) and the VOMI (-8.2 ± 1.1 dB vs. -11.8 ± 0.9 dB; p = 0.026) were both significantly higher in infants that displayed PB vs. those without. Conclusions: LG and VOMI determined from the ventilatory responses to spontaneous sighs can provide a practical approach to assessing ventilatory control instability in preterm infants. Such simple techniques may help identify infants at particular risk for ventilatory instabilities with concomitant hypoxemia and its associated consequences.

AB - Study Objectives: Periodic breathing (PB) is common in newborns and is an obvious manifestation of ventilatory control instability. However, many infants without PB may still have important underlying ventilatory control instabilities that go unnoticed using standard clinical monitoring. Methods to detect infants with "subclinical" ventilatory control instability are therefore required. The current study aimed to assess the degree of ventilatory control instability using simple bedside recordings in preterm infants. Methods: Respiratory inductance plethysmography (RIP) recordings were analyzed from ~20 minutes of quiet sleep in 20 preterm infants at 36 weeks post-menstrual age (median [range]: 36 [34-40]). The percentage time spent in PB was also calculated for each infant (%PB). Spontaneous sighs were identified and breath-by-breath measurements of (uncalibrated) ventilation were derived from RIP traces. Loop gain (LG, a measure of ventilatory control instability) was calculated by fitting a simple ventilatory control model (gain, time-constant, delay) to the post-sigh ventilatory pattern. For comparison, periodic inter-breath variability was also quantified using power spectral analysis (ventilatory oscillation magnitude index [VOMI]). Results: %PB was strongly associated with LG (r2 = 0.77, p < 0.001) and moderately with the VOMI (r2 = 0.21, p = 0.047). LG (0.52 ± 0.05 vs. 0.30 ± 0.03; p = 0.0025) and the VOMI (-8.2 ± 1.1 dB vs. -11.8 ± 0.9 dB; p = 0.026) were both significantly higher in infants that displayed PB vs. those without. Conclusions: LG and VOMI determined from the ventilatory responses to spontaneous sighs can provide a practical approach to assessing ventilatory control instability in preterm infants. Such simple techniques may help identify infants at particular risk for ventilatory instabilities with concomitant hypoxemia and its associated consequences.

KW - breathing control

KW - breathing physiology

KW - pediatrics-breathing control

KW - pediatris-infants

KW - periodic breathing

KW - loop gain

KW - neonates

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