| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
* From the Divisions of Anesthesia and McGill University Health Center Research Institute, McGill University Health Montreal / Montreal Children’s Hospital; and the
Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada.
Address correspondence to: Dr. Karen A. Brown, Division of Pediatric Anesthesia, McGill University Health Center / Montreal Children’s Hospital, 2300 Tupper Street, Rm. C-1118, Montreal, Quebec H3H 1P3, Canada. Phone: 514-412-4400, ext. 22464; Fax: 514-412-4341; E-mail: roula.cacolyris{at}muhc.mcgill.ca
Purpose: Although respiratory inductive plethysmography (RIP) is the method of choice for the assessment of sleep disordered breathing, it has not been applied to the study of infants at risk for postoperative apnea (POA). The purpose of this study was to apply RIP to evaluate breathing in these infants. An additional purpose was to implement, simultaneously, three novel algorithms to detect movement artifact, respiratory pauses, and thoracoabdominal asynchrony, since their combined output both detects respiratory pauses and classifies them as obstructive or central in origin.
Methods: A prospective study design was employed to record the analogue output of RIP, saturation, and finger plethysmography in a convenience sample of infants. The data record underwent a dual analysis: 1) automated detection of respiratory events; and 2) visual coding of the cardiorespiratory data. A novel index, coined pause density, was calculated as the sum of all respiratory pauses.
Results: Twenty infants, whose mean postconceptional ages and weights were 44.47 ± 2.88 weeks and 4.21 ± 0.99 kg, respectively, were recruited. Data recording ranged from four to 24 hr. Ten infants (term = 5) experienced POA: central apnea = 5, mixed obstructive apnea = 6, and two former premature infants experienced both. Twenty-five central apneic events were detected, and the majority followed a sigh. Infants who experienced apnea also had high values of pause density.
Conclusion: Respiratory inductive plethysmography may provide a useful method to evaluate breathing in infants at risk for POA. The study of short respiratory pauses may prove useful in predicting apnea risk.
1 Fisher DM. When is the ex-premature infant no longer at risk for apnea? Anesthesiology 1995; 82: 807–8.[Medline]
2 Galinkin JL, Davis PJ, McGowan FX, et al. A randomized multicenter study of remifentanil compared with halothane in neonates and infants undergoing pyloromyotomy. II. Perioperative breathing patterns in neonates and infants with pyloric stenosis. Anesth Analg 2001; 93: 1387–92.
3 Kurth CD, LeBard SE. Association of postoperative apnea, airway obstruction, and hypoxemia in former premature infants. Anesthesiology 1991; 75: 22–6.[Medline]
4 Malviya S, Swartz J, Lerman J. Are all preterm infants younger than 60 weeks postconceptual age at risk for postanesthetic? Anesthesiology 1993; 78: 1076–81.[Medline]
5 Welborn LG, Rice LJ, Hannallah RS, Broadman LM, Ruttimann UE, Fink R. Postoperative apnea in former preterm infants: prospective comparison of spinal and general anesthesia. Anesthesiology 1990; 72: 838–42.[Medline]
6 Barrington K, Finer N. The natural history of the appearance of apnea of prematurity. Pediatr Res 1991; 29: 372–5.[Medline]
7 Steward DJ. Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiology 1982; 56: 304–6.[Medline]
8 Welborn LG, Ramirez N, Oh TH, et al. Postanesthetic apnea and periodic breathing in infants. Anesthesiology 1986; 65: 658–61.[Medline]
9 Andropoulos DB, Heard MB, Johnson KL, Clarke JT, Rowe RW. Postanesthetic apnea in full-term infants after pyloromyotomy. Anesthesiology 1994; 80: 216–9.[Medline]
10 Cote CJ, Kelly DH. Postoperative apnea in a full-term infant with a demonstrable respiratory pattern abnormality. Anesthesiology 1990; 72: 559–61.[Medline]
11 Anonymous. Cardiorespiratory sleep studies in children. Establishment of normative data and polysomnographic predictors of morbidity. American Thoracic Society. Am J Respir Crit Care Med 1999; 160: 1381–7.
12 Morielli A, Ladan S, Ducharme FM, Brouillette RT. Can sleep and wakefulness be distinguished in children by cardiorespiratory and videotape recordings? Chest 1996; 109: 680–7.[Medline]
13 Ramanathan R, Corwin MJ, Hunt CE, et al. Cardiorespiratory events recorded on home monitors. Comparison of healthy infants with those at increased risk for SIDS. JAMA 2001; 285: 2199–207.
14 Motto AL, Galiana HL, Brown KA, Kearney RE. Automated estimation of the phase between thoracic and abdominal movement signals. IEEE Trans Biomed Eng 2005; 52: 614–21.[Medline]
15 Brown KA, Platt R, Bates JH. Automated analysis of paradoxical ribcage motion during sleep in infants. Pediatr Pulmonol 2002; 33: 38–46.[Medline]
16 Richards JM, Alexander JR, Shinebourne EA, de Swiet M, Wilson AJ, Southall DP. Sequential 22-hour profiles of breathing patterns and heart rate in 110 full-term infants during their first 6 months of life. Pediatrics 1984; 74: 763–77.
17 Ochiai R, Guthrie RD, Motoyama EK. Effects of varying concentrations of halothane on the activity of the genioglossus, intercostals, and diaphragm in cats: an electromyographic study. Anesthesiology 1989; 70: 812–6.[Medline]
18 Hoffstein V, Zamel N, Phillipson EA. Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis 1984; 130: 175–8.[Medline]
19 Horner RL, Liu X, Gill H, Nolan P, Liu H, Sood S. Effects of sleep-wake state on the genioglossus vs. diaphragm muscle response to CO2 in rats. J Appl Physiol 2002; 92: 878–87.
20 Eastwood PR, Szollosi I, Platt PR, Hillman DR. Collapsibility of the upper airway during anesthesia with isoflurane. Anesthesiology 2002; 97: 786–93.[Medline]
21 Ward SL, Marcus CL. Obstructive sleep apnea in infants and young children. J Clin Neurophysiol 1996; 13: 198–207.[Medline]
22 McNamara F, Sullivan CE. Obstructive sleep apnea in infants: relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea. J Pediatr 2000; 136: 318– 23.[Medline]
23 Hoch B, Bernhard M, Hinsch A. Different patterns of sighs in neonates and young infants. Biol Neonate 1998; 74: 16–21.[Medline]
24 Hoppenbrouwers T, Hodgman JE, Arakawa K, et al. Sleep apnea as part of a sequence of events: a comparison of three months old infants at low and increased risk for sudden infant death syndrome (SIDS). Neuropadiatrie 1978; 9: 320–37.[Medline]
25 Knill RL, Gelb AW. Ventilatory responses to hypoxia and hypercapnia during halothane sedation and anesthesia in man. Anesthesiology 1978; 49: 244–51.[Medline]
26 Khoo MC, Marmarelis VZ. Estimation of peripheral chemoreflex gain from spontaneous sigh responses. Ann Biomed Eng 1989; 17: 557–70.[Medline]
27 Fleming PJ, Goncalves AL, Levine MR, Woollard S. The development of stability of respiration in human infants: changes in ventilatory responses to spontaneous sighs. J Physiol 1984; 347: 1–16.
28 Cross KW, Klaus M, Tooley WH, Weisser K. The response of the new-born baby to inflation of the lungs. J Physiol 1960; 151: 551–65.
29 Rabbette PS, Stocks J. Influence of volume dependency and timing of airway occlusions on the Hering-Breuer reflex in infants. J Appl Physiol 1998; 85: 2033–9.
30 Rabbette PS, Fletcher ME, Dezateux CA, Soriano-Brucher H, Stocks J. Hering-Breuer reflex and respiratory system compliance in the first year of life: a longitudinal study. J Appl Physiol 1994; 76: 650–6.
31 Rabbette PS, Costeloe KL, Stocks J. Persistence of the Hering-Breuer reflex beyond the neonatal period. J Appl Physiol 1991; 71: 474–80.
32 Iscoe S. Pulmonary stretch receptor discharge patterns in eupnea, hypercapnia, and hypoxia. J Appl Physiol 1982; 53: 346–54.
33 Brown K, Stocks J, Aun C, Rabbette PS. The Hering-Breuer reflex in anesthetized infants: end-inspiratory vs. end-expiratory occlusion technique. J Appl Physiol 1998; 84: 1437–46.
34 Sackner MA, Watson H, Belsito AS, et al. Calibration of respiratory inductive plethysmograph during natural breathing. J Appl Physiol 1989; 66: 410–20.
35 Adams JA, Zabaleta IA, Stroh D, Johnson P, Sackner MA. Tidal volume measurements in newborns using respiratory inductive plethysmography. Am Rev Respir Dis 1993; 148: 585–8.[Medline]
36 Brown K, Aun C, Jackson E, Mackersie A, Hatch D, Stocks J. Validation of respiratory inductive plethysmography using the qualitative diagnostic calibration method in anaesthetized infants. Eur Respir J 1998; 12: 935–43.[Abstract]
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
