Sleep-disordered breathing symptoms and their association with structural and functional pulmonary changes in children born extremely preterm

• Published in: European journal of pediatrics 2023-01, Vol.182 (1), p.155-163
• Main Authors: Griffiths, Victoria, Blinder, Henrietta, Hayawi, Lamia, Barrowman, Nicholas, Luu, Thuy Mai, Moraes, Theo J., Parraga, Grace, Santyr, Giles, Thébaud, Bernard, Nuyt, Anne-Monique, Katz, Sherri L.
• Format: Article
• Language: English
• Subjects: Airway management; Bronchopulmonary Dysplasia - complications; Bronchopulmonary Dysplasia - diagnosis; Bronchopulmonary Dysplasia - epidemiology; Child; Children; Cross-Sectional Studies; Daytime; Disorders of Excessive Somnolence; Dysplasia; Exercise; Gestational age; Hemorrhage; Humans; Hyperactivity; Infant, Extremely Premature; Infant, Newborn; Lung - diagnostic imaging; Lung diseases; Magnetic resonance imaging; Medicine; Medicine & Public Health; Pediatrics; Physical activity; Questionnaires; Respiration; Respiratory function; Sleep and wakefulness; Sleep Apnea Syndromes - complications; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - epidemiology; Sleep disorders; Structure-function relationships
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-022-04651-0

This study aimed to evaluate symptoms of sleep-disordered breathing (SDB) among children born extremely preterm, with and without a history of bronchopulmonary dysplasia (BPD), including associations between sleep and respiratory symptoms, physical activity, pulmonary function, and pulmonary magnetic resonance imaging (MRI). This multi-center cross-sectional study enrolled children aged 7–9 years born extremely preterm with and without BPD. Participants completed the Pediatric Sleep Questionnaire (PSQ), the modified Epworth sleepiness scale, a respiratory symptom questionnaire, pedometer measurements, pulmonary function testing, and pulmonary MRI. Spearman’s correlations and univariate and multivariable linear regression modelling were performed. Twenty-eight of 45 children included had a history of moderate-to-severe BPD. The prevalence of sleep-related symptoms was low, with the exception of hyperactivity and inattention. There were no differences in mean (SD) scores on sleep questionnaires in children with and without BPD (PSQ: 0.21 (0.13) vs 0.16 (0.14), p  = 0.3; modified Epworth: 2.4 (2.4) vs 1.8 (2.8), p  = 0.4). Multiple regression analyses examining difference in sleep scores between groups, adjusting for gestational age and intraventricular hemorrhage, found no statistical difference ( p  > 0.05). Greater daytime sleepiness was moderately correlated with FEV1%-predicted ( r  =  − 0.52); no other moderate-strong associations were identified.   Conclusions : There was no evidence of clinically important differences in sleep symptoms between children with and without BPD, suggesting that sleep symptoms may be related to prematurity-related factors other than a BPD diagnosis, including airflow limitation. Further research is necessary to explore the relationship between sleep symptoms, airway obstruction, and neurobehavioral symptoms among premature-born children.   Trial registration : NCT02921308. Date of registration : October 3, 2016. What is Known: •  Presence of bronchopulmonary dysplasia (BPD) may further contribute to the development of SDB, though its impact is not well-studied. •  Premature-born children have a greater risk of lung structural and functional differences, including sleep-disordered breathing (SDB). What is New: •  There was no difference in sleep symptoms between children with and without BPD, suggesting that sleep symptoms are related to other prematurity-related factors, such as airflow limitation. •  Greater daytime sleepi