Periodic breathing in neonates. A proposal for differentiation in central and obstructive patterns

Objective: There are some divergent opinions about the pathologic role of periodic breathing (pb) in neonates and infants. As distinguishing feature if there is a pathologic pb with need of therapy, the share of SaO₂(%)-desaturations is used, even if it's uncertain where the nadir (threshold value) of SaO₂(%)-desaturations should be fixed. We could observe that obstructive parts can be found in the periodic breathing and that they are significantly associated with SaO₂(%)-desaturations.

Methods: We compared oxy-cardio-respirographic recordings of neonates with obstructive and central pb-patterns. Reduction of nasale breath (<50%) and paradoxe breath patterns are distinctive marks.

Results: Obstructive pb-patterns showed significantly deeper and proportionely more frequent SaO₂(%)-desaturations. Obstructive pb showed a significant shorter duration of total pb (% total sleeping period), especially after SpO₂(%)-desaturations (arousal). The introduction of the new parameter “area under the curve“ for the evaluation of the SaO₂(%)-distribution over time has turned out as reliable method for a better differentiation of the severeness of SaO₂(%)-desaturations.

Conclusion: The pb can be divided in obstructive and pure central patterns. They differ in severeness of SaO₂(%)-desaturations and consecutive frequency of arousal. Neonates with prolonged obstructive pb should be investigated regarding neurological diseases because this type of pb can be associated with arousal disturbances.

Keywords: periodic breathing, arousal, neonates, obstructive hypopnea