Polysomnography in preterm infants and children with chronic lung disease

Objective To determine the utility of overnight polysomnography (PSG) in assessing pulmonary reserve in stable preterm children with chronic lung disease (CLD). Study design A retrospective review and descriptive study of overnight PSGs and clinic visits of preterm infants/children less than 3 years of age who were diagnosed with bronchopulmonary dysplasia at discharge from the hospital and enrolled in the Johns Hopkins CLD patient registry between 2008 and 2010. Results Sixty-two clinically stable patients underwent at least one overnight polysomnogram for clinical indications. The majority of patients were referred for oxygen titration (71%). PSGs from first studies revealed a mean respiratory disturbance index (RDI) of 8.2±10.1 events/hr and a mean O ₂ saturation (SaO ₂) nadir of 86.2±5.7%. In patients who underwent more than one PSG (n=23), a significant decrease in RDI (P<0.001) was found between the first study (mean age: 8.0±3.3 months) and second study (mean age: 13.4±5.2 months). Outpatient clinical measures of mean room air SaO ₂ and respiratory rate were not predictive of PSG measures of RDI and SaO ₂ nadir. Conclusion Mean RDI was higher in stable preterm infants/children with CLD compared to previously published controls. RDI decreased with age in stable preterm infants/children with CLD suggesting improved pulmonary reserve with age. Outpatient clinical measures (respiratory rate and room air SaO ₂) did not correlate with RDI and SaO ₂ nadir indicating that overnight PSG is more sensitive in assessing pulmonary reserve than outpatient clinical measures.