Evolución clínica y de laboratorio en lactantes con inmadurez del centro respiratorio que presentan episodios de apnea
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Rev. bol. ped.
Abstract
Los episodios de pausas respiratorias y de respiración periódica son normales en los lactantes, conformando un patrón de sueño normal con el crecimiento. Objetivo: evaluar un grupo de lactantes con sospecha de apnea, en quienes se encontraron, mediante polisomnografía (PSG1), evidencias de inmadurez del centro respiratorio, indicándose educación en reanimación cardiopulmonar, monitor cardiorespiratorio (MCRP) y control de polisomnografía (PSG2). Pacientes y métodos: se incluyeron 34 lactantes entre mayo 1997 y mayo 2001. Apnea fue definida como la ausencia de respiración por 20 segundos (central) y 10 segundos (obstructiva y mixta); pausas respiratorias como ausencia de respiración > 6 < 20 seg (central) y > 6 < 10 seg (obstructiva). Resultado: en todos se incluyó MCRP y se realizó un estudio inicial (PSG1) y final (PSG2); se evaluó las características de la PSG1 y se compara la evolución entre los 2 estudios. La muestra incluyó 22 hombres (65%), la edad promedio de la serie fue de 2,7 ± 2,3 meses (x ± DS), rango 0,3-9 meses. Los diagnósticos de referencia fueron apnea: (n = 27), RGE (n = 2) y cianosis (n = 4). Los eventos respiratorios promedio mostraron un índice total de pausas respiratorias de 14,1/hora, con predominio de centrales, y un porcentaje de respiración periódica de 4,5%. El examen fue anormal en 32 casos por presentar desaturación arterial (n = 23), apneas (n = 8), pausas centrales (n = 19), obstructivas (n = 9) y RGE patológico (n = 5). En relación al segundo examen (PSG2), la edad promedio fue de 11,5 ± 4,5 meses. Al comparar PSG1 vs PSG2, hubo diferencias significativas en índice total de pausas (p < 0,01), pausas centrales (p < 0,05) y respiración periódica (p < 0,05). Conclusión: la mayoría de los pacientes con inmadurez del centro respiratorio normalizan sus parámetros al año de vida, y que en éstos, un adecuado uso del monitor cardio-respiratorio es de utilidad.
Episodes of central pauses and periodic breathing are normal in infants and decrease with age and growth. Objective: to evaluate a group of infants that had a polysomnography (PSG) performed due to an episode of apnoea, with elevated immature sleep characteristics and who required home cardiorespiratory monitoring (HCRM) and further control PSGs. Methods: 34 patients, 22 (65%) were male, mean age 27 ± 2 months (PSG1), range 0,3-9 years, were studied between May 1997 and May 2001. Along with the first PSG (PSG1) a second was performed (PSG2) prior to the suspension of HCRM. Apnoea was defined as the absence of respiration for more than 20 sec (central) or more than 10 sec (obstructive and mixed); respiratory pauses as the absence of respiration for more than 6 sec and less than 20 sec (central) or more than 6 sec and less than 10 sec (obstructive). Results: the main indications for PSG were apnoea (27 pts), cyanosis (4 pts) and gastro-oesophageal reflux (GER)in 2. Respiratory events showed mean respiratory pauses of 14.1/hr, mostly central and periodic breathing during 4,5% of the total sleep time (TST). PSG1 was abnormal in 32 cases, with desaturation in 23, apnoea in 8, central pauses in 19, obstructive pauses in 9 and GER in 5. PSG2 was performed at a mean age of 11,5 ± 4 months, range 6-24 months. The comparision of PSG1 vs PSG2 showed significant differences in the total respiratory index (p < 0.01), central pauses (p < 0.05) and periodic breathing (p < 0.05), being always lower in the PSG2. Conclusion: the majority of patients with episodes of apnoea and immature sleep patterns normalized their sleep pattern in the first year of life. In this group the correct use of HCRM is indicated.
Episodes of central pauses and periodic breathing are normal in infants and decrease with age and growth. Objective: to evaluate a group of infants that had a polysomnography (PSG) performed due to an episode of apnoea, with elevated immature sleep characteristics and who required home cardiorespiratory monitoring (HCRM) and further control PSGs. Methods: 34 patients, 22 (65%) were male, mean age 27 ± 2 months (PSG1), range 0,3-9 years, were studied between May 1997 and May 2001. Along with the first PSG (PSG1) a second was performed (PSG2) prior to the suspension of HCRM. Apnoea was defined as the absence of respiration for more than 20 sec (central) or more than 10 sec (obstructive and mixed); respiratory pauses as the absence of respiration for more than 6 sec and less than 20 sec (central) or more than 6 sec and less than 10 sec (obstructive). Results: the main indications for PSG were apnoea (27 pts), cyanosis (4 pts) and gastro-oesophageal reflux (GER)in 2. Respiratory events showed mean respiratory pauses of 14.1/hr, mostly central and periodic breathing during 4,5% of the total sleep time (TST). PSG1 was abnormal in 32 cases, with desaturation in 23, apnoea in 8, central pauses in 19, obstructive pauses in 9 and GER in 5. PSG2 was performed at a mean age of 11,5 ± 4 months, range 6-24 months. The comparision of PSG1 vs PSG2 showed significant differences in the total respiratory index (p < 0.01), central pauses (p < 0.05) and periodic breathing (p < 0.05), being always lower in the PSG2. Conclusion: the majority of patients with episodes of apnoea and immature sleep patterns normalized their sleep pattern in the first year of life. In this group the correct use of HCRM is indicated.
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Vol. 45, No. 2