Download PDF
Am J Perinatol 2022; 39(08): 853-860
DOI: 10.1055/s-0040-1718948
Original Article

What Are the Factors Affecting Total Sleep Time During Video Polysomnography in Infants?

Grace R. Paul 
1   Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, Columbus, Ohio
,
Don Hayes Jr.
2   Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Dmitry Tumin
3   Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
,
Ish Gulati
4   Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
,
Sudarshan Jadcherla
4   Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
,
Mark L. Splaingard
1   Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, Columbus, Ohio
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective The aim of the study is to investigate factors affecting total sleep time (TST) during infant polysomnography (PSG) and assess if <4 hours of TST is sufficient for accurate interpretation.

Study Design Overall, 242 PSGs performed in 194 infants <6 months of chronological age between March 2013 and December 2015 were reviewed to identify factors that affect TST, including age of infant, location and timing of study, presence of medical complexity, and presence of nasal tubes. A continuum of apnea-hypopnea index (AHI) in relation to TST was reviewed. Data were examined in infants who had TST <4 hours and low AHI.

Results Greater TST (p < 0.001) was noted among infants during nocturnal PSGs, at older chronological and post-menstrual ages, and without medical complexity. The presence of nasogastric/impedance probes reduced TST (p = 0.002). Elevated AHIs were identified even in PSGs with TST <4 hours. Short TST may have affected interpretation and delayed initial management in one infant without any inadvertent complications.

Conclusion Clinical factors such as PMA and medical complexity, and potentially modifiable factors such as time of day and location of study appeared to affect TST during infant PSGs. TST < 4 hours can be sufficient to identify high AHI allowing physician interpretation.

Key Points

  • Less than 4 hours of TST is enough for interpretation of infant polysomnography.

  • Shorter TST appears related to infant age, medical complexity, and higher apnea-hypopnea index.

  • Modifiable factors seen with higher TST were time of day, environment, and presence of nasal tubes.

Keywords

infant - polysomnography - total sleep time - sleep disordered breathing

Authors' Contributions

G.R.P. contributed toward the concept and design, collection of data, data analysis, interpretation of data, manuscript writing, and submission. D.H. worked toward the interpretation of data, critical review, manuscript writing, and approval of the final version as submitted. D.T. interpreted the data, did data analysis, critical review, manuscript writing, and approval of the final version as submitted. I.G. contributed toward the interpretation of data and approval of the final version as submitted. S.J. interpretated the data, did the critical review, manuscript writing, and approval of the final version as submitted. M.L.S. worked on the concept and design, collection of data, interpretation of data, critical review, manuscript writing, and approval of the final version as submitted.




Publication History

Received: 01 May 2020

Accepted: 21 September 2020

Article published online:
27 October 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Shellhaas RA, Burns JW, Hassan F, Carlson MD, Barks JDE, Chervin RD. Neonatal sleep-wake analyses predict 18-month neurodevelopmental outcomes. Sleep (Basel) 2017; 40 (11) zsx144
    PubMedSearch in Google Scholar
  • 2 Kennaway DJ, Stamp GE, Goble FC. Development of melatonin production in infants and the impact of prematurity. J Clin Endocrinol Metab 1992; 75 (02) 367-369
    PubMedSearch in Google Scholar
  • 3 MacLean JE, Fitzgerald DA, Waters KA. Developmental changes in sleep and breathing across infancy and childhood. Paediatr Respir Rev 2015; 16 (04) 276-284
    PubMedSearch in Google Scholar
  • 4 Parmelee Jr AH, Wenner WH, Schulz HR. Infant sleep patterns: from birth to 16 weeks of age. J Pediatr 1964; 65: 576-582
    CrossrefPubMedSearch in Google Scholar
  • 5 Kahn A, Dan B, Groswasser J, Franco P, Sottiaux M. Normal sleep architecture in infants and children. J Clin Neurophysiol 1996; 13 (03) 184-197
    CrossrefPubMedSearch in Google Scholar
  • 6 Hunt CE, Corwin MJ, Weese-Mayer DE. et al; Collaborative Home Infant Monitoring Evaluation (CHIME) Study Group. Longitudinal assessment of hemoglobin oxygen saturation in preterm and term infants in the first six months of life. J Pediatr 2011; 159 (03) 377-383.e1
    CrossrefPubMedSearch in Google Scholar
  • 7 Fleming S, Thompson M, Stevens R. et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 2011; 377 (9770): 1011-1018
    CrossrefPubMedSearch in Google Scholar
  • 8 Abu-Shaweesh JM, Martin RJ. Neonatal apnea: what's new?. Pediatr Pulmonol 2008; 43 (10) 937-944
    CrossrefPubMedSearch in Google Scholar
  • 9 Berry RB, Gamaldo CE, Harding SM. et al. AASM scoring manual version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing. J Clin Sleep Med 2015; 11 (11) 1253-1254
    CrossrefPubMedSearch in Google Scholar
  • 10 DeHaan KL, Seton C, Fitzgerald DA, Waters KA, MacLean JE. Polysomnography for the diagnosis of sleep disordered breathing in children under 2 years of age. Pediatr Pulmonol 2015; 50 (12) 1346-1353
    CrossrefPubMedSearch in Google Scholar
  • 11 Ng DK, Chan CH. A review of normal values of infant sleep polysomnography. Pediatr Neonatol 2013; 54 (02) 82-87
    CrossrefPubMedSearch in Google Scholar
  • 12 Brockmann PE, Poets A, Poets CF. Reference values for respiratory events in overnight polygraphy from infants aged 1 and 3months. Sleep Med 2013; 14 (12) 1323-1327
    CrossrefPubMedSearch in Google Scholar
  • 13 Brockmann PE, Schaefer C, Poets A, Poets CF, Urschitz MS. Diagnosis of obstructive sleep apnea in children: a systematic review. Sleep Med Rev 2013; 17 (05) 331-340
    CrossrefPubMedSearch in Google Scholar
  • 14 Daftary AS, Jalou HE, Shively L, Slaven JE, Davis SD. Polysomnography reference values in healthy newborns. J Clin Sleep Med 2019; 15 (03) 437-443
    CrossrefPubMedSearch in Google Scholar
  • 15 Li AM, Wing YK, Cheung A. et al. Is a 2-night polysomnographic study necessary in childhood sleep-related disordered breathing?. Chest 2004; 126 (05) 1467-1472
    CrossrefPubMedSearch in Google Scholar
  • 16 Berry RB, Budhiraja R, Gottlieb DJ. et al; American Academy of Sleep Medicine, Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the scoring of sleep and associated events. J Clin Sleep Med 2012; 8 (05) 597-619
    CrossrefPubMedSearch in Google Scholar
  • 17 Kahlke PE, Witmans MB, Alabdoulsalam T, Young R, MacLean JE, Mandhane PJ. Full-night versus 4h evening polysomnography in children less than 2years of age. Sleep Med 2013; 14 (02) 177-182
    CrossrefPubMedSearch in Google Scholar
  • 18 Lopp S, Navidi W, Achermann P, LeBourgeois M, Diniz Behn C. Developmental changes in ultradian sleep cycles across early childhood. J Biol Rhythms 2017; 32 (01) 64-74
    CrossrefPubMedSearch in Google Scholar
  • 19 Bueno C, Menna-Barreto L. Development of sleep/wake, activity and temperature rhythms in newborns maintained in a neonatal intensive care unit and the impact of feeding schedules. Infant Behav Dev 2016; 44: 21-28
    CrossrefPubMedSearch in Google Scholar
  • 20 Mirmiran M, Maas YG, Ariagno RL. Development of fetal and neonatal sleep and circadian rhythms. Sleep Med Rev 2003; 7 (04) 321-334
    CrossrefPubMedSearch in Google Scholar
  • 21 Grigg-Damberger MM. The visual scoring of sleep in infants 0 to 2 months of age. J Clin Sleep Med 2016; 12 (03) 429-445
    CrossrefPubMedSearch in Google Scholar
  • 22 Wise MS, Nichols CD, Grigg-Damberger MM. et al. Executive summary of respiratory indications for polysomnography in children: an evidence-based review. Sleep (Basel) 2011; 34 (03) 389-398
    CrossrefPubMedSearch in Google Scholar
  • 23 Cielo CM. Question 3: What are the indications for and challenges in performing polysomnography in infants?. Paediatr Respir Rev 2019; 30: 27-29
    PubMedSearch in Google Scholar
  • 24 Joosten K, de Goederen R, Pijpers A, Allegaert K. Sleep related breathing disorders and indications for polysomnography in preterm infants. Early Hum Dev 2017; 113: 114-119
    CrossrefPubMedSearch in Google Scholar
  • 25 McGrath-Morrow SA, Ryan T, McGinley BM, Okelo SO, Sterni LM, Collaco JM. Polysomnography in preterm infants and children with chronic lung disease. Pediatr Pulmonol 2012; 47 (02) 172-179
    CrossrefPubMedSearch in Google Scholar
  • 26 Qubty WF, Mrelashvili A, Kotagal S, Lloyd RM. Comorbidities in infants with obstructive sleep apnea. J Clin Sleep Med 2014; 10 (11) 1213-1216
    CrossrefPubMedSearch in Google Scholar
  • 27 ElMallah M, Bailey E, Trivedi M, Kremer T, Rhein LM. Pediatric obstructive sleep apnea in high-risk populations: clinical implications. Pediatr Ann 2017; 46 (09) e336-e339
    PubMedSearch in Google Scholar
  • 28 Leonardis RL, Robison JG, Otteson TD. Evaluating the management of obstructive sleep apnea in neonates and infants. JAMA Otolaryngol Head Neck Surg 2013; 139 (02) 139-146
    CrossrefPubMedSearch in Google Scholar
  • 29 Martin RJ, Hibbs AM. Diagnosing gastroesophageal reflux in preterm infants. Pediatrics 2006; 118 (02) 793-794
    CrossrefPubMedSearch in Google Scholar
  • 30 Greenfeld M, Tauman R, Sivan Y. The yield of esophageal pH monitoring during polysomnography in infants with sleep-disordered breathing. Clin Pediatr (Phila) 2004; 43 (07) 653-658
    CrossrefPubMedSearch in Google Scholar
  • 31 Qureshi A, Malkar M, Splaingard M, Khuhro A, Jadcherla S. The role of sleep in the modulation of gastroesophageal reflux and symptoms in NICU neonates. Pediatr Neurol 2015; 53 (03) 226-232
    CrossrefPubMedSearch in Google Scholar
  • 32 Di Fiore T. Use of sleep studies in the neonatal intensive care unit. Neonatal Netw 2005; 24 (01) 23-30
    CrossrefPubMedSearch in Google Scholar
  • 33 Levy J, Hassan F, Plegue MA. et al. Impact of hands-on care on infant sleep in the neonatal intensive care unit. Pediatr Pulmonol 2017; 52 (01) 84-90
    CrossrefPubMedSearch in Google Scholar
  • 34 Rioualen S, Bertelle V, Roué JM, Sizun J. How to improve sleep in a neonatal intensive care unit: a systematic review. Early Hum Dev 2017; 115: 1
    CrossrefPubMedSearch in Google Scholar
  • 35 Erondu AI, Orlov NM, Peirce LB. et al. Characterizing pediatric inpatient sleep duration and disruptions. Sleep Med 2019; 57: 87-91
    CrossrefPubMedSearch in Google Scholar
  • 36 Peirce LB, Orlov NM, Erondu AI. et al. Caregiver and staff perceptions of disruptions to pediatric inpatient sleep. J Clin Sleep Med 2018; 14 (11) 1895-1902
    Search in Google Scholar
  • 37 Engle WA. American Academy of Pediatrics Committee on Fetus and Newborn. Age terminology during the perinatal period. Pediatrics 2004; 114 (05) 1362-1364
    CrossrefPubMedSearch in Google Scholar
  • 38 Poets CF. Intermittent hypoxia and long-term neurological outcome: how are they related?. Semin Fetal Neonatal Med 2020; 25 (02) 101072
    CrossrefPubMedSearch in Google Scholar
  • 39 Khansa I, Hall C, Madhoun LL. et al. Airway and feeding outcomes of mandibular distraction, tongue-lip adhesion, and conservative management in Pierre Robin sequence: a prospective study. Plast Reconstr Surg 2017; 139 (04) 975e-983e
    CrossrefPubMedSearch in Google Scholar
  • 40 Kushida CA, Chediak A, Berry RB. et al; Positive Airway Pressure Titration Task Force, American Academy of Sleep Medicine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008; 4 (02) 157-171
    CrossrefPubMedSearch in Google Scholar