6
AASMMembershipSectionsNewsletter
■
Issue #5
AmericanAcademy
of SleepMedicine
Figure 2
Due to associatedOxygen desaturations, patient was startedon supplimental
Oxygenat 0.51pm. This 10minutePSG fragment shows complete resolution of
periodic breathing.
1.What isPeriodicBreathing?
Breathing instability is common in
newborn infants, and such instability is
characterizedby runs of central apneas
lasting for few seconds. Periodicbreathing is
an expressionof this ontogenyof respiration
and is characterizedby a cyclicpattern in
whichbrief central apneas alternatewith a
small number of normal breaths.
2.Howdoyou scorePeriodicBreathing?
ScorePeriodicBreathing if there are>
(greater than) 3 episodes of central apnea
lasting> (greater than) 3 seconds, separated
bynomore than20 seconds of normal
breathing (2012AASM scoringmanual
version2.0). Central apneas that occur
within a runof periodicbreathing shouldbe
scored as individual apneas (Fig. 1). Please
note that desaturations arenot necessary for
scoringPeriodicBreathing.
3. What is theprevalenceofPeriodic
Breathing?
Premature infants have ahigher
propensity for respiratory instability, and
suchvulnerability improveswith increasing
gestational age and increasingpostnatal
age.Theprevalenceof periodicbreathing
is inversely related togestational age,
with close to100%prevalence in infants
weighing< (less than) 1000grams at birth.
There is age-dependent appearance and
disappearanceof periodbreathing. While
periodicbreathing is rarely seen in thefirst
fewdays after birth, it reaches its peak in the
first fewweeks of life.There is a subsequent
decrease inperiodicbreathingwith
maturity such that it occurs for 3%of total
sleep time at 2months of age and less than
1%of total sleep time at 5months of age.
Figure 1:
Central apneas
11Day old infant with frequent desaturations during sleepwas referred for a
polysomnograph study. This 2minute fragment demonstratesPeriodicBreathing in
quiet (NREM) sleep. Therewere frequent desaturations noted in associationwith
periodic breathing.
PeriodicBreathing–an illustrativeexampleof ontogenyof respiration
Dr.HariBandla,MD,MRCP
