Caffeine and supplemental oxygen effectively suppress periodic breathing with only minor effects during long episodes of apnoea in preterm infants.

Abstract

We investigated the characteristics and effects of sleep stage, supplemental oxygen and caffeine on periodic breathing (PB) and apnoea of prematurity (AOP) in preterm infants. This 2013-2015 study recruited 21 preterm infants on neonatal wards in the Helsinki and Uusimaa Hospital District, Finland, at a median corrected gestational age of 35.7weeks and performed polysomnography at baseline, during supplemental oxygen and during caffeine treatment. All infants demonstrated PB, during a median of 11% of sleep time and 85% of PB occurred during non-rapid eye movement sleep (NREM). Apnoea episodes were brief during PB, but 66% were associated with oxygen desaturation. Supplemental oxygen substantially reduced PB time by 99% and caffeine by 91%. Oxygen desaturation decreased from 38 per hour at baseline to 8.5 with oxygen and 24 with caffeine (all p<0.001). AOPs decreased from 1.4 per hour at baseline to 0.4 with oxygen (p=0.03) and 0.3 with caffeine (p=0.07). Most (84%) apnoea episodes over 15seconds were mixed episodes during REM sleep. PB occurred predominantly during NREM sleep, caused intermittent hypoxia, and was suppressed by supplemental oxygen and caffeine. In contrast, long apnoea episodes representing AOP were only modestly decreased.