The role of central sleep apnea in assessing infants with apparent life-threatening event

Abstract

Introduction Apparent life-threatening event (ALTE) is not a specific diagnosis characterized by a combination of central or obstructive apnea, color change, marked change in muscle tone and choking or gagging; which frightens and requires an interventions from the observer. Gastroesophageal reflux, metabolic abnormalities, arrhythmia and seizures must be studied as a possible underlying condition that explains the ALTE. The aim of this study is to show our experience with video-polysomnography (VPSG) in children with ALTE. Materials and methods Descriptive study, enrolling all children with ALTE attended at our hospital during the last 4 years. A complete study was performed including VPSG. Results 27 children were hospitalized from 5 days to 23 months of age. They presented medical history of: premature birth (7), gastroesophageal reflux (1), and idiopathic hypercalcemia (1), malformative syndrome (2), apnea of prematurity (1), and previous ALTE (1). The cardiological study showed patent foramen ovale in 13 patients, with normal cardiological study in the rest of children. In 10 infants (37%) gastroesophageal reflux was confirmed by upper gastrointestinal series, none of them had regurgitation previous history; they received treatment with domperidone and ranitidine. In 20 patients the brain neuroimaging had not significant abnormalities. VPSG was performed in 25 patients, with apnea-hypoapnea index (AHI) altered in 21 (84%) cases (AHI:1,2 −70). All patients suffered predominantly central apneas in REM sleep associated with oxygen desaturation. These were not any cases of obstructive apnea or EEG alteration. 19 cases received treatment with caffeine citrate and 21 required home monitor, which was retired when they normalized VPSG. In evolution, all children improved AHI, except 3 cases that developed a transitory deterioration with eventual normal studies. Conclusion The VPSG is a useful method for assessing the characteristic, frequency and evolution of infant apnea with ALTE. In our series, central sleep apnea was the main cause of ALTE, probably related with a neuro-madurative process. This technique allows the detection of cardio-respiratory events, pathological disturbance in sleep architecture and abnormal EEG paroxysm. We consider that VPSG must be included in the routine etiological study of ALTE. Acknowledgement Dres. Quintana, Saez, Paradinas, Lorenzo y Morillo.