Episodes Of Hypoxemia Research Articles

Positioning for acute respiratory distress in hospitalised infants and children

Because of the association of prone positioning with sudden infant death syndrome (SIDS) it is recommended that young infants be placed on their backs (supine). However, the prone position may be a non-invasive way of increasing oxygenation in participants with acute respiratory distress. Because of substantial differences in respiratory mechanics between adults and children and the risk of SIDS in young infants, a specific review of positioning for infants and young children with acute respiratory distress is warranted. To compare the effects of different body positions in hospitalised infants and children with acute respiratory distress. We searched Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 3), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to April week 1, 2012), EMBASE (2004 to April 2012) and CINAHL (2004 to April 2012). Randomised controlled trials (RCTs) or pseudo-RCTs comparing two or more positions in the management of infants and children hospitalised with acute respiratory distress. Two review authors independently extracted data from each study. We resolved differences by consensus or referral to a third review author. We analysed bivariate outcomes using an odds ratio and 95% confidence interval (CI). We analysed continuous outcomes using a mean difference and 95% CI. We used a fixed-effect model unless heterogeneity was significant, in which case we used a random-effects model. We extracted data from 53 studies. We included 24 studies with a total of 581 participants. Three studies used a parallel-group, randomised design which compared prone and supine positions only. The remaining 21 studies used a randomised cross-over design. These studies compared prone, supine, lateral, elevated and flat positions.Prone positioning was significantly more beneficial than supine positioning in terms of oxygen saturation (mean difference (MD) 1.97%, 95% CI 1.18 to 2.77), arterial oxygen (MD 6.24 mm Hg, 95% confidence interval (CI) 2.20 to 10.28), episodes of hypoxaemia (MD -3.46, 95% CI -4.60 to -2.33) and thoracoabdominal synchrony (MD -30.76, 95% CI -41.39 to -20.14). No adverse effects were identified. There were no statistically significant differences between any other positions.As the majority of studies did not describe how possible biases were addressed, the potential for bias in these findings is unclear. The prone position was significantly superior to the supine position in terms of oxygenation. However, as most participants were ventilated preterm infants, the benefits of prone positioning may be most relevant to these infants. In addition, although placing infants and children in the prone position may improve respiratory function, the association of SIDS with prone positioning means that infants should only be placed in this position while under continuous cardiorespiratory monitoring.

Pediatric hyperbaric oxygen therapy in Victoria, 1998–2010

The aim of this review is to identify clinical conditions currently treated in a pediatric population referred to the Alfred hyperbaric unit, to describe outcomes, and detail any complications occurring during treatment or transfer between units. Retrospective, noncontrolled, clinical study. Adult hyperbaric unit in a university hospital. Children aged <16 yrs referred for hyperbaric oxygen therapy between January 1998 and December 2010. Hyperbaric oxygen therapy at pressures from 2.0 to 3.0 atmospheres absolute. Fifty-four patients with a median age at presentation of 15 yrs (range, 0.25-16 yrs) received 668 treatment sessions (mean, 12.4; 95% confidence interval, 9.2-15.5). Fourteen patients were identified as having successfully completed treatment while managed in intensive care units. There were 44 events in 668 treatments (6.6%) in the pediatric group and 12 events in 126 treatments (9.6%) in the pediatric intensive care unit group. There were two oxygen toxicity convulsion (0.3%), two episodes of progressive hypoxemia (0.3%), and four episodes of brief hypotension (0.6%). Provision of hyperbaric oxygen to children with significant illness is feasible and associated with a low risk of complications. The most difficult aspect of managing pediatric hyperbaric oxygen therapy is in the coordination of the treatment with ongoing surgical and intensive care management. The lack of pediatric staff and facilities in major hyperbaric units necessitates multiple transfers for appropriate treatment.

Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients?

Obstructive sleep apnea syndrome (OSAS) is associated with a variety of long-term consequences such as high rates of morbidity and mortality, due to excessive diurnal somnolence as well as cardiovascular and metabolic diseases. Obesity, recurrent episodes of upper airway obstruction, progressive hypoxemia, and sleep fragmentation during sleep cause neural, cardiovascular, and metabolic changes. These changes include activation of peripheral sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, insulin sensitivity, and inflammatory cytokines alterations, which predispose an individual to vascular damage. Previous studies proposed that OSAS modulated the expression and secretion of inflammatory cytokines from fat and other tissues. Independent of obesity, patients with OSAS exhibited elevated levels of C-reactive protein, tumor necrosis factor-α and interleukin-6, which are associated with sleepiness, fatigue, and the development of a variety of metabolic and cardiovascular diseases. OSAS and obesity are strongly associated with each other and share many common pathways that induce chronic inflammation. Previous studies suggested that the protective effect of exercise may be partially attributed to the anti-inflammatory effect of regular exercise, and this effect was observed in obese patients. Although some studies assessed the effects of physical exercise on objective and subjective sleep parameters, the quality of life, and mood in patients with OSAS, no study has evaluated the effects of this treatment on inflammatory profiles. In this review, we cited some studies that directed our opinion to believe that since OSAS causes increased inflammation and has excessive daytime sleepiness as a symptom and being that physical exercise improves inflammatory profiles and possibly OSAS symptoms, it must be that physical exercise improves excessive daytime sleepiness due to its improvement in inflammatory profiles.

Implications of Resolved Hypoxemia on the Utility of Desaturation Alerts Sent from an Anesthesia Decision Support System to Supervising Anesthesiologists

Hypoxemia (oxygen saturation <90%) lasting 2 or more minutes occurs in 6.8% of adult patients undergoing noncardiac anesthesia in operating room settings. Alarm management functionality can be added to decision support systems (DSS) to send text alerts about vital signs outside specified thresholds, using data in anesthesia information management systems. We considered enhancing our DSS to send hypoxemia alerts to the text pagers of supervising anesthesiologists. As part of a voluntary application for an investigative device exemption from our IRB to implement such functionality, we evaluated the maximum potential utility of such an alert system. Pulse oximetry values (Spo(2)) were extracted from our anesthesia information management systems for all cases performed in our main operating rooms and ambulatory surgical center between September 1, 2011, and February 4, 2012 (n = 16,870). Hypoxemic episodes (Spo(2) < 90%) were characterized as either (a) lasting one or more minutes or (b) lasting 2 or more minutes. A single simulated "alert" was modeled as having been sent at the timestamp of the first (a) or the second (b) hypoxemic value. The hypoxemic episode was considered resolved at 1, 3, or 5 minutes after the time of the alert if the Spo(2) value was no longer below the 90% threshold. Two-sided 99% conservative confidence limits were calculated for the percentage of unresolved alerts at the 3 evaluation intervals and compared with 70%, the lower limit of an acceptable true alarm rate for clinical utility. There was at least 1 hypoxemic episode lasting 1 minute or longer in 23% of cases, and at least 1 episode lasting 2 minutes or longer in 8% of cases. Only 7% (99% confidence interval [CI] 6% to 8%) of the 1-minute hypoxemic episodes were unresolved after 3 minutes, and only 8% (99% CI 6%to 9%) of 2-minute episodes after 5 minutes (both P < 10(-6) in comparison with 70% minimum reliability rate). Low utility should be expected for a DSS sending hypoxemia alerts to supervising anesthesiologists, because nearly all hypoxemic episodes will have been resolved before arrival of the anesthesiologist in the operating room. These results suggest that the principal research focus should be on developing more sophisticated alerts and processes within rooms for the anesthesia care provider to initiate treatment promptly, to interpret or correct artifacts, and to make it easier to call for assistance via a rapid communication system.

Acute hypoxia during propofol-anesthesia, but not during sevoflurane-anesthesia, stimulates macro- and microcirculatory hemodynamics in dogs

Schwarte, L.; Schober, P.; Scheeren, T. W.L.; Schwartges, I.; Picker, O. Author Information

Hypoxia‐induced muscle atrophy involves direct and indirect signaling towards protein turnover regulation

BackgroundAs COPD patients may experience hypoxemic episodes, we hypothesized that subsequent tissue hypoxia is a trigger of COPD‐associated skeletal muscle atrophy.MethodsMice were kept under normoxia or hypoxia. Oxygen levels were reduced stepwise to 8% during 48h, and maintained for 21 days. Food intake was monitored and mice were sacrificed at days 4 and 21. To discern direct and indirect effects of hypoxia, fully differentiated C2C12 myotube cultures were exposed to hypoxia (4% O2).ResultsHypoxia induced hypoxemia, acidosis, erythremia. Gastrocnemius muscle weight decreased, which was only in part attributable to hypophagia. Comparing hypoxia with pair‐fed, expression of ER‐stress markers Atf4 and Gadd34, were increased as a direct effects of hypoxia and at day 4 partially by hypophagia. Protein synthesis was induced evidenced by reduced p‐eIF2α levels and increased mTOR signaling. Foxo‐1 activity and expression were directly induced by hypoxia and at day 4 by hypophagia. Gene expression associated with autophagy and ubiquitin 26S proteasomal degradation was induced and at day 4 partially attributable to hypophagia. As opposed to MuRF1, Atrogin‐1 and LC3B, Bnip3 expression was directly regulated by hypoxia.Conclusion: Hypoxia‐induced muscle atrophy is characterized by signaling suggestive of increased muscle protein turnover.Supported by the Dutch Top Institute Pharma (project # T1‐201).

Novel methods to diagnose obstructive sleep apnea in children

Sleep-disordered breathing encompasses a spectrum of disorders that increase in severity from snoring to obstructive sleep apnea (OSA). OSA is a clinical disorder that requires a polysomnogram (PSG) to make the diagnosis. The PSG is the gold standard to confirm OSA. Alternative diagnostic tests are presented to supplement the clinical evaluation with objective information when evaluating the snoring child. Diagnostic tests to identify the anatomical site of obstruction are also discussed.

A Higher Incidence of Intermittent Hypoxemic Episodes Is Associated with Severe Retinopathy of Prematurity

A Higher Incidence of Intermittent Hypoxemic Episodes Is Associated with Severe Retinopathy of Prematurity

A New Bottle Design Decreases Hypoxemic Episodes during Feeding in Preterm Infants

Oxygen saturation is lower during bottle feeding than during breastfeeding in preterm infants. Our objective was to compare two different bottle systems in healthy preterm infants before discharge in terms of SpO2 and oral feeding efficiency (rate of milk intake). Infants without supplement oxygen needs were evaluated twice on the same day during two consecutive feeds, by the same nurse. Infants served as their own controls for comparison of two systems of bottles, the order of which was randomized. The new bottle's nipple design mimics mom's breast in shape and feel, and the bottle vents to air when the child sucks on the nipple. The other system was the hospital's standard plastic bottle with silicone nipple. The rate of milk intake was calculated as the total volume transferred minus volume lost divided by time of feeding, mL/min. Thirty-four infants (BW: 1, 163 ± 479.1 g) were studied at 35.4 ± 1.3 weeks after-conception. SpO2 was significantly higher in infants fed with the new bottle design. Milk intake rate was significantly higher with the new bottle than with the standard bottle design. The new bottle design improves oral feeding performance in preterm infants near to discharge when compared to that of a standard bottle.

A new method for continuous monitoring of chest wall movement to characterize hypoxemic episodes during HFOV

A new method for continuous monitoring of chest wall movement to characterize hypoxemic episodes during HFOV

Etiopathogenetic mechanisms of pulmonary hypertension in sleep-related breathing disorders.

Obstructive sleep apnea syndrome is a common disorder with significant health consequences and is on the rise in consonance with the obesity pandemic. In view of the association between sleep-disordered breathing and pulmonary hypertension as depicted by multiple studies, current clinical practice guidelines categorize obstructive sleep apnea as a risk factor for pulmonary hypertension and recommend an assessment for sleep disordered breathing in evaluating patients with pulmonary hypertension. The dysregulatory mechanisms associated with hypoxemic episodes observed in sleep related breathing disorders contribute to the onset of pulmonary hypertension and identification of these potentially treatable factors might help in the reduction of overall cardiovascular mortality.

Combined Cesarean Delivery and Repair of Acute Ascending and Aortic Arch Dissection at 32 Weeks of Pregnancy

n a r AHEALTHY 35-YEAR-OLD gravida 2 para 1 woman at 32 3 weeks’ gestational age was admitted to an outside ospital for an acute onset of chest pain that began that day at er baby shower. Owing to an episode of transient hypoxemia, he was worked up for pulmonary embolism. Computed tomoraphic examination was negative for pulmonary embolism but id show a Stanford type-A dissection. Before this admission, he pregnancy was uneventful and included a normal transthoacic echocardiogram (echocardiography was performed owing o a history suggestive of connective tissue disease). The paient was transferred to the authors’ institution, where an emerency cesarean section was performed, and a healthy male nfant was delivered. The infant’s birth was followed by immediate aortic repair nd aortic valve resuspension. Postoperatively, the patient and er newborn infant underwent genetic testing that was diagostic for Marfan syndrome. This case report discusses the anagement of aortic dissection in pregnancy and Marfan yndrome.

828: Perinatal outcomes associated with obstructive sleep apnea in pregnancy: a prospective study

sleep apnea in pregnancy: a prospective study Judette Louis, Susan Redline, Dennis Auckley, Anna Shepherd, Patricia Mencin, Brian Mercer MetroHealth Medical Center-Case Western Reserve University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, Harvard Medical School, Division of Sleep Medicine, Department of Internal Medicine, Boston, MA, MetroHealth Medical Center-Case Western Reserve University, Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland, OH, MetroHealth Medical CenterCase Western Reserve University, Obstetrics G Carlsbad, CA) that recorded nasal pressure, oxygen saturation, snoring, and head movements. All studies were manually scored by a central masked Sleep Reading Center using American Academy of Sleep Medicine diagnostic criteria. An apnea hypopnea index (AHI) 5 was considered to be diagnostic of OSA, [Mild (AHI: 5-15), Moderate (AHI: 15-30) and Severe (AHI: 30]. Perinatal outcomes were compared between women with and without OSA (p5 days, and readmission. Evaluated neonatal outcomes were: NICU admission, RDS, transient tachypnea (TTN), sepsis, and death. RESULTS: Among 170 evaluated obese women, the prevalence of OSA was 12.4% (12 mild, 7 moderate, 2 severe). Women with OSA had a mean AHI of 20 / 6 events per hour of sleep and spent 6.5 / 2.5% of the night with an SpO2 90%. Compared with controls, the OSA group had higher BMIs (49 / 11 vs. 39 / 6 k/m2, p 0.001) but similar rates of chronic hypertension (58 vs. 33%, p 0.07) and pregestational diabetes (15 vs. 20%, p 0.76). Severe maternal complications included: Maternal death (N 1, amniotic fluid embolus, control group) and cardiac arrest (N 1, intraoperative at cesarean delivery, OSA group). One previable birth and 2 stillbirths occurred in the control group. Among livebirths, OSA was associated with more frequent PET, NICU admission and TTN. (Table). After controlling for BMI, OSA was not associated with PET [OR .4(.11-1.4, p 0.15). After controlling for diabetes, gestational age and cesarean, neonates of women with OSA were more likely to have TTN (OR 4.7 (1.1-19.1, p 0.02) CONCLUSION: Untreated OSA among obese women in pregnancy is associated with more frequent neonatal respiratory complications 829 Nocturnal hypoxemia and neonatal body composition Judette Louis, Dennis Auckley, Susan Redline, Anna Shepherd, Patricia Mencin, Brian Mercer, Patrick Catalano MetroHealth Medical Center-Case Western Reserve University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, MetroHealth Medical Center-Case Western Reserve University, Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland, OH, Harvard Medical School, Division of Sleep Medicine, Department of Internal Medicine, Boston, MA, MetroHealth Medical Center-Case Western Reserve University, Obstetrics G Carlsbad, CA) that recorded nasal pressure, oxygen saturation, snoring, and head movements. Sleep studies were manually scored by an independent masked Sleep Reading Center using American Academy of Sleep Medicine diagnostic criteria. Any SpO2 90% was considered an episode of hypoxemia. Maternal and neonatal body composition was measured by air displacement plethysmography (BodPod, PeaPod). Neonatal morphometry was evaluated using a standardized protocol within 72 hours of birth. The primary outcome was neonatal lean body composition (%lean body mass, NLBM %). This analysis was restricted to neonates delivered 37 weeks. RESULTS: The cohort included 78 maternal/neonatal pairs. On average women were screened for OSA at mean [S.D.] gestational age of 22 [5] weeks, were age 27 [6] years, BMI 40.1 [8] kg/m2, % body fat (MBF %) 44 [6] %. And delivered at 38.6[1.3] weeks. Chronic hypertension (33%), pregestational (18%) and gestational diabetes (14%) were common. Eleven percent of these mothers had OSA who spent 2.5[1.1] % of the total sleep time with hypoxemia, and had a mean lowest SpO2 of 85 [5] %. Mean birth weight for the cohort was 3284 [507] gm, and NLBM% 86 [4] %. NLBM% was associated with maternal BMI (r 0.23, p 0.04), but not MBF% ( .15, p 0.06), degree of nocturnal hypoxemia (r .07, p 0.58) or lowest SpO2 (r .266, p 0.1). Neonates of OSA mothers were similar to neonates of non-OSA mothers regarding ponderal index (2.8 vs. 2.9, p 0.45) and NLBM% (85.1 vs. 87.7%, p 0.05). CONCLUSION: In obese pregnant women, using standardized methodology and criteria, neither prospectively diagnosed maternal OSA nor nocturnal hypoxia were associated with increased neonatal adiposity

The Role of Sleep Studies in Children Receiving Long Term Ventilation

Background: Follow-up sleep studies are recommended for children on long term ventilation (LTV), yet only one study has looked at their utility. While changes to ventilation are commonly needed, we wanted to identify: i) which measures in the sleep study showed abnormalities, and ii) the frequency and nature of changes made to ventilator settings. Method: LTV sleep study results over 5.8 years were collated. Recordings included: SpO2, ECG, heart rate, chest and abdominal movements, transcutaneous and end-tidal CO2, airway pressure and video (Visilab 3, Stowood Medical, Oxford). Data were obtained on: oxygenation, CO2, patient-ventilator synchrony, variance of airway pressures from those prescribed, pressure waveform, and outcome.Results: There were 153 studies from 51 patients: age range 0.1 to 19.8 years (median 11.1). Conditions included: congenital central hypoventilation syndrome (15), sleep related upper airway obstruction (13), neuromuscular disease (11), severe neurodisability (5), craniofacial abnormalities (3), and others (4). Abnormal findings existed in 134/153 (88%) studies. Sixty five out of 152 (43%) had abnormalities in gas exchange, including low baseline SpO2 in 53, episodic hypoxaemia in 44, and raised CO2 in 33. Seventeen (11%) had inadequate pressures or synchrony: pressures were satisfactory in 79 / 92 with data; synchrony was seen in 90/94 studies. Changes were made in 47 (31%); an increase in ventilation in 32 and reduction in 15.Conclusion: This confirms a place for assessing blood gas exchange, airway pressures and adequacy of synchrony in children receiving LTV. Further work needs to identify the appropriate interval for review studies.

A Modified Difficult Airway Management Algorithm Incorporating Video Devices in Routine Anesthesia Practice

A Modified Difficult Airway Management Algorithm Incorporating Video Devices in Routine Anesthesia Practice

Hypoxémie, chémorécepteurs périphériques et rythme cardiaque fœtal

The perinatal results of the widespread adoption of the continuous electronic fetal heart rate monitoring during labor remain rather disappointing. This is due in part to a lack of consistent interpretation of the fetal heart tracings. Despite efforts by referral agencies over the past decade the situation has not improved. In defense of practitioners the heterogeneity and complexity of definitions and classifications patterns especially morphological currently proposed should be noted. Whereas with the recent advances in the field of neuroscience, it is now possible to visualize the chain of pathophysiological events that lead from the hypoxemic stimulus of the glomus cell to changes in the morphology of the fetal heart rate tracing. Thus by taking some examples of real situations, we propose a method of analysis that dissects the fetal heart tracing and take into account the functional specifications of the chemoreceptor when exposed to a hypoxic environment. Furthermore we can identify tracings with a "threshold effect" and also "sensitization and desensitization effects" according to the intensity, duration and recurrence of hypoxaemic episodes. This new approach based upon specific research into the mechanism behind the fetal heart rate abnormalities may be useful to complement the morphological study of the fetal heart tracing, to provide a better idea of the fetal status and to better define the indications of fetal blood sampling procedures.

Low-flow oxygen therapy in intensive care: An observational study

There is scant published evidence that explains how ICU nurses' manage low-flow oxygen therapy; and, hence little is known about how low-flow oxygen therapy is delivered on a daily basis. The aims of this study were first to observe how ICU nurses' manage low-flow oxygen therapy and then to compare observed nursing practice on the management of oxygen therapy with patients' documented measures of oxygen saturation (SpO2) and respiratory rate (RR). From May to July 2009, eight 2h observation periods were conducted in one ICU of a metropolitan hospital in Melbourne, Victoria. Data were collected at using a structured observation tool, field notes and chart review. Quantitative data were analysed using descriptive and frequency statistics, and textual data were reviewed using a content analysis procedure. Over the 16 h of observed nursing practice, there were 96 points of measurement involving 16 patients and 16 ICU nurses. The management of low-flow oxygen therapy varied between nurses and data revealed that nurses did not always promote effective oxygenation. Documented SpO2 was 98.0% (SD 2.8%) and observed SpO2 was 96.3% (SD 1.8%). Documented RR was 19.6 breaths/min (SD 3.5) and observed RR was 21.0 breaths/min (SD 16.8). Episodes of hypoxaemia and tachypnoea occurred while patients were receiving oxygen and nurses did not always respond appropriately. ICU nurses' management of low-flow oxygen therapy was suboptimal and documentation of oxygenation and respiratory rate was inaccurate. Further exploration of how ICU nurses manage low-flow oxygen therapy is a necessary prelude to the conduct of interventional studies and the development of better guidance to support low-flow oxygen therapy in the ICU.

A new method for continuous monitoring of chest wall movement to characterize hypoxemic episodes during HFOV

Monitoring ventilated infants is difficult during high-frequency oscillatory ventilation (HFOV). This study tested the possible causes of hypoxemic episodes using a new method for monitoring chest wall movement during HFOV in newborn infants. Three miniature motion sensors were attached to both sides of the chest and to the epigastrium to measure the local tidal displacement (TDi) at each site. A >20% change in TDi was defined as deviation from baseline. Eight premature infants (postmenstrual age 30.6 ± 2.6 weeks) were monitored during 10 sessions (32.6 h) that included 21 hypoxemic events. Three types of such events were recognized: decrease in TDi that preceded hypoxemia (n = 11), simultaneous decrease in TDi and SpO2 (n = 6), and decrease in SpO(2) without changes in TDi (n = 4). In the first group, decreases in TDi were detected 22.4 ± 18.7 min before hypoxemia, and were due to airway obstruction by secretions or decline in lung compliance. The second group resulted from apnea or severe abdominal contractions. In the third group, hypoxia appeared following a decrease in FiO2. Monitoring TDi may enable early recognition of deteriorating ventilation during HFOV that eventually leads to hypoxemia. In about half of cases, hypoxemia is not due to slowly deteriorating ventilation.

Longitudinal Assessment of Hemoglobin Oxygen Saturation in Preterm and Term Infants in the First Six Months of Life

To report longitudinal home recordings of hemoglobin O(2) saturation by pulse oximetry (Spo(2)) during unperturbed sleep in preterm and term infants. We recorded continuous pulse oximetry during the first 3 minutes of each hour of monitor use (nonevent epochs) for 103 preterm infants born at <1750 g and ≤ 34 weeks postmenstrual age (PMA), and 99 healthy term infants. Median baseline Spo(2) was approximately 98% for both the preterm and term groups. Episodes of intermittent hypoxemia occurred in 74% of preterm and 62% of term infants. Among infants with intermittent hypoxemia, the number of seconds/hour of monitoring <90% Spo(2) was initially significantly greater in the preterm than the term group and declined with age at a similar rate in both groups. The 75(th) to 95(th) percentiles for seconds/hour of Spo(2) <90% in preterm infants were highest at 36 weeks PMA and progressively decreased until 44 weeks PMA, after which time they did not differ from term infants. Clinically inapparent intermittent hypoxemia occurs in epochs unperturbed by and temporally unrelated to apnea or bradycardia events, especially in preterm infants at 36 to 44 weeks PMA.

Nocturnal saturation and glucose tolerance in children with cystic fibrosis

BackgroundGlucose intolerance is common in cystic fibrosis (CF), and is associated with worsening pulmonary function and nutritional status, and increased mortality. As sleep-disordered breathing is associated with disorders of glucose...