Episodes Of Apnea Research Articles

Congenital Central Hypoventilation Syndrome (Ondine’s Curse): Clinical Case

Background. Congenital central hypoventilation syndrome (CCHS), or Ondine’s Curse, is rare, incurable and life-threatening disease characterized by autonomic nervous system disorders, it manifests with disability to maintain ventilation function during sleep. Sensitivity to hypoxia and hypercapnia is reduced in case of CCHS, thus, it leads to recurrent episodes of deep apnea. The world literature describes just over 1000 cases of this disease. Clinical case description. An infant born at 37th week of gestation, weight of 3330 g, had episodes of apnea and hypercapnia from the first day of life. CCHS was suspected by the 28th day of life after excluding other causes of respiratory disorders, and it was genetically confirmed by the 43rd day of life — pathogenic variant of PHOX2B gene was revealed. Mechanical ventilation has been initiated by the age of 1 month after disease worsening. Analysis of CCHS cases published in Russian-language medical literature was performed. Typical symptoms and timing of their manifestation, as well as the time before correct diagnosis were mentioned. Conclusion. Symptoms that can be suggestive of CCHS presence early after birth and can urge to perform all the necessary genetic testing that are crucial for timely treatment onset and for minimizing the negative effect of hypoxemia and hypercapnia on the child are described.

Opioids for procedural pain in neonates.

Opioids for procedural pain in neonates.

A Narrative Review of the Association of Obstructive Sleep Apnea with Hypertension: How to Treat Both When They Coexist?

Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the upper airways due to anatomic and/or functional disturbances. There is mounting evidence of a relationship between OSA and HT. In patients with OSA, HT is predominantly nocturnal and characterized by high diastolic blood pressure and usually by a nondipping pattern. Optimizing the blood pressure control is recommended in the current guidelines as the first treatment option in hypertensive patients with OSA. Continuous positive airway pressure (CPAP) therapy may reduce blood pressure, albeit only slightly as a stand-alone treatment. CPAP, as an add-on treatment to antihypertensive medication, appears to be an efficient treatment modality when both conditions coexist. This narrative review aims to summarize the current perspectives on the association of OSA with HT and the treatment options available for adults with OSA-related HT.

0516 Biopsychosocial intervention using virtual multidisciplinary group with improved PAP adherence after 1 year post intervention

Abstract Introduction Prevalence of untreated sleep apnea among veterans is 22.2 %. Untreated patients are at risk for multiple adverse outcomes including chronic sleep deprivation, excessive day time sleepiness, chronic fatigue, depression, and cardiovascular complications including hypertension, coronary artery disease, cerebrovascular accidents, pulmonary hypertension as result of increased sympathetic activity during apnea episodes. Nonadherence to PAP therapy within the first week of treatment are up to 50 % of patients who use PAP device during the first week between 12-25 % discontinue by PAP use by year 3. Barriers to PAP use include physical problems with PAP hardware, knowledge gaps, and psychological issues. Methods Veterans from sleep medicine and sleep apnea clinics as well as multiple primary care clinics participated in the PAP adherence group following 6 weeks biopsychosocial model. The intervention included weekly synchronized video encounters of behavior sleep specialist, respiratory therapist and sleep clinic nurse with the targeted group of veterans with sleep apnea and poor PAP adherence. This approach has multiple benefits, including being patient centered, cost effective and efficient with ability to help veterans at various motivational levels, assist 6-10 veterans virtually in 6 one-hour group sessions and easy care coordination. Results A total of 21 veterans with sleep apnea participated in virtual multidisciplinary group to improve PAP adherence between September 2020 and January 2021. Patients PAP adherence before intervention, post intervention and 1year after intervention was evaluated. Percent of patients using PAP >2 hours before intervention was 5 %, immediately after intervention it increased to 20 %, and there was further increase up to 33% after 1 year post. Conclusion A structured multidisciplinary biopsychosocial intervention demonstrated statistically significant improvement in PAP adherence which persisted up till 1 year post intervention. In fact additional improvement of >2 hours of PAP usage was noted in this patient group suggesting possible long term benefit of psychosocial multidisciplinary intervention on PAP adherence. This study also demonstrated efficiency of utilization of virtual/telemedicine platform for psychosocial intervention and brief behavioral therapy. Support (if any)

Obstructive Sleep Apnea Syndrome Associated with Atrial Fibrillation in Adult Patients: A Systematic Review and Meta-Analysis

Introduction: Obstructive sleep apnea syndrome (OSAHS) is a common disease. However, its diagnosis and treatment are underestimated. The main reason is that the upper airway completely or partially collapses, leading to repeated sleep apnea episodes. In addition, atrial fibrillation(AF) is the most frequent arrhythmia in the world, these two entities may be related and are important public health problems.
 Objective: To determine the association between obstructive sleep apnea syndrome and atrial fibrillation in adult patients.
 Materials and Methods: A systematic review and meta-analysis of observational studies that associate obstructive sleep apnea syndrome and atrial fibrillation was carried out. The search was carried out in 4 databases: PUBMED, Web of Science, Embase, Scopus.
 Results: Eight studies were included (n=562241). A significant association was found between obstructive sleep apnea and atrial fibrillation (OR: 1.38; 95% CI 1.24 to 1.54). In addition, low heterogeneity was found between studies I2: 13%.
 Conclusions: It was found that obstructive sleep apnea and atrial fibrillation are significantly associated.

Sleep quality and polysomnographic changes in patients with chronic pain with and without central sensitization signs

BackgroundInsufficient sleep is common nowadays and it can be associated with chronic pain. ObjectiveTo describe the main polysomnographic findings in patients with chronic musculoskeletal pain and to estimate the association between sleep quality, polysomnography variables and chronic musculoskeletal pain. MethodsThis cross-sectional research analyzed a database from polysomnography type 1 exams results and then collected data via an electronic form from these patients. The form collected sociodemographic data and presented clinical questionnaires for measuring sleep quality, sleepiness, pain intensity and central sensitization signs. Pearson's correlation coefficient and odds ratio were used to estimate the associations. ResultsThe mean age of the respondents was 55.1 (SD 13.4) years. The mean score of the Central Sensitization Inventory showed signs of central sensitization (50.1; SD 13.4) in the participants. Most patients (86%) had 1 or more nocturnal awakenings, 90% had one or more episodes of sleep apnea, 47% had Rapid Eye Movement sleep phase latency greater than 70–120 min and the mean sleep efficiency among all participants was 81.6%. The Pittsburgh Sleep Quality Index score was correlated with the CSI score (r = 0.55; 95% CI: 0.45, 0.61). People with central sensitization signs have 2.6 times more chance to present sleep episodes of blood oxygen saturation below 90% (OR = 2.62; 95% CI:1.23, 6.47). ConclusionMost people with central sensitization signs had poor sleep quality, night waking episodes and specific disturbances in sleep phases. The findings showed association between central sensitization, sleep quality, nocturnal awakening, and changes in blood oxygen saturation during sleep.

Opioids for procedural pain in neonates.

Opioids for procedural pain in neonates.

Non-opioid analgesics for procedural pain in neonates.

Non-opioid analgesics for procedural pain in neonates.

Dynamic Bayesian Model for Detecting Obstructive Respiratory Events by Using an Experimental Model.

In this study, we propose a model-based tool for the detection of obstructive apnea episodes by using ECG features from a single lead channel. Several sequences of recurrent apnea were provoked in separate 15-min periods in anesthetized rats during an experimental model of obstructive sleep apnea (OSA). Morphology-based ECG markers and the beat-to-beat interval (RR) were assessed in each sequence. These markers were used to train dynamic Bayesian networks (DBN) with different orders and feature combinations to find a good tradeoff between network complexity and apnea-detection performance. By using a filtering approach, the resulting DBNs were used to infer the apnea probability signal for subsequent episodes in the same rat. These signals were then processed using by 15-s epochs to determine whether epochs were classified as apneic or nonapneic. Our results showed that fifth-order models provided suitable RMSE values, since higher order models become significantly more complex and present worse generalization. A global threshold of 0.2 gave the best overall performance for all combinations tested, with Acc = 81.3%, Se = 69.8% and Sp = 81.5%, using only two parameters including the RR and Ds (R-wave downslope) markers. We concluded that multivariate models using DBNs represent a powerful tool for detecting obstructive apnea episodes in short segments, which may also serve to estimate the number of total events in a given time period.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Central Apnea in Patients with COVID-19 Infection

Background: The Coronavirus Disease 2019 (COVID-19) is a global pandemic that has killed over 1.5 million people worldwide. A constellation of multisystem involvement with SARS-CoV-2 has been reported. COVID-19 has been shown to affect the human nervous system, however, both the extent and severity of involvement have yet to be fully elucidated. In this manuscript, we aimed to better understand the effect of COVID-19 on neuro-respiratory status by studying COVID-19 patients who presented with central apnea. Methodology: We analyzed patient characteristics, clinical outcomes, laboratory results, and imaging results of three patients with symptomatic, PCR-proven COVID-19 and episodes of central apnea. Results: Of the three patients included in this study, two patients developed new central apnea, and one patient developed an exacerbation of underlying central apnea despite COVID-19 treatments with systemic steroids and remdesivir. All occurred, on average, 15 days after the onset of COVID-19 symptoms. At 1-year follow-up, all patients experienced complete resolution of apneic breathing. Conclusions: Physicians should be vigilant for the presentation of COVID-19 with central apnea. Central apnea may be a complication in patients with severe COVID-19 infection. More research is warranted to further understand this association.

Abstract Number ‐ 113: A Lateral Medullary Infarct Complicated by Central Hypoventilation Syndrome

Introduction A 43‐year‐old male with no known past medical history presented to a primary stroke center for sudden onset headache, nausea, vomiting, and dizziness while driving. A computed tomography angiogram of the head and neck revealed a left vertebral artery occlusion, and the patient was transferred to our comprehensive stroke center for further evaluation and treatment. Upon arrival at our facility, the patient was noted to have a national institute of health stroke scale score of 7 with left facial droop, dysarthria, and right upper extremity dysmetria. A cerebral angiogram revealed a tortuous left vertebral artery with dissection in the V4 segment. Subsequent brain diffusion weighted imaging revealed an acute infarct in the right lateral medulla measuring 1.4cm and several acute cerebellar infarcts. (fig. 1) In the postangiography period, the patient had dysphagia, sialorrhea, multiple aspiration episodes, and oral secretions requiring early tracheostomy and percutaneous endoscopic gastrostomy on hospital day (HD) #6. The subsequent hospital course was complicated by prolonged singultus lasting until HD #23 and repetitive vomiting requiring a transition from a gastric to a gastro‐jejunal feeding tube. Methods A central hypoventilation syndrome (CHS) prolonged ventilator weaning. Despite preserved ability to take large‐volume voluntary breaths, the patient experienced multiple episodes of sleep‐associated apnea and rapid shallow breathing pattern during daily spontaneous breathing trials (SBT). The apnea episodes were registered with ventilator apnea alarms set at 20 seconds. This pattern continued when attempting an SBT utilizing a T‐piece adaptor. The ability to maintain adequate minute ventilation in an asleep state subsequently improved, and the patient was able to tolerate 48 hours of spontaneous breathing with no apnea on HD #35. Results Few cases of CHS secondary to lateral medullary infarction (LMI) have been documented in the literature.(1‐3) As the respiratory drive originates from neurons in the latero‐rostro‐ventral medulla, infarcts in this brainstem region may lead to respiratory failure. More specifically to our patient, ataxic breathing may result from lesions in the rostro‐ventral medulla with yawning and hiccups being seen in lesions to the posterolateral medulla.(4) As our patient presented with a sizable 1.4cm lesion, likely impairing these brainstem centers, it is expected that his symptoms would account for multiple respiratory symptoms. The unique feature of the acquired CHS in the setting of LMI is its unilateral location implying lateralization of the respiratory control. In addition to the aforementioned symptoms, his lesion likely led to prolonged weaning from the ventilator as has been described previously.(5) Conclusions This case raises awareness regarding potentially disastrous complications of the lateral medullary syndrome like central hypoventilation syndrome. We urge caution and careful evaluation of patients with lateral medullary infarctions for disorders of the respiratory control system.

Respiratory Monitoring after Opioid-Sparing Bariatric Surgery in Patients with Obstructive Sleep Apnea (OSA)

Introduction with Aim: Postoperative respiratory depression can complicate a patient’s recovery after surgery. A predictive score (PRODIGY) was recently proposed to evaluate the risk of opioid-induced postoperative respiratory depression. For the first time, we applied this score to a cohort of patients receiving bariatric surgery, stratified by Obstructive Sleep Apnea (OSA) status. In addition, we recorded continuous postoperative capnography to evaluate respiratory depression and apnea episodes (Respiratory Events, RE). Materials and Methods: The present study was approved by our IRB and comprised continuous surveillance of respiratory variables during postoperative recovery (in PACU) after robotic bariatric surgery. We utilized continuous capnography and pulse oximetry (Capnostream 35, Medtronic Inc., and Profox Respiratory Oximetry software). Preoperative preparation included OSA evaluation for all bariatric patients, additional sleep studies for severe OSA grades, and evaluation of risk for respiratory depression (low, intermediate, or high) using the published PRODIGY score. In addition, we evaluated patients by OSA status. All patients received multimodal intraoperative non-opioid anesthesia from the same team. After surgery, all patients received continuous respiratory surveillance in PACU (average duration exceeding 140 min). Respiratory depression events were scored using a modified list of the five standard published categories. Events were measured according to analysis of continuously recorded tracing of the compiled respiratory variables by observers kept blind from the study patient’s group. Results: Of the 80 patients evaluated (18 male), 56 had obstructive sleep apnea and were using CPAP at home (OSA); 24 did not. OSA patients received CPAP via an oronasal mask or a nasal pillow pressure support immediately after arriving in PACU, utilizing their at-home settings. We encountered 115 respiratory depression events across 48 patients. The most frequent respiratory event recorded was a transient desaturation (as low as 85%), which usually lasted 20–30 sec and resolved spontaneously in 3 to 5 min; most episodes followed small boluses of IV opioid analgesia administered during recovery, on demand. All episodes resolved spontaneously without any nursing or medical intervention. OSA patients had significantly more events than non-OSA patients (1.84 (1.78–1.9) mean events vs. 0.50 (0.43–0.57) for non-OSA, p = 0.0002). The level of PRODIGY score (low, intermediate, or high), instead, was not predictive of the number of events when we treated this variable as continuous (p = 0.39) or categorical (high vs. low, p = 0.65, and intermediate vs. low, p = 0.17). Conclusions: We attribute these novel results, showing a lack of respiratory events requiring intervention, to opioid-free anesthesia, early CPAP utilization, and head-up positioning on admission to PACU. Furthermore, all these patients had light postoperative narcotic requirements. Finally, an elevated PRODIGY score in our patients did not sufficiently predict respiratory events, but OSA status alone did. Key Points Summary: We investigated the incidence of Respiratory Events (RE) in Obstructive Sleep Apnea patients after surgery (56 patients) and compared them to similar patients without OSA (24 patients). All patients received identical robotic-assisted surgery and low- or no-opiate anesthesia. Patients were pre-screened with the standard published PRODIGY scores and were monitored after PACU arrival with continuous oximetry and capnography (Capnostream 35 and Profox analysis). OSA patients showed more RE than non-OSA (1.8 vs. 0.5, p = −0.0002). However, patients with elevated PRODIGY scores did not develop more frequent RE compared to patients with low scores. We attribute these novel results to opioid-sparing anesthesia/analgesia and immediate CPAP utilization on admission to PACU.

SÍNDROME DA HIPOVENTILAÇÃO CENTRAL CONGÊNITA ASSOCIADA À DOENÇA DE HIRSCHSPRUNG: A IMPORTÂNCIA DO DIAGNÓSTICO DIFERENCIAL E PRECOCE

Congenital central hypoventilation syndrome (CCHS, OMIM #209880), also known as Ondine's curse is characterized by episodes of central apnea, which is a dysfunction of the autonomic nervous system (ANS), occurring soon after birth or in the first month of life. Mutations in the PHOX2B gene, located on chromosome 4p12, are responsible for the development of the CCHS. This study reports the case of a newborn with recurrent episodes of apnea, diagnosed with CCHS associated with Hirschsprung's disease. Female patient, 10 years old, born at preterm, after birth presented episodes of apnea and oxygen saturation fall, which required positive pressure ventilation and admission to a pediatric intensive care unit. The patient was kept in Continuous Positive Airway Pressure (CPAP) during the first 24 h of life to treat the apnea, and after that, presented hypercapnia being submitted to intubation. She also had intestinal constipation and abdominal distension. Several tests were carried out without elucidation of the diagnostic, therefore the patient was follow-up with a geneticist, and after a genetic research using DNA sequencing, she was diagnosed with congenital central hypoventilation syndrome associated to Hirschsprung's disease. CCHS is a rare syndrome, but underdiagnosed. Clinical manifestations in the acute and chronic hypoventilation include apnea and hypoventilation at birth, oxygen desaturation and cyanosis, severe central sleep apnea, acquired pulmonary hypertension, and delayed recovered from anaesthesia or opioids are. Early recognition of the clinical features previously described is indispensable to the diagnostic, as well as access to genetic testing in order to corroborate CCHS.

Односторонний парез гортани: особенности клинической картины и сложности диагностики

The article presents the experience of the phoniatric department of the Saint Petersburg Institute of Ear, Throat, Nose, and Speech in the management of patients with unilateral vocal fold paresis. Variants of the clinical picture of the disease that complicate the compensation of the phonatory, respiratory, and protective functions of the larynx have been studied. The most common clinical picture of unilateral laryngeal paresis is the presence of complaints of hoarseness, diplophonia, inspiratory dyspnea during physical activity, aspiration. However, complaints about the voice may be absent, or they may be presented in the form of an aphonia. Patients may not complain of shortness of breath, or inspiratory stridor appears with minimal physical activity, snoring with episodes of apnea, laryngospasm attacks. The article presents cases of rare manifestations of paresis associated with the phenomena of hypotension and hypotrophy of the laryngeal muscles. These include the weakening of the tension of the medial edge of the vocal fold, thinning of the vocal fold, contouring of the vocal process of the arytenoid cartilage, lower location of the paralyzed vocal fold relative to healthy, rotation of the arytenoid cartilage, rotation of the epiglottis, and others. Compensatory mechanisms of phonation are described. Possible difficulties in diagnosing laryngeal paresis based on video laryngoscopy data, including hypomobility of the vocal fold, as well as options for simulating paresis due to neoplasms and post-traumatic changes in the larynx are considered.

A plethysmography investigation comparing respiration rate before onset and after the end of central sleep apnoea episodes

The study explored possible changes in respiration rate immediately before onset and after end of central sleep apnoea (CSA) episodes using respiratory inductive plethysmography (RIP). RIP signals were recorded simultaneously from the chest and abdomen of 31 paediatric patients (mean age 7.12 years, standard deviation 4.40 years, 20 females, 11 males) attending a children’s hospital for overnight sleep disorder monitoring. The patients were also monitored for electrocardiogram, electroencephalogram, electrooculogram, electromyograph, CO2, body position, SpO2 and if they tolerated, their respiratory airflow using a thermistor (placed under the nose) and nasal prongs (placed in the nostrils). An experienced clinical physiologist scored the recorded data by indicating the time point of each respiratory pause, its duration and type (i.e., apnoea or hypopnoea; central or obstructive). The RIP signals from the chest and abdomen were summed and converted to a respiration rate signal by determining the time points they crossed the time axis. Events were scored using standard paediatric sleep and breathing scoring rules. Statistical analysis indicated significant differences between the skewness and kurtosis of respiratory rate values immediately before the onset and after the end of CSA episodes, however the mean respiration rate did not change significantly. This indicates possible changes in the pattern of respiration rate immediately after the end of CSA episodes. It may be possible to use these results to predict the onset of a CSA episode, however, to confirm the finding a larger study will be needed.

The role of cone-beam computed tomography in the radiographic evaluation of obstructive sleep apnea: A review article.

The apnea-hypopnea index is widely regarded as a measure of the severity of obstructive sleep apnea (OSA), a condition characterized by recurrent episodes of apnea or hypopnea during sleep that induce airway collapse. OSA is a catastrophic problem due to the wide range of health issues it can cause, including cardiovascular disease and memory loss. This review was conducted to clarify the roles of various imaging modalities, particularly cone-beam computed tomography (CBCT), in the diagnosis of and preoperative planning for OSA. Unfortunately, 2-dimensional imaging techniques yield insufficient data for a comprehensive diagnosis, given the complex anatomy of the airway. Three-dimensional (3D) imaging is favored as it more accurately represents the patient's airway structure. Although computed tomography and magnetic resonance imaging can depict the actual 3D airway architecture, their use is limited by factors such as high radiation dose and noise associated with the scans. This review indicates that CBCT is a low-radiation imaging technique that can be used to incidentally identify patients with OSA, thereby facilitating early referral and ultimately enhancing the accuracy of surgical outcome predictions.

The Association between Obstructive Sleep Apnea and Glycated Haemoglobin A1c (Hba1c) Level in Diabetes Mellitus Type II Patient

Abstract Background: Obstructive sleep apnea (OSA) is a chronic condition characterized by repetitive episodes of upper airway collapse, apnea, and arousal during sleep. OSA and type 2 diabetes mellitus (T2DM) are common comorbid conditions. Haemoglobin A1c (HbA1c) is an approximation of an individual’s average blood glucose level for the prior two to three months, and therefore is considered to be a major index for monitoring glycaemic control in diabetic patientsObjective: This study aimed to examine the association between OSA and HbA1c levels in T2DM patients.Methods: This was a cross-sectional study. The study assesses the association between OSA and HbA1c levels in 75 T2DM patients. OSA in the patient was asses with Epworth Sleepiness Scale (ESS) questionnaire. HbA1c values were obtained from the patient’s records. Data presented in mean ± SD, max, and min. Correlations analyses using Pearson correlation coefficient with p < 0.05 were considered statistically significant.Results: A total of 75 T2DM has a mean BMI were 25.26 ± 48.31 kg/m2 with mean HbA1c levels of about 7.1 ± 0.19%. The mean ESS score was 5 ± 0.429. The very weak correlation between OSA and BMI was statistically significant, r = 0.213; p = 0.047. Meanwhile, a very weak correlation between OSA and HbA1c levels was not statistically significant, r = 0.137; p = 0.242Conclusion: Among adults with T2DM, the correlation between OSA with HbA1c was not statistically significant

Obstructive Sleep Apnea, Circadian Clock Disruption, and Metabolic Consequences.

Obstructive sleep apnea (OSA) is a chronic disorder characterized by recurrent episodes of apnea and hypopnea during sleep. It is associated with various cardiovascular and metabolic complications, including type 2 diabetes mellitus (T2DM) and obesity. Many pathways can be responsible for T2DM development in OSA patients, e.g., those related to HIF-1 and SIRT1 expression. Moreover, epigenetic mechanisms, such as miRNA181a or miRNA199, are postulated to play a pivotal role in this link. It has been proven that OSA increases the occurrence of circadian clock disruption, which is also a risk factor for metabolic disease development. Circadian clock disruption impairs the metabolism of glucose, lipids, and the secretion of bile acids. Therefore, OSA-induced circadian clock disruption may be a potential, complex, underlying pathway involved in developing and exacerbating metabolic diseases among OSA patients. The current paper summarizes the available information pertaining to the relationship between OSA and circadian clock disruption in the context of potential mechanisms leading to metabolic disorders.

Наиболее значимые постнатальные факторы, влияющие на течение различных форм ретинопатии недоношенных

Purpose.To evaluate the most significant factors affecting the course of ROP. Material and methods. From 2009 to 2018, we examined 4120 children with ROP. The examination of children was carried out as part of a neonatal screening to detect ROP using standard diagnostic methods. Results. Against the background of prolonged oxygen therapy in children with broncho-pulmonary dysplasia (BPD), severe forms of ROP developed in 9.7% of cases, which is significantly lower than similar indicators in the pathology departments of premature and newborns. Among children with severe apnea, the onset of different-sized hemorrhages, mainly preretinal located in various parts of the fundus, mostly at the ends of the vascular arcades is observed in 70.4% of cases. In 25.9% of children with severe ROP, partial hemophthalmus appears. During blood transfusions in children with severe forms of ROP, the transition of the disease to a more severe stage was reduced in 64.0%, caliber and tortuosity of the retinal vessels increased in 79.8%, retinal edema and exudative manifestations intensified in 39,3%, hemorrhagic changes rose in 49,4%, extraretinal proliferation increased in 50.6%. Against the background of adenoviral epidemic keratoconjunctivitis (AEK) in children with severe forms of ROP, the exudation in the vitreous body sharply increased in 34.7%, retinal detachment developed in 4.1% of cases, even though the children had already undergone laser coagulation of the retina at the time of infection, fresh hemorrhages mainly at the ends of the vascular arcades appeared in 57.1%. Conclusions. Prolonged oxygen therapy under BPD reduces the severity of the ROP. The impact of blood transfusions is observed only in severe forms of ROP. Frequent episodes of apnea contribute to the development of intraocular hemorrhages during ROP. The course of adenoviral AEK exacerbates the course of severe forms of ROP. Key words: retinopathy of prematurity, blood transfusion, apnea, broncho-pulmonary dysplasia, adenoviral epidemic keratoconjunctivitis, risk factors of retinopathy of prematurity