Unexplained Significant Central Sleep Apnea in Infants: Clinical Presentation and Outcomes

Abstract

Objective: Unexplained significant central sleep apnea in term infants presents as central apneas with associated oxygen desaturations requiring respiratory support and monitoring for prolonged periods. However, there is a paucity of literature describing idiopathic central sleep apnea (ICSA) in term or near-term infants. Our aim was to describe the clinical manifestations, polysomnography data, interventions, and trajectory of ICSA in infants. Design: This is a retrospective study of infants (gestational age ≥ 35 weeks) who presented with significant central apneas and were subsequently diagnosed with ICSA following polysomnography and clinical investigations between January 2011 and April 2021 at a tertiary care hospital in Canada. Polysomnography data, clinical investigations, and treatments were documented. Results: Eighteen infants (male, 78%; median gestational age 38 weeks) with ICSA were included. Initial polysomnograms were completed at a median (interquartile range [IQR]) age of 1.2 (0.6–1.6) months (n = 18) and follow-up polysomnograms at 12.4 (10.6–14.0) months (n = 13). Compared to baseline diagnostic polysomnograms, at follow-up there was a significant reduction in the median (IQR) central apnea–hypopnea index (26.1 [18.2–52.9] versus 4.2 [2.6–7.2] events/hour; p = 0.001), desaturation index (30.9 [12.2–57.4] versus 3.9 [3.0–7.9] events/hour; p = 0.002), average transcutaneous carbon dioxide (41.9 [40.1–47.3 versus 39.4 [37.5–42.7] mmHg; p = 0.025), and improved nadir oxygen saturation (79.8 [69.1–83.0] versus 85.5 [83.2–87.8]%; p = 0.033), respectively. Prescribed treatments included supplemental oxygen (14/18, 78%), caffeine (5/18, 28%), and noninvasive ventilation (1/18, 6%). Conclusions: Infants with significant unexplained ICSA have a favorable clinical trajectory over time. Further research is needed to understand the etiology of this rare disorder.