HIGHER SAO(2) IN CHRONIC NEONATAL LUNG-DISEASE - DOES IT IMPROVE SLEEP

Sleep fragmentation, decreased rapid eye movement (REM) sleep time, an d REM sleep hypoxemia have been reported in infants with chronic neona tal lung disease (CNLD) in early infancy despite an awake hemoglobin o xygen saturation (SaO(2)) >93%. Interestingly, higher inspired O-2 con centrations have been demonstrated to reduce REM sleep fragmentation i n CNLD patients in middle infancy. However, the effect of increased Sa O(2) on sleep architecture in infants with CNLD near the time of disch arge from neonatal intensive care has not been reported. We performed paired overnight polysomnography in a sleep laboratory on 16 infants w ith CNLD (4 weeks median corrected age) in air or their usual inspired oxygen (SaO(2) >93%) and again when receiving 0.25 L/min higher than baseline inspired oxygen via nasal catheters (SaO(2) >97%). A control group of seven healthy preterm infants was similarly studied. For CNLD infants on supplemented O-2, sleep duration decreased by 15% (422 +/- 66 min vs. 359 +/- 89 min; P < 0.005), and sleep efficiency decreased by 7% (73.2 +/- 10.6% vs. 66.4 +/- 14.0%; P < 0.005) but percentage o f time in REM sleep (REM%) (31.5 +/- 8.9% vs. 29.8 +/- 8.6%; P = 0.560 ), REM epoch duration (12.4 +/- 2.8 min vs. 13.4 +/- 4.3 min; P = 0.42 0), and REM arousal index (18.6 +/- 6.5 vs. 18.8 +/- 7.2; P = 0.990) w ere not significantly affected. Conversely, higher O-2 did not alter s leep architecture in the control group. The mean non-REM (NREM) respir atory rate decreased (CNLD: P = 0.003; controls: P = 0.02), NREM SaO(2 ) increased (P < 0.05), although the mean transcutaneous CO2 was unalt ered in both CNLD and control groups. This study confirmed low REM% in CNLD infants in early infancy and demonstrated that a higher SaO(2) a dversely affected sleep time but did not influence REM sleep duration or arousal frequency. A target SaO(2) >93% is, therefore, as efficacio us as an SaO(2) >97% in optimizing sleep architecture in CNLD infants. Pediatr Pulmonol, 1998; 26:235-240, (C) 1998 Wiley-Liss, Inc.