Emotional, behavior problems and sleep in premature infants

Abstracts/Sleep Medicine 16 (2015) S2–S199

OSA. Except sleep-disordered breathing, sleep fragmentation should be paid more attention in asthmatic population. There is little data on sleep in children with asthma and association with severity of lung disease. Materials and methods: A prospective study was conducted in asthma children. A total of sixty-four children with asthma were enrolled in the study. Subjects were questioned for daytime sleepiness using the Paediatric Daytime Sleepiness Scale (Epworth Scale), and sleep complaints using Michigan Scale. Enrolled asthma children finished lung function, such as spirometric measurements (FVC,FEV1, PEF as a percent predict). Complete overnight polysomnography techniques were performed on all subjects before and after asthma control, to evaluate the association between sleep disorder and asthma control. Results: (1) Studies have shown decreased quality of sleep defined as reduced sleep time, reduced sleep quality, snoring, difficulty in maintaining sleep, and daytime sleepiness in asthmatic children, especially in non-well controlled asthmatics. Non-well controlled asthmatic children had a significant decrease in sleep efficiency [SE; 76.3% (W) vs 79.1%(N); p < 0.05], prolonged rapid eye movement (REM) latency [150.5 min (W) vs 88 min (N); p < 0.05], and reduction in percentage of REM sleep [12.7 (W) vs 18.3 (N); p < 0.05]. The data suggest that the prevalence of pediatric sleep-disordered breathing and sleep fragmentation could be very high among children with asthma, no matter well-controlled or non-well controlled. (2) Nonwell controlled asthmatic children had a higher apnea–hypopnea index (p < 0.05) and apnea–hypopnea-related arousal index (p < 0.05) as compared with well-controlled asthmatics. (3) SE indicated the degree of sleep disruption, was correlated with FEV1. However, there was no significant correlation between SE and oxygen desaturation or SE and end-tidal pCO2. Conclusion: It is concluded that asthmatic children have significant sleep fragmentation. OSA may coexist with asthma. Sleep disruption is associated with severity of lung disease, but is not directly correlated with the degree of nocturnal hypoxemia or hypoventilation. http://dx.doi.org/10.1016/j.sleep.2015.02.055

Emotional, behavior problems and sleep in premature infants Y. Chuang 1, Y. Huang 1, C. Guilleminault 2 1 Sleep Center and Child Psychiatry Department, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan 2 Stanford University Sleep Medicine Division, Stanford, CA, USA

Introduction: Previous study showed children with sleep disordered breathing (SDB) demonstrating more emotional, behavior problems such as hyperactivity, and lower social competency. Premature infants have more SDB problems than full-term infants. We wondered whether there is a relationship between sleep problems and emotional and behavior problems in preterm infants. Materials and methods: We enrolled neonates of gestational age less than 37 weeks. Basic obstetric and birth data were collected as baseline data. The participants were followed up at 6, 12, 18, and 24 months and at every 6 months of corrected age. Premature infants were tested by actigraphy, and night-time polysomnography initially. They were followed up and evaluated for their sleep habit with Chinese Brief Infant Sleep Questionnaire (CBISQ) and sleep diary. They were also assessed development with Bailey-Scales of Infant Development (BSID) – II and the Denver Developmental Screening Test (DDST). These assessments were done and filled out by the parents or the caregivers at each visit. The infant emotional and social behavior were evaluated by Brief Infant-Toddler Social and Emo-

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tional Assessment (BITSEA), and Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant-Toddler Checklist. The raw data were analyzed with the software PASW Statistics (SPSS) version 18. Demographic statistics were performed by t test and chi-squared test. Correlation of emotional, behavior and sleep data was analyzed by Pearson’s correlation. Results: We enrolled 201 premature infants, but only 88 subjects completed all examination and questionnaire assessments at each visit. The mean of gestation age was 31.56 ± 3.19 weeks, and the mean of birth body weight was 1684.80 ± 543.04 g. Enrolled premature infants were divided into two groups: Group 1: premature infants with apnea–hypopnea index (AHI) > 1 and Group 2: infants with AHI < 1. DDST shows a highly significant difference in gross motor skill between Group 1 and Group 2. The other three categories also showed more problems in Group 1 than in Group 2. Although BSIDII results showed no significant difference between these two groups, MDI and PDI showed more problems in Group 1 than in Group 2. BITSEA showed significant difference in problem composition and competence composition (p = 0.000). In CSBS DP result, the symbolic composite is highly significant with p = 0.03. The means of the other three composites and total score were higher also in Group 1 than in Group 2. Conclusion: Our data showed that preterm infants with SBD have greater impairment in mental and motor development compared with those without SDB. Also the SDB-preterm infants have more emotional, social function, and symbolic behavior development delay. http://dx.doi.org/10.1016/j.sleep.2015.02.056

Relationship between oral flow patterns, nasal airway, and respiratory events during sleep M. Suzuki Department of Otolaryngology, Teikyo University Chiba Medical Center, Japan

Introduction: We hypothesized that different kinds of oral flow (OF) patterns exist during sleep. The aim of this study was to clarify the relationship between OF patterns, nasal airway obstruction, and obstructive respiratory events such as flow limitation, RERA, hypopnea, and apnea. Materials and methods: We conducted an observational crosssectional study of 85 Japanese adults. Nasal flow and OF were measured separately by PSG. Nasal air flow was measured with pressure and thermistor sensors at the nostrils. For the OF measurement, another pressure sensor cannula with its tip cut off was positioned 2 cm in front of the lips. Nasal resistance was measured with an anterior rhinomanometer in the supine position 1 h before sleep studies. On the basis of nasal endoscopy and X-ray findings, subjects were classified as those with or without nasal obstruction: those with nasal obstruction had nasal resistance ≥ 0.41 Pa/cm3/s and nasal disease such as nasal deviation, nasal allergy, or nasal polyp; those without nasal obstruction were those with nasal resistance ≤ 0.18 Pa/cm3/s and no nasal disease or complaints of nasal obstruction. Results: OF could be divided into three main patterns: OF after a respiratory event (OF post-event), OF during a respiratory event (during-event OF), and spontaneous arousal-related OF (SpArrelated OF). OF post-event refers to OFs that begin at the end of flow reduction, are preceded by respiratory arousal, and are accompanied by postapneic hyperventilation. During-event OF refers to OFs that occur during nasal flow reduction. SpAr-related OF refers to OFs