Cardioventilatory Control in Preterm Born Children and the Risk of Obstructive Sleep Apnea.
Rationale The contribution of ventilatory control to the pathogenesis of obstructive sleep apnea (OSA) in preterm born children is unknown. Objectives To characterize phenotypes of ventilatory control that are associated with the presence of OSA in preterm born children during early childhood. Methods Preterm and term born children without comorbid conditions were enrolled. They were categorized into OSA group and non-OSA group based on polysomnography. Measurements Loop gain, controller gain and plant gain, reflecting ventilatory instability, chemoreceptor sensitivity and blood gas response to a change in ventilation, respectively, were estimated from spontaneous sighs identified during polysomnography. Cardiorespiratory coupling, a measure of brainstem maturation, was estimated by measuring the interval between inspiration and the preceding electrocardiogram R-wave. Cluster analysis was performed to develop phenotypes based on controller gain, plant gain, cardiorespiratory coupling and gestational age. Results 92 children, 63 preterm (41% OSA) and 29 term (48% OSA) were included. 3 phenotypes of ventilatory control were derived with a risk for OSA being 8%, 47% and 77% in clusters 1, 2 and 3, respectively. There was a step-wise decrease in controller gain and an increase in plant gain from clusters 1 to 3. Children in cluster 1 had significantly higher cardiorespiratory coupling and gestational age compared to clusters 2 and 3. No difference in Loop gain was found between clusters. Conclusion The risk for OSA could be stratified according to controller gain, plant gain, cardiorespiratory coupling and gestational age. These findings could guide a personalized care to children at risk for OSA.