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Delayed chemoreceptor responses in infants with apnoea

Correspondence to:
Correspondence to:
Assoc. Prof. M Katz-Salamon
Dept for Women’s and Child Health, Karolinska Institute, Elevhemmet H1O2, S-171 76 Stockholm, Sweden; miriam.katz-salamon{at}ks.se

Aims: To test the hypothesis that apnoea of infancy (AOI) is due to a deficit in chemoreception.

Methods: Tests were performed on 112 infants: 43 healthy control infants, 28 infants with periodic breathing or central apnoea (PBCA), and 41 infants with obstructive apnoea (OA) on overnight polysomnography. Chemoreceptor responses to hypercapnia (4% and 6% CO₂ in air) for 6–8 minutes and hyperoxia (100% O₂) for 60 seconds were expressed in terms of response strength and reaction time. Age at birth (gestational week 37–41) and age at test (2–34 postnatal weeks) were comparable across groups (median, min–max value). A total of 70 CO₂ and 71 O₂ tests were analysed.

Results: The strongest and fastest CO₂ responders were control infants: their median increase in ventilation was 291%/kPaCO₂ and their reaction time 16 breaths. In infants with PBCA and OA, the increase in ventilation was 41% and 130%/kPaCO₂, and reaction time 64 and 54 breaths, respectively. There was a significant negative correlation between CO₂ response strength and response time. In response to hyperoxia there was a comparable decrease in ventilation in all infants (12–20%), but a significantly longer response time in infants with apnoea (20 v 12 breaths). There was no correlation between the response strength and response time to O₂ and CO₂.

Conclusion: An inappropriate central control of respiration is an important mechanism in the pathogenesis of apnoea of infancy.

Abbreviations: ALTE, apparent life threatening event; AOI, apnoea of infancy; CA, central apnoea; OSA, obstructive sleep apnoea; PB, periodic breathing; PBCA, periodic breathing and central apnoea

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