Sigh-induced changes of breathing pattern in preterm infants

Kerstin Jost, Philipp Latzin, Sotirios Fouzas, Elena Proietti, Edgar W Delgado-Eckert, Urs Frey, Sven M Schulzke, Kerstin Jost, Philipp Latzin, Sotirios Fouzas, Elena Proietti, Edgar W Delgado-Eckert, Urs Frey, Sven M Schulzke

Abstract

Sighs are thought to play an important role in control of breathing. It is unclear how sighs are triggered, and whether preterm birth and lung disease influence breathing pattern prior to and after a sigh in infants. To assess whether frequency, morphology, size, and short-term variability in tidal volume (VT) before, during, and after a sigh are influenced by gestational age at birth and lung disease (bronchopulmonary dysplasia, BPD) in former preterm infants and healthy term controls measured at equivalent postconceptional age (PCA). We performed tidal breathing measurements in 143 infants during quiet natural sleep at a mean (SD) PCA of 44.8 (1.3) weeks. A total of 233 sighs were analyzed using multilevel, multivariable regression. Sigh frequency in preterm infants increased with the degree of prematurity and severity of BPD, but was not different from that of term controls when normalized to respiratory rate. After a sigh, VT decreased remarkably in all infants (paired t-test: P < 0.001). There was no major effect of prematurity or BPD on various indices of sigh morphology and changes in VT prior to or after a sigh. Short-term variability in VT modestly increased with maturity at birth and infants with BPD showed an earlier return to baseline variability in VT following a sigh. In early infancy, sigh-induced changes in breathing pattern are moderately influenced by prematurity and BPD in preterm infants. The major determinants of sigh-related breathing pattern in these infants remain to be investigated, ideally using a longitudinal study design.

Keywords: Bronchopulmonary dysplasia; control of breathing; preterm infant; sigh; variability.

© 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Figures

Figure 1
Figure 1
Representative tidal breathing traces of VT (A) and coefficient of variation in VT (CVVT) (B) for an infant with severe bronchopulmonary dysplasia (BPD) and a term healthy control infant. VT,pre, mean tidal volume over the first 30 breaths of the measurement; VT,post, mean tidal volume over the first five breaths after the sigh; VT,end, mean tidal volume over the last 30 breaths of the measurement; CVpre, CVpost, and CVend, coefficient of variation in VT,pre, VT,post, and VT,end, respectively; CVprior, coefficient ofvariation in VT over 15 breaths preceding a sigh.
Figure 2
Figure 2
Flow of patients through the phases of the study.
Figure 3
Figure 3
Short-term variation in tidal volume (CVVT) for different subgroups (Term Healthy; Preterm infants without BPD at 36 weeks GA; Preterm infants with BPD at 36 weeks GA). CVVT was measured using moving window technique at the start of the measurement (CVpre), prior to the sigh (CVprior), just after a sigh (CVpost), and at the end of a measurement (CVend).

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