title: Obstructive sleep apnea in the formerly preterm infant: an overlooked diagnosis.
abstract: BACKGROUND
  Obstructive sleep apnea syndrome (OSA) is a frequent disorder in children. The clinical characteristics of OSA in very young children under 2 years of age, and more particularly, in those born prematurely, and who have respiratory complications such as bronchopulmonary dysplasia (BPD), are not well defined. We therefore retrospectively reviewed our experience in a group of preterm infants with OSAS.
  
  
  METHODS
  The records of premature infants with BPD followed in the Pediatric Pulmonary Clinic at the University of Chicago who were diagnosed with OSA from 2004 to 2009 were reviewed and analyzed.
  
  
  RESULTS
  Twelve children, eight males, and four females with a mean gestational age of 27 weeks were found to have OSA. Mean age at diagnosis was 19 months. Inability to wean nighttime oxygen, the need to resume oxygen after intercurrent respiratory illness, and snoring were the most common presenting symptoms. The apnea-hypopnea index ranged from 1 to 120/h total sleep time (TST; mean: 29). SpO(2) nadir ranged from 50 to 91%. Despite adenotonsillectomy (AT), all children had persistent sleep disordered breathing.
  
  
  CONCLUSIONS
  In preterm infants, while snoring is a frequent symptom, poor weight gain, and inability to wean nighttime oxygen may indicate the need for further investigation for OSA. In the former preterm infant structural changes in the airway may play an important role along with adenotonsillar hypertrophy. A high level of clinical awareness is required to identify OSA in the formerly preterm infant.
authors.affiliation: Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Comer Children's Hospital, University of Chicago Chicago, IL, USA.
authors.forename: Preeti B
authors.initials: PB
authors.lastname: Sharma
authors.forename: Fuad
authors.initials: F
authors.lastname: Baroody
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.forename: Lucille A
authors.initials: LA
authors.lastname: Lester