Sleep-disordered breathing, craniofacial development, and neurodevelopment in premature infants: a 2-year follow-up study

Introduction: Sleep problems, neuro-developmental development, and sleep-disordered-breathing (SDB), are reported as more prevalent in premature infants than in full-term infants. We investigated the relationship between neuro-development, and SDB in preterm infants at 24 months corrected age (CA) with a narrow palatal presentation over time.

Methods: We enrolled infants 40 weeks or younger at birth collecting obstetric and birth data. Participants were followed up at 6, 12, 18, and 24 months CA. We evaluated craniofacial development by inspecting and photo documenting hard palate; sleep using sleep diary, actigraphy and night-time polysomnography-PSG-; and development using Bayley- Scales-of-Infant-Development and Denver-Developmental-Screening-Test (DDST) at each visit and comparing results at six months and two years.

Results: 244 premature infants [139 (57.0%) boys, [at birth: mean gestational age-GA- 31.5 ± 3.2 weeks, 1691.9 ± 593.9 g, 40.2 ± 5.2 cm], and 30 full term infants (50% boys), [mean GA 39.3 ± 1.0 weeks, 3131.0 ± 390.0 g, and 49.38 ± 2.0 cm] were enrolled in the study. At 6 and 24 months, 65.2% premature infants had a narrow hard palate (NHP). At 24 months, 79% had an apnea-hypopnea- index (AHI) > 1 events/hour at PSG, with a mean AHI of 3.00 ± 2.95. Only 10% of full term infants had NHP at birth and the mean AHI was 0.5 ± 0.2 event/hour at 24 months.

Conclusion: Preterm infants have a higher occurrence of NHP at birth. At two years of age they have more sleep problems, most commonly associated with obstructive-SDB, and a higher rate of development delays. Frequency of NHP is still abnormally high, suggesting not only abnormal orofacial growth over-time, but also impact of this abnormal growth in the genesis of the obstructive-SDB.