pii: jc-18- 00514https://dx.doi.org/10.5664/jcsm.

7670

S CI E NT IF IC IN VES TIGATIONS

Polysomnography Reference Values in Healthy Newborns

Ameet S. Daftary, MBBS, MS1; Hasnaa E. Jalou, MD1; Lori Shively, RN1; James E. Slaven, MS2; Stephanie D. Davis, MD3
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana;
1

Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana; 3Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
2

Study Objectives: Polysomnography (PSG) is increasingly used in the assessment of infants. Newborn PSG reference values based on recent
standardization are not available. This study provides reference values for PSG variables in healthy newborn infants.
Methods: Cross-sectional study of normal term newborn infants using standardized PSG collection and American Academy of Sleep Medicine
interpretation criteria.
Results: Thirty infants born between 37 and 42 weeks gestation underwent PSG testing before 30 days of age (mean 19.6 days). The infants had a mean
sleep efficiency of 71% with average proportions of transitional, NREM and REM sleep estimated at 16.1%, 43.3% and 40.6% respectively. Mean arousal
index was 14.7 events/h with respiratory arousal index of 1.2 events/h. Mean apnea-hypopnea index (AHI) was 14.9 events/h. Central, obstructive, and mixed
apnea indices were 5.4, 2.3, and 1.2 events/h respectively. Mean oxygen saturation in sleep was 97.9% with a nadir of 84.4%. Mean end tidal CO2 was 35.4
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mmHg with an average of 6.2% of sleep time spent above end-tidal CO2 45 mmHg and 0.6% above 50 mmHg.
Conclusions: The sleep efficiency was significantly lower and the AHI was significantly higher compared to healthy children older than 1 year. The AHI
was also higher than reported in healthy infants older than 1 month. These findings suggest current severity classifications of sleep apnea may not apply to
newborn infants.
Keywords: apnea, infant, polysomnography, sleep study
Citation: Daftarya AS, Jaloua HE, Shivelya L, Slavenb JE, Davisc SD. Polysomnography reference values in healthy newborns. J Clin Sleep Med.
2019;15(3):437–443.

BRIEF SUMMARY
Current Knowledge/Study Rationale: Polysomnography (PSG) is increasingly used in the assessment of young infants, notably for airway
obstruction. However, available reference data for PSG interpretation do not include newborns since procedural standardization by the AASM. Older
reference values have used nonstandard methodology.
Study Impact: This study provides reference values in healthy newborns to assist with PSG interpretation and clinical decision making on major
interventions at this vulnerable age.
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.

I N T RO D U C T I O N sleep apnea has been well documented to occur in the litera-

Infant apnea is clinically well recognized and has been a sub-
ject of considerable research over the years because of concerns
for its association with sudden infant death syndrome,1 airway
obstruction especially with craniofacial and chromosomal ab-
normalities,2–4 and decreased respiratory reserve in chronic
lung disease.5 Infants spend significant amounts of each day
asleep; therefore, it is intuitive that those prone to apnea would
experience such events during sleep. Newborns have a higher
predisposition to apnea during sleep due to various physiologic
limitations including immature control of breathing, as well
as higher upper airway and chest wall compliance resulting in
a lower respiratory reserve.6–9 Nerve conduction delays due to
neuronal immaturity have been associated with apnea in neo-
nates.10 The Collaborative Home Infant Monitoring Evaluation
study corroborated this by demonstrating a higher prevalence
of apnea in infants younger than 42 weeks postconceptional
age, with a maturational decline in frequency of events.1 Infant
ture11; however, little is known about the long-term outcome
of the condition and therefore clinicians are constantly facing
dilemmas regarding when intervention is necessary.
Polysomnography (PSG) is the gold standard test to evalu-
ate for sleep apnea, and several studies have been performed
over the years in healthy children with the goal of establish-
ing normative data.12–16 Studies involving PSG during infancy
have varied in testing methodology and largely excluded
neonates, restricting generalizability for clinical use in the
newborn age group.17 A review of infant PSG demonstrates
a much higher occurrence of respiratory disturbances com-
pared to older children.17 With the increasing use of PSG in
infant sleep assessment, the American Academy of Sleep
Medicine standardized this tool for infants and urged de-
velopment of reference values in healthy newborns.18,19 The
aim of our study was to describe the PSG findings in healthy
newborn infants using recently standardized testing and
interpretation criteria.20

Journal of Clinical Sleep Medicine, Vol. 15, No. 3 437 March 15, 2019
 AS Daftary, HE Jalou, L Shively, et al.
METHODS
Healthy newborn infants were enrolled from the nurseries of
regional hospitals in the Indianapolis metropolitan area. Infor-
mational posters regarding the study were posted in the postna-
tal wards of area hospitals as a source of awareness. A financial
incentive was offered to participants. Newborns were recruited
for the purposes of this study and were not part of a cohort of
participants in other research studies at our institution. Indi-
viduals were identified after direct contact from families inter-
ested in participation. The maternal and infant medical records
of potential participants were then screened for suitability for
study participation. Any missing information was subsequently
acquired by direct contact between the family and the study
coordinator (LS). The study was approved by the Indiana Uni-
versity School of Medicine Institutional Review Board and in-
formed consent was obtained from all parents. Newborns were
defined as infants younger than 31 days for the purposes of this
study. PSG tests were performed at the American Academy of
Sleep Medicine (AASM) accredited sleep laboratory at Riley
Hospital for Children at Indiana University Health. We included
healthy newborns born at 38 to 42 weeks gestation determined
based on postmenstrual age, to mothers aged 17 to 40 years
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at the time of delivery. Mothers who were on prenatal vita-
mins and had received courses of antibiotics during pregnancy
and labor were included. As neonates typically sleep for 3 to
4 hours between awakenings for feedings, we included all in-
fants who had at least 2.5 hours of sleep time with presence of
both REM and NREM sleep. Exclusion criteria included infants
born to mothers with any chronic medical illness or gestational
complications (hospitalization for hyperemesis gravidarum,
antepartum bleeding that required hospitalization or surgical
management, gestational diabetes that required more than diet
control, pregnancy induced hypertension needing any inter-
vention, antenatal steroid use or substance abuse, history of a
medical or surgical illness that required hospitalization during
pregnancy). Additional exclusion criteria included history of
maternal smoking during or after pregnancy, any resuscitation
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.
at birth beyond airway suction and blow by oxygen for more
than 5 minutes, congenital anomalies, gastroesophageal reflux
requiring treatment, hypotonia, feeding difficulties, meconium
stained amniotic fluid, neonatal respiratory illness—including
transient tachypnea of the newborn, apnea, stridor or stertor, hy-
perbilirubinemia requiring phototherapy, genetic or metabolic
problems and a family history of childhood apnea, congenital
heart disease, metabolic disorders, inherited neurologic disor-
ders, stillbirth, or sudden infant death syndrome. Participants
were evaluated by a board certified pediatric sleep medicine
physician on the day of the PSG to ensure there were no health
concerns. A detailed clinical assessment to ensure newborns
were healthy, with no respiratory concerns including snoring,
stridor, and tachypnea, was performed by the physician.
PSG tests were attended, performed at an altitude of 732 feet
above sea level, at ambient temperature of 20–23°C, and lasted
6 hours. Infants were studied in the supine position in a crib,
clothed, and swaddled. The infants were allowed to feed and to
use pacifiers during the study. Because neonates do not have es-
tablished circadian rhythms, the studies were performed during
Journal of Clinical Sleep Medicine, Vol. 15, No. 3
Polysomnography in Healthy Newborns
the daytime—9:00 am to 3:00 pm. PSG tests were performed in
technical accordance with standards proposed by the AASM, by
a single registered polysomnography technician for consistency
in collection. We collected electroencephalogram (placement of
frontal [F3,F4], central [C3,C4], occipital [O1, O2] referenced to
the opposite mastoid electrodes [M1,M2]), electro-oculogram,
electromyogram (chin and both legs), electrocardiogram, pres-
sure transducer and thermistor airflow, uncalibrated respira-
tory inductance plethysmography, oximetry, and end-tidal CO2
(ETCO2) data with video monitoring of the study for scoring
support. All studies were scored by a single pediatric pulmo-
nologist board certified in sleep medicine (AD), in accordance
with the pediatric scoring rules proposed by the AASM. In ad-
dition to the routine PSG variables and indices recommended by
the AASM, we calculated a respiratory arousal index for each
infant, as the frequency of arousals per hour that followed respi-
ratory events within 1 second of event termination. Fifteen stud-
ies were re-analyzed by a second board-certified pediatric sleep
medicine physician (HJ) for quality control. Scorers were not
blinded to the study goal. The interscorer agreement was high
with a mean kappa statistic of 0.9. PSG variable data were col-
lected using the following equipment: Natus SleepWorks PSG
software (Pleasanton, California, United States), nasal airflow
and side stream ETCO2 sampling using nasal sensors (Dyna-
medix Diagnostics, Shoreview, Minnesota, United States; Salter
Labs, Arvin, California, United States), Protech 2 channel pe-
diatric thermistor (Philips Respironics, Murrysville, Pennsyl-
vania, United States), oximetry (Massimo Radical 7, Irvine,
California, United States), and respiratory inductance pleth-
ysmography (PerfectFit, Dynamedix Diagnostics, Shoreview,
Minnesota, United States), and Capnography (Capnocheck Plus,
Smiths Medical PM, Inc, Waukesha, Wisconsin, United States).
Statistical Analysis
Univariate analyses were performed for both descriptive pur-
poses and to determine the distributions of the variables of in-
terest. Correlation analyses and analyses of variance (ANOVAs)
were performed to test for associations between the PSG vari-
ables of interest and the independent clinical and demographic
variables, with correlation analyses being performed with
continuous independent variables and ANOVA models being
performed with categorical independent variables. If variables
were skewed, Spearman nonparametric analyses were per-
formed for continuous variables and log transformations were
performed on the PSG variables when necessary for ANOVAs,
to follow ANOVA assumptions. All analyses were performed
using SAS v9.4 (SAS Institute, Cary, North Carolina, United
States). The value of significance was P < .05 in this study.
R ES U LT S
A total of 38 healthy newborns were enrolled in the study, of
whom 31 underwent PSG. Seven infants did not show for the
PSG within the newborn period and were excluded. One re-
cord from the 31 completed studies was excluded due to cor-
ruption of the raw data after collection; therefore, data from
30 newborns were analyzed and are reported (Figure 1).
438 March 15, 2019
 AS Daftary, HE Jalou, L Shively, et al. Polysomnography in Healthy Newborns

Demographic and clinical information on the participants is statistically significant correlations between the AHI or peri-
summarized in Table 1. Twelve males and 18 female infants odic breathing and the following variables: birth weight, birth
participated. Twenty (66.7%) were Caucasian, four (13.3%) length, gestational age, maternal age, Apgar score, birth order,
were African American, and six (20%) were Latino or part or age at time of study.
Latino-Caucasian. Twenty-six babies were delivered vaginally The median oxygen saturation during sleep was 98% with
and four were delivered via cesarean section. The mean age at nadir of 85% (range: 95.5 to 99.7% and 69 to 93% respectively).
time of study was 19.6 days (median 19.5, range 7 to 30 days). The median proportion of sleep time less than 90% oxygen satu-
Sleep architectural variables are summarized in Table 2 and ration was 0.3% of total sleep time (range 0 to 2%). The median
respiratory variables in Table 3. The mean duration of NREM
sleep was 111.5 minutes (range 69–145); REM sleep, 105.3
minutes (33–151.5); and transitional, 40 minutes (15–68.5). Figure 1—Study consort diagram.
The mean apnea-hypopnea index (AHI) was 14.9 events/h
(median 14.5, range 1 to 37), with hypopneas being the most 38 newborns enrolled
common respiratory events, followed by central, obstructive,
and then mixed sleep apneas. There was a preponderance of
respiratory events in REM sleep for a mean REM AHI of 23.6
7 newborns did not show or withdrew
events/h (median 20.6, range 2 to 92.6). The mean duration
of central apneas was 5.7 seconds (median 5.6, range 4.3 to
8.1) with an average maximum duration of 8.3 seconds (me-
dian 8.4, range 4.3 to 13.8). The mean duration of obstructive 31 newborns completed
apneas was 6 seconds (median 5.9, range 4.6 to 8.3) with an
average maximum duration of 7.6 seconds (median 7.5, range
4.9 to 11.5) and the mean duration of mixed apneas was 6.6 sec-
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1 record was corrupted and excluded

onds (median 6.7, range 4.3 to 9.2) with an average maximum
duration of 8 seconds (median 7.5, range 4.9 to 13.5). The mean
duration of hypopneas was 6.8 seconds (median 6.7, range 4.9
to 9.7) with an average maximum duration of 11.2 seconds (me- 30 PSG tests per goal analyzed
dian 10.8, range 7.3 to 17.3 seconds). Periodic breathing was
present in 12 of the newborns (40%) for a mean of 1.16% of
total sleep time (median 0, range 0 to 11.3%). We did not find PSG = polysomnography.

Table 1—Demographic and clinical characteristics (n = 30).

Variable
Sex, male (n) 12
Race Caucasian (n = 20), African American (n = 4), other (n = 6)
Mean Standard Deviation Median Range
Gestational age (weeks) 39.3 0.8 39.0 38.0–41.0
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.

Age at time of study (days) 19.6 6.6 19.5 7.0–30.0

Birth weight (kg) 3.3 0.5 3.3 2.5–4.5
Birth length (cm) 50.7 2.6 50.4 44.5–56.0
Apgar score at 10 minutes 8.9 0.5 9.0 7.0–10.0
Maternal age (years) 28.1 5.6 29.2 19.5–37.9

Table 2—Sleep architecture variables.

Variable Mean Standard Deviation Median Range
TST (minutes) 260.5 43.9 258.3 160.0–362.0
Sleep efficiency (%) 71.9 8.8 72.1 47.0–85.7
Transitional sleep (%TST) 16.1 4.8 15.7 6.1–28.7
NREM sleep (%TST) 43.3 7.3 44.5 27.6–61.5
REM sleep (%TST) 40.6 7.4 41.1 19.5–56.3
Total arousal index (events/h) 14.7 3.9 13.9 6.2–22.3
Awakening index (events/h) 8.1 2.3 8.0 4.1–13.8
Respiratory arousal index (events/h) 1.2 0.7 1.1 0.0–3.2

NREM = non-rapid eye movement, REM = rapid eye movement, TST = total sleep time.

Journal of Clinical Sleep Medicine, Vol. 15, No. 3 439 March 15, 2019
 AS Daftary, HE Jalou, L Shively, et al. Polysomnography in Healthy Newborns

Table 3—Respiratory variables during sleep.

Variable Mean Standard Deviation Median Range
Apnea-hypopnea index (events/h) 14.9 9.1 14.5 1.0–37.7
Central apnea index (events/h) 5.4 6.2 3.3 0.0–27.2
Obstructive apnea index (events/h) 2.3 2.5 1.8 0.2–12.5
Mixed apnea index (events/h) 1.2 1.5 0.9 0.0–8.3
Hypopnea index (events/h) 6.3 3.4 5.9 0.7–12.9
Mean SpO2 (%) 97.9 1.2 98.2 95.5–99.7
Nadir SpO2 (%) 84.4 4.8 85.0 69.0–93.0
Oxygen desaturation index (events/h) 17.6 11.0 16.6 0.5–41.0
Time < SpO2 90% (%) 0.5 0.5 0.3 0.0–2.0
Mean ETCO2 (mmHg) 35.4 4.7 35.4 27.0–47.0
Mean max ETCO2 (mmHg) 46.1 4.5 46.2 36.5–55.0
Time > ETCO2 45 mmHg (%) 6.2 14.3 0.1 0.0–54.3
Time > ETCO2 50 mmHg (%) 0.6 2.5 0.0 0.0–12.9

ETCO2 = end tidal carbon dioxide, SpO2 = oxygen saturation.

Table 4—Published PSG parameter values in healthy infants.

Brockmann Brockmann
Variable Daftary et al. Duenas-Meza et al. Scholle et al.*
et al. et al.
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n 30 37 37 106 22
Age group < 30 days 1 month 3 months < 45 days 1.1–1.7 years
AASM staging AASM staging and respiratory
No sleep staging, No sleep staging, Non-AASM staging
Methodological differences and respiratory scoring for age, 2 different
no ETCO2 no ETCO2 criteria used, no ETCO2
scoring for age PSG software, no ETCO2
Altitude above sea level 732 feet N/A N/A 5,250 feet
Sleep efficiency (%) 71.9 N/A N/A 79.7 87.9
NREM sleep (%TST) 43.3 N/A N/A 45.9 73.0
REM sleep (%TST) 40.6 N/A N/A 53.2 25.6
Transitional sleep (%TST) 16.1 N/A N/A N/A N/A
Arousal index (events/h) 14.7 N/A N/A 19.0 8.5
Respiratory arousal index (events/h) 1.2 N/A N/A 1.6 N/A
Median duration CA (seconds) 5.6 5.1 5.1 N/A
Median duration OA (seconds) 5.9 5.1 5.1 N/A Mean duration of respiratory
Median duration MA (seconds) 6.7 6.8 6.8 N/A events = 7.9 seconds
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.

Median hypopnea duration (seconds) 6.7 6.6 6.6 N/A

Apnea-hypopnea index (events/h) 14.9 7.8 4.9 21.4 2.8
Mean SpO2 (%) 97.9 N/A N/A 92.5 98.0
Nadir SpO2 (%) 84.4 N/A N/A 70.0 92.0
Time < SpO2 90% (%) 0.5 N/A N/A 10.3
Oxygen desaturation index (events/h) 17.6 8.2 7.5 REM 91.7; NREM 47.1 0.1
Mean ETCO2 (mmHg) 35.44 N/A N/A N/A N/A
Mean time > ETCO2 45 mmHg (%) 6.2 N/A N/A N/A N/A

* = data compiled from the same participants published in three different manuscripts by authors. CA = central apnea, ETCO2 = end tidal carbon dioxide,
MA = mixed apnea, NREM = non-rapid eye movement, OA = obstructive apnea, ODI = oxygen desaturation index, PSG = polysomnography, REM = rapid
eye movement, SpO2 = oxygen saturation, TST = total sleep time.

ETCO2 in sleep was 35.4 mmHg with a peak of 46.2 mmHg.
Ten infants spent more than 1% of total sleep time above an
ETCO2 of 45 mmHg, of whom three spent more than 25% of
total sleep time above an ETCO2 of 45 mmHg. Two newborns
spent sleep time above an ETCO2 of 50 mmHg and none had
more than 5% of total sleep time above an ETCO2 50 mmHg.
D I SCUS S I O N
To our knowledge this is the first study that provides PSG ref-
erence values for infants younger than 1 month utilizing the
recently standardized AASM testing and scoring guidelines.20
Our data corroborate that newborns spend relatively equal

Journal of Clinical Sleep Medicine, Vol. 15, No. 3 440 March 15, 2019
 AS Daftary, HE Jalou, L Shively, et al.
Figure 2—Comparison of ETCO2 tracings.
Top: ETCO2 tracing of a 16-year-old. Bottom: ETCO2 tracing of a study
participant. Top tracing shows plateauing of the wave form, barely seen
in the newborn ETCO2 tracing. ETCO2 = end-tidal carbon dioxide.
proportions of time in NREM and REM sleep (after excluding
transitional sleep).21 Respiratory events were common in our
participants, with most being brief and less than 10 seconds
in duration. No events exceeded 20 seconds duration in our
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study. The AHI was higher in our newborns than established
normative data in older children12,13,22 with a higher prevalence
of respiratory events in REM as compared to NREM sleep.23
Oxygen desaturations were common in our participants, but
brief and self-resolving, with a cumulative sleep time spent
below a saturation of 90% never exceeding 2% of total sleep
time. The mean ETCO2 was lower in our participants than in
older children14 and exceeded 50 mmHg in fewer than 1% of
the participants.
Previously published literature on respiratory and sleep
parameters in infants has used varying methodology limiting
current clinical generalizability.17 Although our study used the
new sleep staging recommendations from the AASM, the sleep
efficiency, arousal indices and relative proportions of REM
and NREM sleep are similar to data from previously reported
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.
literature21,23 (Table 4). Consistent with previously reported
data using PSG in infants, our study shows that the mean AHI
in healthy newborns is higher than older children.17,24,25 Our
study revealed that hypopneas are the most frequent respira-
tory events, followed by central apneas, obstructive apneas
and mixed apneas, in that order. Brockmann et al. reported
reference values for respiratory events in healthy infants at 1
and 3 months of age and also found central apneas to be more
prevalent than obstructive apneas, which in turn were more
prevalent than mixed apneas; however, their hypopnea index
was much lower than in our study.24 Potential explanations
may be the older age of participants, differences in sensitiv-
ity of their monitoring equipment, altitude of the study (not
reported), or underestimation of hypopneas (if significant por-
tions of nasal airflow data were disregarded due to artifact as
was implied). The duration of respiratory events was similar
between Brockmann et al. and our study (Table 4). Brock-
mann et al. and Duenas-Meza et al.25 reported that obstructive
respiratory events are normal in infants. Obstructive respira-
tory events have been described based on airway endoscopy in
Journal of Clinical Sleep Medicine, Vol. 15, No. 3
Polysomnography in Healthy Newborns
Figure 3—Distribution of AHI by age of newborns.
AHI = apnea-hypopnea index.
infants, and are attributed most commonly to airway dynamic
collapse with trend towards spontaneous resolution with air-
way maturation26,27
Although there is some lack of consensus, an AHI > 1 event/h
is considered abnormal in the pediatric age group, which is
based off normative data from older children.13,28 Using such a
low threshold can potentially result in overtreatment of sleep
apnea in young infants, particularly if treatment guidelines
from the American Academy of Pediatrics were extrapolated
to this age group.29 Our study results support consideration of
a different severity classification for sleep apnea in infancy.
The AASM defines pediatric hypoventilation as > 25% of total
sleep time above an ETCO2 of 50 mmHg.30 The faster respira-
tory rates of young infants preclude plateauing of the ETCO2
wave form (Figure 2), resulting in the potential for underesti-
mation of CO2 as compared to formal blood gas testing. It is
therefore not surprising that the CO2 values we report are lower
than those in normative data studies performed in older chil-
dren. Our study shows that capnography can be performed in
newborns and provides reference values for noninvasive CO2
estimation using this modality. Capnography data have not
been described by Brockmann et al. or Duenas-Meza et al. in
their infant PSG reference studies.
With the increasing use of PSG in treatment decisions rang-
ing from apparent life-threatening episodes (now brief resolved
unexplained events), to oxygen supplementation in neonatal
chronic lung disease, to surgical interventions for neonatal
airway obstructive disorders, reference values from healthy
infants are important for treatment decisions.3,5,31 Although the
AHI is the most commonly used index to base clinical deci-
sions, our data show a wide range in this index in newborns.
As seen in Figure 3, there is considerable intersubject vari-
ability in the AHI. We did not find significant correlations with
demographic variables to explain this variance, which could
be partly because of our small sample size, but may also be
a reflection of the inherent immaturity of control of breath-
ing and immature pulmonary physiology characteristic of this
age group. The oxygen saturation nadir in our study is lower
441 March 15, 2019
 AS Daftary, HE Jalou, L Shively, et al.
than in normative data studies performed at older ages. This
can be explained by the respiratory physiologic limitations at
this age.32 These limitations include not only the need to dy-
namically maintain functional residual capacity above closing
volume, but also the predominance of fetal hemoglobin in the
newborn with its parabolic oxygen dissociation curve enabling
rapid desaturation when O2 reserves are depleted.
Our study has several limitations, including potential for se-
lection bias from those interested and completing the study as
well as an overrepresentation of Caucasians. Our study has a
relatively small number of participants along with exhaustive
exclusion criteria that may limit generalizability to all popula-
tions. The results show a high degree of variance, which may
also be a consequence of the sample size. Currently recom-
mended hypopnea scoring guidelines by the AASM render
it challenging to clearly distinguish obstructive from central
hypopneas due to physiologic thoracoabdominal asynchrony
at this age. We did not use esophageal pressure monitoring to
differentiate hypopneas as obstructive versus central, which
can be helpful in this regard. Because of funding constraints,
our cross-sectional study is unable to provide follow-up PSG
data in the study participants to document the trajectory of re-
spiratory events over time. Such a follow-up study would be
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required to provide true normative data on sleep and PSG vari-
ables through infancy.
CO N CLUS I O N S
Our study provides reference values for sleep architecture, re-
spiratory events, and gas exchange in healthy newborns using
standardized PSG methodology. The study suggests that as-
ymptomatic newborns can have a wide range of obstructive
and central respiratory events. We hope our data will provide
a guide to newborn PSG interpretation, as this diagnostic mo-
dality is increasingly used for clinical management. Studies
with larger numbers of healthy neonates serially monitored by
PSG over several time points through infancy will be helpful
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.
in confirming the high variance of events and establishing nor-
mative data by describing the natural progression of the AHI
with age and maturation during this critical period of growth
and development.
A B B R E V I AT I O N S
AASM, American Academy of Sleep Medicine
AHI, apnea-hypopnea index
ETCO2 , end tidal carbon dioxide
O2 , oxygen
PSG, polysomnography
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ACK N O W L E D G M E N T S
The authors thank the families that participated in this study and the staff that
supported its execution. We also acknowledge the grant support by the Department
of Pediatrics, Indiana University School of Medicine to enable this study.
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Journal of Clinical Sleep Medicine, Vol. 15, No. 3 443 March 15, 2019