Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age.

Abstract

RATIONALE:

Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain.

OBJECTIVES:

We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep.

METHODS:

A total of 201 ex-preterm children aged 5-12 years who participated as neonates in a double-blind, randomized, controlled clinical trial of caffeine versus placebo underwent actigraphy, polysomnography, and parental sleep questionnaires. Coprimary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography.

MEASUREMENTS AND MAIN RESULTS:

There were no significant differences in primary outcomes between the caffeine group and the placebo (adjusted mean difference of -6.7 [95% confidence interval (CI) = -15.3 to 2.0 min]; P = 0.13 for actigraphic total sleep time; and adjusted rate ratio [caffeine/placebo] for apnea-hypopnea index of 0.89 [95% CI = 0.55-1.43]; P = 0.63). Polysomnographic total recording time and total sleep time were longer in the caffeine group, but there was no difference in sleep efficiency between groups. The percentage of children with obstructive sleep apnea (8.2% of caffeine group versus 11.0% of placebo; P = 0.22) or elevated periodic limb movements of sleep (17.5% in caffeine group versus 11% in placebo group) was high, but did not differ significantly between groups.

CONCLUSIONS:

Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood. Ex-preterm infants, regardless of caffeine status, are at risk for obstructive sleep apnea and periodic limb movements in later childhood.

• Authors: Carole L Marcus, Lisa J Meltzer, Robin S Roberts, Joel Traylor, Joanne Dix, Judy D'ilario, Elizabeth Asztalos, Gillian Opie, Lex W Doyle, Sarah N Biggs, Gillian M Nixon, Indra Narang, Rakesh Bhattacharjee, Margot Davey, Rosemary S C Horne, Maureen Cheshire, Jeremy Gibbons, Lorrie Costantini, Ruth Bradford, Barbara Schmidt, Caffeine for Apnea of Prematurity–Sleep Study
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 190 Issue 7 Pg. 791-9 (Oct 01 2014) ISSN: 1535-4970 [Electronic] United States
• PMID: 25171195 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Central Nervous System Stimulants
• Caffeine

Topics

• Actigraphy (methods)
• Apnea (drug therapy)
• Caffeine (adverse effects, therapeutic use)
• Central Nervous System Stimulants (adverse effects, pharmacology)
• Child
• Child, Preschool
• Double-Blind Method
• Female
• Follow-Up Studies
• Humans
• Infant, Newborn
• Infant, Premature
• Infant, Premature, Diseases (drug therapy)
• Male
• Parents
• Polysomnography (methods)
• Prospective Studies
• Sleep (drug effects)
• Sleep Wake Disorders (chemically induced)
• Surveys and Questionnaires
• Time