• Keren Armoni Domany, Md Monir Hossain, Leonardo Nava-Guerra, Michael C Khoo, Keith McConnell, John L Carroll, Yuanfang Xu, Mark DiFrancesco, and Raouf S Amin.
• 1 Division of Pulmonary Medicine.
• Am. J. Respir. Crit. Care Med. 2018 Jun 15; 197 (12): 159616031596-1603.

RationaleThe contribution of ventilatory control to the pathogenesis of obstructive sleep apnea (OSA) in preterm-born children is unknown.ObjectivesTo characterize phenotypes of ventilatory control that are associated with the presence of OSA in preterm-born children during early childhood.MethodsPreterm- and term-born children without comorbid conditions were enrolled. They were categorized into an OSA group and a non-OSA group on the basis of polysomnography.Measurements And Main ResultsLoop gain, controller gain, and plant gain, reflecting ventilatory instability, chemoreceptor sensitivity, and blood gas response to a change in ventilation, respectively, were estimated from spontaneous sighs identified during polysomnography. Cardiorespiratory coupling, a measure of brainstem maturation, was estimated by measuring the interval between inspiration and the preceding electrocardiogram R-wave. Cluster analysis was performed to develop phenotypes based on controller gain, plant gain, cardiorespiratory coupling, and gestational age. The study included 92 children, 63 of whom were born preterm (41% OSA) and 29 of whom were born at term (48% OSA). Three phenotypes of ventilatory control were derived with risks for OSA being 8%, 47%, and 77% in clusters 1, 2, and 3, respectively. There was a stepwise decrease in controller gain and an increase in plant gain from clusters 1 to 3. Children in cluster 1 had significantly higher cardiorespiratory coupling and gestational age than clusters 2 and 3. No difference in loop gain was found between clusters.ConclusionsThe risk for OSA could be stratified according to controller gain, plant gain, cardiorespiratory coupling, and gestational age. These findings could guide personalized care for children at risk for OSA.

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