Abstract â–¡ 167

A standardized set of questions and clinical evaluation was established in 1984 following previous investigations and was subsequently performed beginning in 1985 on infants referred for an apparent life threatening event (ALTE). All children that were submitted to this "core evaluation protocol" during a 10-year period were reviewed. Only children with a complete data set were included in the study. The systematic data collection included documentation of clinical complaints, symptoms and signs of sleep-disordered breathing, a sleep/wake evaluation, a systematic evaluation of the face and naso-oro-pharynx, nocturnal polygraphic recording, and systematic follow up. A total of 346 infants had complete data sets. We recruited a smaller group of 46 age-matched healthy infants as controls. These infants were investigated with the same "core evaluation" and compared to the referred infants.

The 346 referred infants were divided into two groups, A and B, based on the results of polygraphic investigation. Subgroup A, 42.6% of the population, included infants with no abnormal findings based on nocturnal polygraphic recording. These infants were no different than controls at initial evaluation and during follow-up. Subgroup B, 57.4% of the population, included infants with abnormal breathing during sleep that became more obvious over time. Subgroup B children were shown to have obstructive breathing during sleep at polygraphic recording. These last infants also had clinical symptoms of sleep-disordered breathing and had mild facial dysmorphia that became easier to recognize with aging. At 6 months of age, signs and symptoms seen initially in the children of subgroup B persisted and were more obvious. The ALTE was an indication of a sleep-disordered breathing syndrome that needs to be recognized early.