A reexamination of "the apnea monitor business"

Abstract

Home monitoring is usually considered for 2 types of patients: the otherwise healthy premature infant whose hospitalization is prolonged because of recurrent apneic and cyanotic episodes and the healthy infant who, at home, develops apneic and cyanotic episodes of unknown etiology. Hospitalization for an indefinite period of time is associated with high costs, utilization of nursing personnel, separation of the infant from the family unit and a general disruption of family activity. Conversely, discharging the infant with a monitoring system alters the family''s life-style and requires that parents be available and capable of providing effective resuscitation if necessary. The final decision must be made on an individual basis after discussion with the parents. At present, the apnea monitors in general use are designed to alarm during periods of diaphragmatic apnea and will not identify the occurrence of upper airway obstruction. The distinction between diaphragmatic apnea and upper airway obstruction points out the importance, for management, in clarifying the underlying pathophysiology when evaluating infants who have sleep-associated hypoxic or cyanotic episodes.