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Infant tidal flow–volume parameters and arousal state

Karen Eline Stensby Bains, Martin Färdig, Hrefna Katrín Gudmundsdóttir, Catarina Almqvist, Gunilla Hedlin, Live S. Nordhagen, Eva M. Rehbinder, Håvard O. Skjerven, Cilla Söderhäll, Riyas Vettukattil, Björn Nordlund, Karin C. Lødrup Carlsen
ERJ Open Research 2022 8: 00163-2022; DOI: 10.1183/23120541.00163-2022
Karen Eline Stensby Bains
1Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
2University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
8These authors contributed equally and share first authorship
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Martin Färdig
3Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
4Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
8These authors contributed equally and share first authorship
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  • For correspondence: martin.fardig@ki.se
Hrefna Katrín Gudmundsdóttir
1Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
2University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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Catarina Almqvist
4Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
5Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Gunilla Hedlin
3Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
4Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Live S. Nordhagen
6VID Specialized University, Oslo, Norway
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  • ORCID record for Live S. Nordhagen
Eva M. Rehbinder
2University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
7Dept of Dermatology, Oslo University Hospital, Oslo, Norway
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Håvard O. Skjerven
1Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
2University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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  • ORCID record for Håvard O. Skjerven
Cilla Söderhäll
3Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
4Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Riyas Vettukattil
1Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
2University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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Björn Nordlund
3Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
4Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Karin C. Lødrup Carlsen
1Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
2University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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Abstract

Background Infant lung function can be assessed with tidal flow–volume (TFV) loops. While TFV loops can be measured in both awake and sleeping infants, the influence of arousal state in early infancy is not established. The aim of the present study was to determine whether TFV loop parameters in healthy infants differed while awake compared to the sleeping state at 3 months of age.

Methods From the population-based Scandinavian Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) birth cohort, 91 infants had reproducible TFV loops measured with Exhalyzer® D in both the awake and sleeping state at 3 months of age. The TFV loops were manually selected according to a standardised procedure. The ratio of time to peak tidal expiratory flow (tPTEF) to expiratory time (tE) and the corresponding volume ratio (VPTEF/VE), as well as tidal volume (VT) and respiratory rate were compared using nonparametric tests.

Results The mean (95% CI) tPTEF/tE was significantly higher while awake compared to the sleeping state: 0.39 (0.37–0.41) versus 0.28 (0.27–0.29); with the corresponding VPTEF/VE of 0.38 (0.36–0.40) versus 0.29 (0.28–0.30). The VT was similar, while the respiratory rate was higher while awake compared to the sleeping state: 53 (51–56) breaths·min−1 versus 38 (36–40) breaths·min−1.

Conclusion Higher tPTEF/tE, VPTEF/VE and respiratory rate, but similar VT while awake compared to the sleeping state suggests that separate normative TFV loop values according to arousal state may be required in early infancy.

Abstract

Tidal flow–volume (TFV) loop measurements can be measured in awake and sleeping infants, but the differences in TFV parameters according to arousal state suggest the need for separate normative TFV values in early infancy https://bit.ly/3nTUxME

Introduction

Lung function is an important indicator of respiratory health. Impaired lung function in early infancy tracks into later life with increased risk of future respiratory diseases [1]. Although several techniques to measure infant lung function exist, few are feasible in clinical settings or larger epidemiological studies, if sleep or sedation is necessary to obtain sufficient collaboration for reproducible measurements. Tidal flow–volume (TFV) loop measurements require minimal cooperation beyond a calm infant [2], presenting compound measurements of lung function including the size of the conducting airways, mechanical characteristics of the lung [3] and respiratory control [4]. In addition, the technique may expose abnormal breathing patterns and airway obstruction [5]. To reduce intra-individual variation, lung function measurements should be standardised and performed under similar circumstances [6], including arousal state, which beyond infancy usually is in the awake state. Infants and children with obstructive airways diseases generally reach peak tidal expiratory flow (PTEF) earlier (and consequently after a smaller expiratory volume (VE)) during the expiratory phase [7]. The most commonly used TFV loop parameter is the ratio of time to peak tidal expiratory flow (tPTEF) to expiratory time (tE) [8], of which lower ratios have been demonstrated to capture airway obstruction [9, 10], associated with the development of asthma [8]. In a Norwegian longitudinal birth cohort study, reduced lung function in adolescents with asthma, atopic dermatitis and allergic rhinitis was present already at birth, observed as a lower ratio of tPTEF/tE measured in the awake state [11]. Another closely related TFV loop parameter is the ratio of volume at peak tidal expiratory flow (VPTEF) to VE, of which lower values have been reported in children with airway obstruction [7, 12].

Historically, TFV loop measurements have mostly been performed in sleeping or sedated infants [13], and according to existing guidelines measurements are commonly obtained during quiet sleep to enable the recording of undisturbed regular breathing [6]. Yet, there is a need for research on lung function techniques allowing for repeated measurements in awake young children [2]. One study from the early 1990s reported that TFV loop measurements in 19 infants appeared more stable in the awake, rather than in the sleeping arousal state [14]. The methodology at the time allowed sampling of maximum four loops per test, in contrast to present software, allowing longer sampling periods of representative TFV loops. The authors are unaware of other studies assessing the influence of arousal state on the tPTEF/tE and VPTEF/VE ratio in healthy infants. Therefore, this study aimed to determine if TFV loop parameters differed in the awake compared to sleeping state at 3 months of age, focusing on the most commonly used parameters including the tPTEF/tE and VPTEF/VE ratios.

Methods

Study design and study population

In the present study we included 91 infants with TFV loops measured both in the awake and sleeping state at the 3-month clinical investigations in the Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) study, a Scandinavian multicentre population-based prospective birth cohort described elsewhere [15]. Briefly, infants were recruited antenatally by enrolling their pregnant mothers in connection with the national routine ultrasound examination at ∼18 weeks gestational age (GA) at hospitals and separate maternal clinics at Oslo University Hospital and Østfold Hospital Trust (Norway) and in the region of Stockholm (Sweden). Mothers were recruited between December 2014 and October 2016, while their singleton or twin infants born without severe disease at a gestational age of ≥35 weeks were enrolled at birth. Infants attended regular follow-up visits after birth, the first at 3 months of age [15].

Informed written consent was collected from the mothers at enrolment, and parents at infant inclusion. The PreventADALL study was approved by the regional committee for medical and health research ethics in South-Eastern Norway (2014/518) and in Sweden (2014/2242-31/4), as well as registered at clinicaltrials.gov (NCT02449850).

Data collection

Lung function measurements

In the PreventADALL study, 1183 infants had at least one acceptable TFV loop measurement at 3 months of age: 899 in the awake state, 375 in the sleeping state, and 91 in both the awake and sleeping state. Overall, lung function measurements were performed prior to other investigations, in the arousal state in which the infants arrived at the study site, in order to ensure that infants were calm. If the first TFV measurement was conducted while the infant was asleep, a second test was attempted in the awake state. Infants were positioned in a supine position in the caregiver's lap or the cot, whichever was successful. Using the Exhalyzer® D (Eco Medics, Duernten, Switzerland), TFV loops were sampled through an ultrasound flow head and a dead-space reducer, with a carefully fitted face mask with an air-inflated rim, by a stable grip over the mouth and nose of the infant, using fingers to control for minimal leakage from the mask, according to existing guidelines [6, 16]. When the infant breathed calmly and evenly into the mask, loop sampling started, aspiring to record at least 10 consecutive breaths. Infants were considered “awake” if they were quietly alert (open eyes, lively face, quiet body movements) or actively alert (active face and body movements). Infants were considered “sleeping” if drowsy (closed eyes, dozing), lightly sleeping (moving while sleeping, startling at noises) or deeply sleeping (laying quietly without body movements). A dedicated group of trained personnel performed the TFV loop measurements, and three reviewers manually selected acceptable TFV loops using a set of standardised criteria according to a previously described method [17]. Infant arousal state was added as a comment in each test in the software programme, and therefore blinded evaluation of the TFV measurements and loop selection was not feasible.

Outcomes and definitions

The primary outcomes were the tPTEF/tE and corresponding VPTEF/VE ratios.

The secondary outcomes were the additional time and volume parameters, given in seconds and millilitres, as outlined in table 1. Additionally, the number of breaths available in each test, as well as respiratory rate and the mean intra-individual variation (given as standard deviation) are reported in the awake and sleeping state.

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TABLE 1

Outcomes and definitions

A tPTEF/tE <0.20 was pre-defined as a ratio value of interest, based on previous studies in awake infants identifying clinical and epidemiological associations to subsequent obstructive airway disease [8, 18, 19]. Ratios >0.25 in awake [18], sleeping [20, 21] or sedated [21–23] infants have previously been reported as normal [18, 20–23]. As we were interested in the lower range of the ratio tPTEF/tE, comparison of ratios below 0.20 and 0.25 between the awake and sleeping measurements were reported.

Statistical analyses

Data are presented in numbers and percentages or mean (95% CI) or mean±sd. Comparisons between measurements with skewed distribution in the awake and sleeping state were performed by Wilcoxon signed-rank tests of paired samples. The McNemar test was conducted to compare cut-off values of the tPTEF/tE and VPTEF/VE ratios between the two arousal states. Conditional logistic regression was used to estimate odds and probability for defined cut-off values of the two ratios between paired awake and sleeping measurements. The statistical significance was set to 0.05. Statistical analyses were conducted using IBM SPSS Statistics 26 software. This project used data from the PreventADALL project database at the Service for Sensitive Data at Oslo University, which comply with General Data Protection Regulation legislation.

Results

The 91 infants, of whom 51 (56.0%) were girls had a mean±sd gestational age of 40.0±1.3 weeks at birth and a mean±sd age of 91.0±7.3 days at the time of the 3-month investigation. The birth and background characteristics of the infants are given in table 2. The mean (95% CI) number of breaths available for analyses was significantly lower, and the respiratory rate was significantly higher while awake compared to the sleeping state (table 3).

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TABLE 2

Background characteristics of the study population (n=91) with tidal flow–volume loop measurements in both the awake and sleeping arousal state

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TABLE 3

Tidal flow–volume loop parameters in the awake and sleeping state (n=91). The mean of the individual standard deviation is given to demonstrate variability related to arousal state and number of breaths

The mean (95% CI) tPTEF/tE of 0.39 (0.37–0.41) in the awake state was significantly higher than that in the sleeping state (0.28, 0.27–0.29), as shown in table 3 and figure 1a. While the mean tPTEF was similar between the arousal states, the mean tE was significantly shorter while awake compared to the sleeping state (table 3). The corresponding volume ratio (VPTEF/VE) was significantly higher while awake compared to the sleeping state, as shown in table 3 and figure 1b. The mean tidal volume (VT) and VE were similar in the awake and sleeping states, whereas mean VPTEF was significantly higher while awake (table 3). The mean standard deviation for the time parameter ratio tPTEF/tE, reflecting the loop-to-loop variability, was larger in awake compared to sleeping measurements (p=0.006), while the variability for the volume parameter ratio VPTEF/VE was similar between the two arousal states.

FIGURE 1
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FIGURE 1

Distributions of a) the ratio of time to peak tidal expiratory flow (tPTEF) to expiratory time (tE) and b) the volume at peak tidal expiratory flow (VPTEF) to expiratory volume (VE) in awake and sleeping tidal flow–volume loop measurements (n=91).

A tPTEF/tE <0.20 was observed in none of the 91 infants in the awake state and in six (6.6%) in the sleeping state, while six (6.6%) infants had a tPTEF/tE <0.25 while awake compared to 33 (36.3%) in the sleeping state (p<0.001). Three out of the six awake infants with a tPTEF/tE <0.25 had a tPTEF/tE <0.25 in the sleeping state. A VPTEF/VE <0.20 was observed in none of the awake infants and one (1.1%) of the sleeping infants, whereas three (3.3%) infants had a VPTEF/VE <0.25 while awake compared to 19 (20.9%) in the sleeping state (p<0.001). None of the three infants with a VPTEF/VE <0.25 while awake had a VPTEF/VE <0.25 in the sleeping state.

Compared to awake infants, the OR (95% CI) for having a ratio of tPTEF/tE and VPTEF/VE <0.25 was significantly higher among sleeping infants: unadjusted OR 10.0 (3.05–32.8) and 6.33 (1.87–21.4), respectively (p<0.005) (figure 2). Stratified by arousal state, the distribution of the tPTEF/tE and VPTEF/VE ratios are shown in supplementary figure S1.

FIGURE 2
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FIGURE 2

OR (95% CI) for ratios of time to peak tidal expiratory flow (tPTEF) to expiratory time (tE) and volume at peak tidal expiratory flow (VPTEF) to expiratory volume (VE) <0.25 among sleeping compared to awake tidal flow–volume loop measurements (n=91).

Discussion

Lung function parameters were influenced by arousal state among 91 healthy 3-month-old infants, with higher tPTEF/tE and VPTEF/VE in the awake versus sleeping state. In the awake compared to the sleeping state tE was shorter while tPTEF was similar, whereas for the volume parameters, VE was similar while the VPTEF was higher. Infants had 10 and six times higher odds, respectively, of a tPTEF/tE and VPTEF/VE <0.25 while awake compared to the sleeping state.

The higher tPTEF/tE ratio while awake compared to the sleeping state is in line with a study from 1992 demonstrating a higher mean tPTEF/tE in awake compared to sleeping state in 19 healthy newborn infants [14]. We are not aware of other studies comparing tidal lung function measures in awake and sleeping infants, older children or adults. The tPTEF was similar, while the tE, was longer in sleeping compared to awake state, possibly explained by the physiological inhibition of skeletal muscle tone during sleep that may lead to increased diaphragmatic work of breathing, and subsequently a longer expiratory time compared to the awake state [24]. In a study examining the effect of sleep phases on TFV loop measurements in sedated wheezing infants, tPTEF, tE and tPTEF/tE varied during sleep and lower values were probably related to decreased respiratory muscle tone [25]. Interestingly, breathing during sleep is more prone to airway obstruction [26], and nocturnal worsening of asthma related symptoms is common [27]. Thus, it is possible that asthma symptom thresholds are lower in the sleeping compared to the awake state, reflected in the overall lower tPTEF/tE in sleeping infants.

Higher respiratory rates were observed while awake compared to the sleeping state, in line with previously reported findings [28]. During sleep, in addition to the reduced tone in respiratory muscles, healthy infants’ breathing patterns are typically regular with reduced respiratory rate and lung volumes, decreasing ventilation, which together with a supine position may cause airway flow restriction [29]. As all lung function measurements were performed in a supine position and the tidal volumes were similar between the arousal states, the overall lower respiratory rates in the sleeping state may also have influenced the time and volume ratios. Supporting this theory, a previous study found a positive correlation between respiratory rate and tPTEF/tE in sedated infants with a history of wheezing [30].

A swifter rise to tPTEF has previously been described as a distinct feature of airway obstruction in adults and infants [12, 22, 31]. Our findings indicating that tPTEF remains stable irrespective of arousal state as well as correlating with obstructive airways disease [19] suggest that tPTEF may be useful as an outcome variable in future studies.

In contrast to the shortened tE, we observed that VE and VT remained similar between the arousal states, while the VPTEF was higher among awake infants, resulting in higher ratio VPTEF/VE in the awake measurements.

The loop-to-loop variability of the tPTEF/tE ratio was larger while awake compared to the sleeping state, in line with a previous study [14], while no significant difference in the variability of VPTEF/VE was observed between the arousal states. These differences may reflect the more irregular breathing pattern seen in healthy awake infants [29]. Moreover, the lower number of available breaths for analysis might explain the larger variation expressed as standard deviation of tPTEF/tE seen among awake infants. The tPTEF/tE and VPTEF/VE ratio showed a wider distribution of ratios in the awake tests, while a larger proportion of the sleeping infants had ratios in the lower range.

Strengths and limitations

Our findings are based upon healthy infants, standardised to 3 months of age, in a study of almost five times the number of subjects compared to the only previous study that to our knowledge reported measures in awake and sleeping infants [14]. Furthermore, our results were based upon a mean number of available TFV loops per test of 21 and 33 in the awake and sleeping states, respectively, in line with the guidelines suggesting ⩾10 loops [7].

The TFV loop measurements and subsequent loop selection were not performed by blinded reviewers unaware of infant arousal state, and may introduce expectation bias. However, the thorough loop selection of TFV loop measurements performed according to a validated standard operating procedure [17] strengthen the reliability of our findings. Lung function was only measured at one time point in early infancy in the PreventADALL study, lacking longitudinal TFV loop data. Therefore, the authors are unable to establish whether the differences in TFV loop parameters, including the time and volume ratios, between the awake and sleeping states will remain stable or change with increasing age and decreasing respiratory rate. In a study by Anık and Uysal [32], the authors found a positive correlation between age and tPTEF/tE ratio among awake infants and children aged 8–23 months with recurrent wheeze, with or without high risk of atopy. Therefore, the generalisability of our findings, differences and similarities, may be limited to TFV loop measurements in young infants. Potential effect-modifying factors, such as differences in respiratory rate, might balance out between the awake and sleeping arousal state in normal growth development [28].

Clinical implications for future research

Our findings provide evidence that both awake and sleeping TFV loop measurements are feasible in infancy, while tidal breathing parameters in early infancy should be interpreted according to arousal state with separate normative values and probably different cut-off values for tPTEF/tE and VPTEF/VE. The arousal state should be stated in measurements with TFV loop measurements in both research and clinical settings.

Although impaired lung function in infancy in both awake and sleeping measurements has been associated with later obstructive airways disease, standardisation of arousal state, optimal parameters for clinical as well as research use and clinical usefulness of such parameters are yet to be determined.

Conclusion

Lung function measured by TFV loops differed according to arousal state, with higher tPTEF/tE and VPTEF/VE ratios while awake compared to the sleeping state, at 3 months of age. Future studies should focus on identifying appropriate TFV loop values in infants, in which separate normative TFV loop values according to arousal state in early infancy may be required.

Supplementary material

Supplementary Material

Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

Supplementary material 00163-2022.SUPPLEMENT

Acknowledgements

We sincerely thank all families participating in the PreventADALL (Preventing Atopic Dermatitis and ALLergies) study, and the study personnel contributing to recruiting, performing lung function measurements, and managing the study: Caroline-Aleksi Olsson Mägi, Sandra G. Tedner, Ann Berglind, Alexandra Goldberg, Jessica Björk, Kajsa Sedergren, Natasha Sedergren and Ellen Tegnerud (Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden and Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden); Ingvild Essén and Malén Gudbrandsgard (Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway); and Christine Monceyron Jonassen (Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway and Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway).

Footnotes

  • Conflicts of interest: The authors have no conflicts of interest to disclose. The authors have no conflict of interest relating to or relationship with Exhalyzer® D or its manufacturer.

  • Support statement: The PreventADALL study has received funding from the Regional Health Board South East, the Norwegian Research Council, Oslo University Hospital, the University of Oslo, Health and Rehabilitation Norway, the Foundation for Healthcare and Allergy Research in Sweden (Vårdalstiftelsen), the Swedish Asthma and Allergy Association's Research Foundation, the Swedish Research Council – the Initiative for Clinical Therapy Research, the Swedish Heart–Lung Foundation, SFO-V Karolinska Institutet, Østfold Hospital Trust, the European Union (MeDALL project), by unrestricted grants from the Norwegian Association of Asthma and Allergy, the Kloster Foundation, Thermo-Fisher, Uppsala, Sweden (through supplying allergen reagents) and Fürst Medical Laboratory, Oslo, Norway (through performing IgE analyses), Norwegian Society of Dermatology and Venerology, Arne Ingels Legat, Region Stockholm (ALF-project and individual grants), Forte, Swedish Order of Freemasons Foundation Barnhuset, the Sven Jerring Foundation, the Hesselman Foundation, the Magnus Bergwall Foundation, the Konsul Th.C. Bergh's Foundation, the Swedish Society of Medicine, the King Gustaf V 80th Birthday Foundation, KI grants, the Cancer and Allergy Foundation, the Pediatric Research Foundation at Astrid Lindgren Children's Hospital, the Samaritan Foundation for Pediatric Research, Barnestiftelsen at Oslo University Hospital, Roche and the Frithjof Nansen Institute. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received April 1, 2022.
  • Accepted July 3, 2022.
  • Copyright ©The authors 2022
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References

  1. ↵
    1. Duijts L
    . Fetal and infant origins of asthma. Eur J Epidemiol 2012; 27: 5–14. doi:10.1007/s10654-012-9657-y
    OpenUrlCrossRefPubMed
  2. ↵
    1. Moeller A,
    2. Carlsen KH,
    3. Sly PD, et al.
    Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation. Eur Respir Rev 2015; 24: 204–215. doi:10.1183/16000617.00003914
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. van der Ent CK,
    2. Brackel HJ,
    3. van der Laag J, et al.
    Tidal breathing analysis as a measure of airway obstruction in children three years of age and older. Am J Respir Crit Care Med 1996; 153: 1253–1258. doi:10.1164/ajrccm.153.4.8616550
    OpenUrlCrossRefPubMed
  4. ↵
    1. Seddon PC,
    2. Davis GM,
    3. Coates AL
    . Do tidal expiratory flow patterns reflect lung mechanics in infants? Am J Respir Crit Care Med 1996; 153: 1248–1252. doi:10.1164/ajrccm.153.4.8616549
    OpenUrlPubMed
  5. ↵
    1. Pijnenburg MW,
    2. Baraldi E,
    3. Brand PL, et al.
    Monitoring asthma in children. Eur Respir J 2015; 45: 906–925. doi:10.1183/09031936.00088814
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Bates JH,
    2. Schmalisch G,
    3. Filbrun D, et al.
    Tidal breath analysis for infant pulmonary function testing. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/American Thoracic Society. Eur Respir J 2000; 16: 1180–1192. doi:10.1034/j.1399-3003.2000.16f26.x
    OpenUrlAbstract
  7. ↵
    1. Beydon N,
    2. Davis SD,
    3. Lombardi E, et al.
    An official American Thoracic Society/European Respiratory Society statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med 2007; 175: 1304–1345. doi:10.1164/rccm.200605-642ST
    OpenUrlCrossRefPubMed
  8. ↵
    1. Håland G,
    2. Carlsen KC,
    3. Sandvik L, et al.
    Reduced lung function at birth and the risk of asthma at 10 years of age. N Engl J Med 2006; 355: 1682–1689. doi:10.1056/NEJMoa052885
    OpenUrlCrossRefPubMed
  9. ↵
    1. Leonhardt S,
    2. Ahrens P,
    3. Kecman V
    . Analysis of tidal breathing flow volume loops for automated lung-function diagnosis in infants. IEEE Trans Biomed Eng 2010; 57: 1945–1953. doi:10.1109/TBME.2010.2046168
    OpenUrlCrossRefPubMed
  10. ↵
    1. Schultz ES,
    2. Melén E
    . Lung development in children: role of genetic and environmental factors. Acta Paediatr 2013; 102: 672–674. doi:10.1111/apa.12251
    OpenUrl
  11. ↵
    1. Lødrup Carlsen KC,
    2. Mowinckel P,
    3. Hovland V, et al.
    Lung function trajectories from birth through puberty reflect asthma phenotypes with allergic comorbidity. J Allergy Clin Immunol 2014; 134: 917–923. doi:10.1016/j.jaci.2014.05.020
    OpenUrlCrossRef
  12. ↵
    1. Morris MJ,
    2. Lane DJ
    . Tidal expiratory flow patterns in airflow obstruction. Thorax 1981; 36: 135–142. doi:10.1136/thx.36.2.135
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Milner AD
    . Lung function testing in infancy. Arch Dis Child 1990; 65: 548–552. doi:10.1136/adc.65.5.548
    OpenUrlFREE Full Text
  14. ↵
    1. Lødrup KC,
    2. Mowinckel P,
    3. Carlsen KH
    . Lung function measurements in awake compared to sleeping newborn infants. Pediatr Pulmonol 1992; 12: 99–104. doi:10.1002/ppul.1950120208
    OpenUrlPubMed
  15. ↵
    1. Lødrup Carlsen KC,
    2. Rehbinder EM,
    3. Skjerven HO, et al.
    Preventing Atopic Dermatitis and ALLergies in Children – the PreventADALL study. Allergy 2018; 73: 2063–2070. doi:10.1111/all.13468
    OpenUrlCrossRef
  16. ↵
    1. Lødrup Carlsen KC,
    2. Magnus P,
    3. Carlsen KH
    . Lung function by tidal breathing in awake healthy newborn infants. Eur Respir J 1994; 7: 1660–1668. doi:10.1183/09031936.94.07091660
    OpenUrlAbstract/FREE Full Text
  17. ↵
    1. Bains KES,
    2. Gudmundsdóttir HK,
    3. Färdig M, et al
    . Infant lung function: criteria for selecting tidal flow-volume loops. ERJ Open Res 2022; in press [https://doi.org/10.1183/23120541.00165-2022].
  18. ↵
    1. Lodrup Carlsen KC,
    2. Carlsen KH,
    3. Nafstad P, et al.
    Perinatal risk factors for recurrent wheeze in early life. Pediatr Allergy Immunol 1999; 10: 89–95. doi:10.1034/j.1399-3038.1999.00028.x
    OpenUrlCrossRefPubMed
  19. ↵
    1. Lødrup Carlsen KC,
    2. Stenzler A,
    3. Carlsen KH
    . Determinants of tidal flow volume loop indices in neonates and children with and without asthma. Pediatr Pulmonol 1997; 24: 391–396. doi:10.1002/(SICI)1099-0496(199712)24:6<391::AID-PPUL3>3.0.CO;2-K
    OpenUrlCrossRefPubMed
  20. ↵
    1. Yuksel B,
    2. Greenough A,
    3. Giffin F, et al.
    Tidal breathing parameters in the first week of life and subsequent cough and wheeze. Thorax 1996; 51: 815–818. doi:10.1136/thx.51.8.815
    OpenUrlAbstract/FREE Full Text
  21. ↵
    1. Martinez FD,
    2. Morgan WJ,
    3. Wright AL, et al.
    Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. N Engl J Med 1988; 319: 1112–1117. doi:10.1056/NEJM198810273191702
    OpenUrlCrossRefPubMed
  22. ↵
    1. Hevroni A,
    2. Goldman A,
    3. Blank-Brachfeld M, et al.
    Use of tidal breathing curves for evaluating expiratory airway obstruction in infants. J Asthma 2018; 55: 1331–1337. doi:10.1080/02770903.2017.1414234
    OpenUrl
  23. ↵
    1. Young S,
    2. Arnott J,
    3. Le Souef PN, et al.
    Flow limitation during tidal expiration in symptom-free infants and the subsequent development of asthma. J Pediatr 1994; 124: 681–688. doi:10.1016/S0022-3476(05)81355-1
    OpenUrlCrossRefPubMed
  24. ↵
    1. Heraghty JL,
    2. Hilliard TN,
    3. Henderson AJ, et al.
    The physiology of sleep in infants. Arch Dis Child 2008; 93: 982–985. doi:10.1136/adc.2006.113290
    OpenUrlAbstract/FREE Full Text
  25. ↵
    1. Gracia-Tabuenca J,
    2. Seppä VP,
    3. Jauhiainen M, et al.
    Tidal breathing flow profiles during sleep in wheezing children measured by impedance pneumography. Respir Physiol Neurobiol 2020; 271: 103312. doi:10.1016/j.resp.2019.103312
    OpenUrl
  26. ↵
    1. Krieger J
    . Breathing during sleep in normal subjects. Clin Chest Med 1985; 6: 577–594. doi:10.1016/S0272-5231(21)00396-8
    OpenUrlPubMed
  27. ↵
    1. Francisco CO,
    2. Bhatawadekar SA,
    3. Babineau J, et al.
    Effects of physical exercise training on nocturnal symptoms in asthma: systematic review. PLoS One 2018; 13: e0204953. doi:10.1371/journal.pone.0204953
    OpenUrl
  28. ↵
    1. Rusconi F,
    2. Castagneto M,
    3. Gagliardi L, et al.
    Reference values for respiratory rate in the first 3 years of life. Pediatrics 1994; 94: 350–355. doi:10.1542/peds.94.3.350
    OpenUrlPubMed
  29. ↵
    1. Ross KR,
    2. Rosen CL
    . Sleep and respiratory physiology in children. Clin Chest Med 2014; 35: 457–467. doi:10.1016/j.ccm.2014.06.003
    OpenUrlCrossRef
  30. ↵
    1. Rusconi F,
    2. Gagliardi L,
    3. Aston H, et al.
    Changes in respiratory rate affect tidal expiratory flow indices in infants with airway obstruction. Pediatr Pulmonol 1996; 21: 236–240. doi:10.1002/(SICI)1099-0496(199604)21:4<236::AID-PPUL6>3.0.CO;2-M
    OpenUrlCrossRefPubMed
  31. ↵
    1. Stocks J,
    2. Dezateux CA,
    3. Jackson EA, et al.
    Analysis of tidal breathing parameters in infancy: how variable is TPTEF:TE? Am J Respir Crit Care Med 1994; 150: 1347–1354. doi:10.1164/ajrccm.150.5.7952563
    OpenUrlCrossRefPubMed
  32. ↵
    1. Anık A,
    2. Uysal P
    . Impaired lung functions using tidal breath analysis in high-risk infants with recurrent wheezing. Trends Pediatr 2020; 1: 49–54.
    OpenUrl
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Infant tidal flow–volume parameters and arousal state
Karen Eline Stensby Bains, Martin Färdig, Hrefna Katrín Gudmundsdóttir, Catarina Almqvist, Gunilla Hedlin, Live S. Nordhagen, Eva M. Rehbinder, Håvard O. Skjerven, Cilla Söderhäll, Riyas Vettukattil, Björn Nordlund, Karin C. Lødrup Carlsen
ERJ Open Research Oct 2022, 8 (4) 00163-2022; DOI: 10.1183/23120541.00163-2022

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Infant tidal flow–volume parameters and arousal state
Karen Eline Stensby Bains, Martin Färdig, Hrefna Katrín Gudmundsdóttir, Catarina Almqvist, Gunilla Hedlin, Live S. Nordhagen, Eva M. Rehbinder, Håvard O. Skjerven, Cilla Söderhäll, Riyas Vettukattil, Björn Nordlund, Karin C. Lødrup Carlsen
ERJ Open Research Oct 2022, 8 (4) 00163-2022; DOI: 10.1183/23120541.00163-2022
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