Stubborn Hypoxia in Neonates with D-Transposition of the Great Arteries after Arterial Switch Operation: Central Sleep Apnea as the Cause and Potential Indicator of Brain Immaturity

D-transposition of the great arteries (d-TGA) is surgically repaired with the arterial switch operation (ASO) with excellent results, however short and long-term morbidities still develop including neurocognitive delay. Clinically significant central sleep apnea is uncommon in non-premature infants, but when present indicates immature autonomic control of respiration likely due to a neurologic disorder. We report the unanticipated finding of central sleep apnea in four-term neonates with d-TGA after uncomplicated ASO, with the short-term complication of delayed hospital discharge and long-term concerns regarding this early marker of brain immaturity and its hindrance to normal development. Within this report, we will review each patient’s clinical course and then examine the literature on pediatric central sleep apnea, neurodevelopmental outcomes after ASO, and the important overlap of these entities in the care of patients going forward.