Infantile apnea

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Infantile apnea is a rare condition characterized by the cessation of breathing in infants for at least 20 seconds or a shorter respiratory pause associated with a slow heart rate, bluish discoloration of the skin, extreme paleness, and/or decreased muscle tone. Infantile apnea occurs in children under the age of one, and it is more common in premature infants. Symptoms of infantile apnea typically occur during the rapid eye movement (REM) stage of sleep. The nature and severity of breathing problems in patients can be detected in a sleep study called a polysomnography, which measures the brain waves, heartbeat, body movements, and breathing of a patient overnight. Infantile apnea can be caused by developmental problems that result in an immature brainstem or other medical conditions. As children grow and develop, infantile apnea usually does not persist. Infantile apnea may be related to some cases of sudden infant death syndrome (SIDS), but the relationship between infantile apnea and SIDS is not known.

Central Apnea

Central apnea is characterized by insufficient responsiveness from respiratory centers such as the medulla, which results in poor coordination of the body systems necessary for breathing. Respiratory muscles and nerves lose the ability to effectively receive and process signals from the brain, causing respiratory efforts to cease. Central apnea is quite common and can be found in healthy, full-term infants for short periods of time before breathing patterns in the infant stabilize. In premature infants, central apnea is attributed to an underdeveloped respiratory system, which results in a decreased response to higher carbon dioxide levels and difficulty breathing. Head trauma may also cause central apnea as it interferes with the normal signaling of the central respiratory system; this might be present in infants who suffer from abuse, so investigating patient background is an important consideration.

Obstructive Apnea

Obstructive apnea occurs when the airway passages are obstructed and little to no air exchange occurs, resulting in impaired breathing. In some cases, it occurs when patients are born with a small airway opening. Patients with obstructive apnea often have vigorous inspiratory effort, but the efforts are still ineffective. Normally, the muscles at the level of the throat relax and dilate while asleep to open up the airway; however, patients with obstructive apnea may have decreased neuromuscular tone of the muscles responsible for dilating the pharynx during sleep. The inability of the vocal cords to move and the presence of a foreign body may also cause obstructive apnea. Cases of obstructive apnea are rarely found in healthy infants.

Mixed Apnea

Mixed apnea is a combination of both central and obstructive factors. The majority of premature infants with sleep apnea have mixed apnea.

Epidemiology

When infants have a lower birth weight or younger gestational age, there is a greater risk of infantile apnea. With the advancement of neonatal intensive care units and the greater technology available, there are more successful premature births compared to the past. With the greater number of premature infants being born, there is also a greater number of children with infantile apnea. Approximately 85 percent of infants born with a weight less than 2.2 pounds (1 kg) experience infantile apnea within the first month after birth. This risk decreases to 25 percent for infants weighing less than 5.5 pounds (2.5 kg). Studies have found that almost 2% of the pediatric population experience obstructive sleep apnea.

Treatment

Treatment for infantile apnea depends on the underlying cause and severity of the condition. In some cases, treatment may not be necessary, as the condition may resolve on its own as the child grows and develops. However, when intervention is required, treatment options may include:

• Continuous Positive Airway Pressure (CPAP) - CPAP is a common treatment for sleep-related breathing disorders, including infantile apnea. The device delivers a constant flow of air through a mask to help keep the airway open during sleep.
• Oxygen therapy - In some cases, supplemental oxygen may be provided to the infant to ensure adequate oxygen levels during sleep.
• Medication - Medications such as caffeine or theophylline may be prescribed to stimulate the infant's respiratory system and reduce the occurrence of apnea episodes.
• Surgery - In cases where obstructive apnea is caused by anatomical abnormalities, surgery may be necessary to correct the issue and improve airflow.

In addition to these treatments, parents and caregivers should follow safe sleep practices, such as placing the infant on their back to sleep, avoiding soft bedding or toys in the crib, and maintaining a smoke-free environment.

See also

• Apnea of prematurity
• Sudden Infant Death Syndrome (SIDS)
• Polysomnography
• Sleep disorders in children

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