Apnea of infancy
Definition
Apnea is a temporary cessation of breathing. Among children, this is most common in newborns.
Description
Babies born prematurely (before 34 weeks of gestation) usually lack a fully developed central nervous system. A component of this temporary deficit is inadequate control of their breathing reflex. The more premature a baby is born, the greater is the likelihood of apnea. Episodes of apnea are also more problematic for smaller than for larger babies. A small baby stores a smaller amount of oxygen, so the effects of oxygen deprivation are more severe. Apnea usually appears within the first several days after the baby is born.
Mild apnea causes no ill effects. The breathing pause is short (10–15 seconds), and the baby starts breathing again on his or her own. In a severe episode, though, breathing may cease for 20 seconds or longer. The infant begins to turn blue (cyanosis) because of the lack of oxygen in the blood. The baby retains carbon dioxide and may lapse into unconsciousness unless stimulated to breathe. Rubbing the infant with a finger or striking the soles of the feet may be all that is needed to end a short episode of apnea. If the baby has become unconscious, however, he or she may need to be revived with an oxygen mask. If apnea is frequent or severe, the baby's doctor may decide to treat it by altering conditions in the incubator, such as lowering the temperature, increasing oxygen, or placing the infant in a rocking incubator. Blood transfusions and medication may also be necessary.
Premature babies are also at higher risk for "late apnea," which occurs when the infant is older than six weeks. Late apnea can also affect full-term babies and may be a sign of an underlying problem such as congenital heart disease , infection, anemia, meningitis , or seizures. The baby usually recovers from apnea as the underlying disease is treated. Even if no underlying cause is found, late apnea is usually outgrown by the time the baby turns one year old.
Demographics
Apnea usually occurs during sleep and is primarily a disorder of premature infants. Sleep apnea before the early 2000s was thought to be a disease of older adults, but it can occur in children as well.
Causes and symptoms
In apnea of newborns, breathing stops and begins again automatically after a few seconds; it can also cause a prolonged pause which requires that the baby be resuscitated. Babies born before 34 weeks of gestation do not have a fully developed central nervous system, and they often do not have adequate control of the breathing reflex.
There are no specific measures for preventing apnea. It seems to be a sign of developmental immaturity, and it subsides as the baby grows older. Usually a premature baby in an incubator is continually monitored, and hospital staff can easily detect apnea. With late apnea, parents may not notice that a child has stopped breathing while sleeping. If apnea is suspected or diagnosed, parents may install a home monitor until the condition is outgrown. Undiagnosed late apnea can be fatal and is associated with sudden infant death syndrome (SIDS). Parents of premature babies need to be apprised of the possibility of apnea and should be instructed on how to resuscitate their infant if it occurs. Those particularly worried about late apnea may also wish to be trained in infant first aid. Since apnea usually occurs during sleep, parents may decide to sleep near the baby.
When to call the doctor
Parents of a newborn who have taken the baby home should call the child's pediatrician if they notice the baby has episodes of not breathing during sleep. This especially true if the child was born prematurely or has other medical conditions.
Diagnosis
Diagnosis of sleep apnea of newborns is made by observation of the baby by a physician. Premature babies who are still in the hospital under neonatal care are monitored by machines that will alert staff when a baby stops breathing.
Treatment
Sleep apnea in infants is treated by gently stimulating the children by stroking their bodies. Touching them this way induces them to resume breathing. In severe cases, giving the baby oxygen or medication may be necessary.
Prognosis
If apnea is diagnosed, it will probably recur, but most premature babies outgrow the condition by the time they reach their normal due date.
Prevention
Premature babies are usually kept in an incubator, where their breathing and heart rate are monitored. A drop in the baby's heart rate or respiratory rate will sound an alarm, and a nurse can stimulate the baby to resume breathing, if necessary.
Parental concerns
Parents should monitor the breathing patterns of infants who are born prematurely. Doing so is especially important during the first few weeks of life or until the infant reaches an age commensurate with full-term gestation.
KEY TERMS
Cyanosis —A bluish tinge to the skin that can occur when the blood oxygen level drops too low.
Sudden infant death syndrome (SIDS) —The general term given to "crib deaths" of unknown causes.
Resources
BOOKS
Apnea: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Health Publications, 2004.
Lavie, Peretz, and Anthony Berris. Restless Nights: Understanding Snoring and Sleep Apnea. New Haven, CT: Yale University Press, 2003.
Phillipson, Eliot A. "Sleep Apnea." In Harrison's Principles of Internal Medicine , 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 1520–2.
Rosen, Carol L., et al. "Obstructive Sleep Apnea and Hypoventilation." In Nelson Textbook of Pediatrics , 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 1397–1400.
Sleep Apnea: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: ICON Health Publications, 2004.
Strohl, Kingman P. "Obstructive Sleep Apnea: Hypopnea Syndrome." In Cecil Textbook of Medicine , 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 576–9.
PERIODICALS
Hoban, T. F. "Sleep and its disorders in children." Seminars in Neurology 24, no. 3 (2004): 327–40.
Schiffman, P. H., et al. "Mandibular dimensions in children with obstructive sleep apnea syndrome." Sleep 27, no. 5 (2004): 959–65.
ORGANIZATIONS
American Academy of Sleep Medicine. 6301 Bandel Road NW, Suite 101, Rochester, MN 55901. Web site: http://www.asda.org/.
American Sleep Apnea Association. 1424 K Street NW, Suite 302, Washington, DC 20005. Web site: http://www.sleepapnea.org/.
WEB SITES
A.P.N.E.A. Network. The Apnea Patient's News, Education & Awareness Network. Available online at http://www.apneanet.org/ (accessed December 20, 2004).
"Sleep Apnea." American Academy of Family Physicians. Available online at http://familydoctor.org/212.xml (accessed December 20, 2004).
"Sleep Apnea." American Sleep Foundation. Available online at http://www.sleepfoundation.org/publications/sleepap.cfm (accessed December 20, 2004).
"Sleep Apnea." MedlinePlus. Available online at http://www.nlm.nih.gov/medlineplus/sleepapnea.html (accessed December 20, 2004).
L. Fleming Fallon Jr., MD, DrPH