Baby Sleep Apnea Is sleep apnea a disease? Sleep apnea (AP
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Dr. Atul Chowdhury
Baby Sleep Apnea

Is sleep apnea a disease?

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

The apneas in infant sleep apnea may be central, obstructive or mixed. Central apneas occur when your body decreases or stops its effort to breathe. This results from a problem in the brain or in the heart. Obstructive apneas occur when soft tissue in the back of the throat collapses and blocks the airway during sleep. Mixed apneas involve a central apnea that is directly followed by an obstructive apnea.

The majority of apneas that occur in small premature infants are mixed apneas. Apneas that occur in larger premature infants and full-term infants tend to be central apneas.

These breathing problems can cause severe complications. The infant may not have enough oxygen in the blood. This is known as “hypoxemia.” The infant also may develop a slow heartbeat. This is known as “bradycardia.” The infant even may lose consciousness and need to be resuscitated.

Infant sleep apnea has two general causes. It can be a developmental problem that results from an immature brainstem. It also can be a secondary problem that is caused by another medical condition.

It is common for there to be some instability in an infant’s breathing. This can be a normal part of an infant’s development. Even healthy infants may have a brief central apnea. This pause may be an isolated event. It also may occur after the child sighs or moves. The duration of these normal events is very short. They rarely last longer than 20 seconds. Obstructive apneas are rare in healthy infants.

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.

Infant Sleep Apnea – Diagnosis & Treatment

Diagnosis

You may need to take your infant to a doctor who is a sleep specialist. If so then you should schedule an appointment at an accredited sleep disorders center. Some centers specialize in helping children. A sleep specialist will review your infant’s history and symptoms. If needed, the doctor will schedule your infant for an overnight sleep study. This kind of study is called a polysomnogram. It is the best way to evaluate your child’s sleep. With the results of this study the doctor will be able to develop an individual treatment plan for your child.

It is also important to know if there is something else that is causing your child’s sleep problems. A sleep specialist can look for other conditions that may be involved. These include:

• Another sleep disorder
• A medical condition
• Medication use
• A mental health disorder

The doctor will need to know if your child was born premature or full-term. He or she will also need to know your child’s weight at birth. Inform the doctor of any complications that you or your baby had during or after delivery. Describe the problems you have observed and when you first noticed them.

An infant who has persistent breathing problems during sleep may need an overnight sleep study. This study is called a polysomnogram. It charts your child’s brain waves, heartbeat, and breathing during sleep. It also records arm and leg movements. The sleep study will reveal the nature of your infant’s breathing problem. It also will show the severity of the problem. The study requires your child to spend the night at the sleep center. A parent or guardian also will need to stay at the sleep center with the child.

Treatment

Infants with infant sleep apnea may need a machine to provide breathing support. They also may need treatment with medications. Both of these options tend to be short-term treatments.

Infant sleep apnea tends to go away as the child grows and matures. Ninety-eight percent of preterm infants will be free of symptoms by 40 weeks after conception. The problem is more likely to persist longer in infants who were born less than 28 weeks after conception.

Any medical condition that causes infant sleep apnea or makes it worse also needs to be treated. The treatment will depend on the nature of the medical problem.

Long-term complications are rare for most children with infant sleep apnea. Problems are more likely for infants who need frequent resuscitation. Health problems also are more common if the infant sleep apnea is related to another severe medical condition.

Outlook (Prognosis)

Apnea is common in premature babies. Most babies have normal outcomes. Although mild apnea is not thought to have long-term effects. However, most doctors feel that preventing multiple or severe episodes is better for the baby over the long-term.
Apnea episodes that began after the second week of life or that last longer than 20 seconds are considered more serious.
Apnea of prematurity usually goes away by the baby's 36th week.

How do I know if my baby has apnea or bradycardia?

Babies that are known to be at risk for these episodes are placed on monitors that are set to alarm if the breathing or heart rate go below certain limits.

What happens if the alarm goes off?

The alarm tells the staff that the baby needs to be checked. Not every alarm means the baby is having a problem; loose wires, a lot of movement and poor connections can all cause alarms. The alarm is to let us know to check the baby.

The staff checks the breathing, heart rate, and color. If the baby is fine, then the monitor is checked to see if it is working right.

If the baby is having apnea or bradycardia, then the nurse will watch to see if the baby will restart breathing. If breathing does not restart, then the nurse may gently rub or stimulate the baby to breathe. Often this gentle action is all that is needed.

If the baby's color is blue, extra oxygen may be given.

If the baby still doesn't breathe, then the staff may help the baby breathe.

Can apnea come back or can my baby develop SIDS?

Once premature babies with apnea mature, they should stop having events and usually are not at risk for the episodes to come back. However, some babies are slower to mature and some babies who have other medical conditions may be at increased risk of having on-going events. Home apnea monitoring and/or medicines may be needed for these infants.

While apnea of prematurity and SIDS are different problems, some babies who need NICU care may have a slight increased risk of later SIDS. We cannot predict which infants are at risk; there is no guarantee that a baby will not develop SIDS later. But the vast majority of infants will not be at risk and will not need monitors.

Is there anything I can do to help prevent SIDS or apnea at home?

There are several things that can be done at home to decrease any baby's risk.

BACK TO SLEEP - babies should be placed on their backs when you put them to sleep or when they are in their cribs.

DON'T SMOKE - infants of parents that smoke have increased risk of SIDS and also have more breathing problems. If you can't stop, at least don't smoke around the baby or in the house.

Breast Feed - infants who have been breastfed seem to have less SIDS.

Avoid pillows or soft mattresses in the crib and do not over bundle or over dress a baby.

Ask you baby's doctor or nurse if you have further questions about your baby.

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.

Risk Factors

Small preterm infants are most likely to have infant sleep apnea. It sometimes occurs in larger preterm or full-term infants. It is less common in infants under the age of six months.

During the first month after birth it occurs in 84 percent of infants who weigh less than 2.2 pounds. The risk decreases to 25 percent for infants who weigh less than 5.5 pounds. It is rare in full-term newborns.

In preterm infants, infant sleep apnea tends to appear between the second and seventh day of life. It is rare on the first day of life. Its presence at birth is usually a sign of another illness.

A variety of medical conditions can cause infant sleep apnea or make it worse. These problems include:

• Acid reflux
• Anemia
• Anesthesia
• Drugs
• Infection
• Lung disease
• Metabolic disorders
• Neurological problems
• Seizures
• Small upper airway
A small percentage of children who die from sudden infant death syndrome (SIDS) have apnea symptoms prior to death. But infant sleep apnea has not been established as a risk factor for SIDS.

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.
Dr Atul Chowdhury
General Medicine
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