The term “apnea” means no breath, in other words, a stoppage of breathing. In general, this occurs mostly during sleep and is referred to as sleep apnea. In children, there are a number of causes of apnea.
In central apnea, the brain’s control of breathing is immature or abnormal. The brain controls the muscles we use to breathe. If the brain does not send the signals to the respiratory muscles, breathing stops. If the pause is long enough, this can lead to a decrease in the heart rate, decreased oxygen to the blood, and even death. As a matter of fact, some experts feel that this may be related to SIDS (Sudden Infant Death Syndrome). Similarly, children with brain damage can also have apnea, because the area of the brain that controls breathing may have been damaged or injured.
Apnea of prematurity
This is a form of central apnea seen in premature infants who often stop breathing because their brain is too immature to fully control it. As a premature baby gets older, the problem tends to disappear. In the meantime, specific treatments and precautions are usually needed.
Obstructive apnea results from a physical blockage of breathing, such as with enlarged adenoids or tonsils. Adenoids and tonsils can get so large that they block the airway, especially during sleep, resulting in breathing pauses or apnea.
In gastro-esophageal reflux (GE reflux), the acid contents of the stomach are regurgitated back into the esophagus instead of moving downwards toward the intestine. This acidity in the esophagus can sometimes trigger apnea in babies—Reflux-Related Apnea—as a result of the vasovagal reflex.
What are the symptoms of sleep apnea?
In some children, the symptoms are obvious: they stop breathing during their sleep. In others, it may be less obvious. For example, they may snore loudly, have periods of on-and-off breathing, or periods of what seem like trying to catch their breath. Many times, children with sleep apnea have disturbed, restless sleep, and wake up tired the next day, because of the frequent nightly apnea episodes.
What is periodic breathing?
Breathing may be irregular in young babies; in other words, the baby may take a few breaths, then pause for a few seconds, then continue again. This is thought to be normal, as they develop and mature their breathing. Apnea, potentially much more serious, is a prolonged stoppage of breathing that can result in low blood oxygen, heart problems, and even death.
Tests to confirm sleep apnea
The best way to confirm sleep apnea is by doing a sleep study. This test consists of attaching the baby to certain machines that monitor and record his respiratory rate and pattern, oxygen levels, and heart rate. Such tests called sleep studies are performed overnight in a sleep lab. However, some hospitals and medical centres may conduct these studies in the child’s home. The sleep study can confirm the presence of sleep apnea, to what degree it is present, and by the pattern of the breathing irregularities can also help distinguish between central or obstructive apnea.
Depending on the individual situation, other tests may be performed, such as certain specific blood tests, a head CAT (computer-assisted tomography, also known as X-ray computed tomography) scan, and an EEG (an electroencephalogram) may be performed to make sure these episodes are not seizures.
In cases where GE reflux is thought to be the cause, a pH study to determine the level of acidity in the esophagus may be performed as well, preferably at the same time as the sleep study. In this way, the specialist reviewing the overnight study can relate the apnea to the reflux; in other words, the apnea occurs whenever the pH of the esophagus becomes acidic due to the contents of the stomach re-entering the esophagus.
How is apnea treated?
Apnea treatment depends on its cause. If a child has obstructive apnea, then the adenoids and/or tonsils are removed and this generally cures the condition. In older individuals, a night-time respirator machine may be needed. Called a CPAP (continuous positive airway pressure) machine, this is attached to a mask worn during sleep. The machine gently pushes air into the airways constantly to ensure that there is no pause in respiration. (This is rarely required in children and is most common in adults.)
If the cause is due to GE reflux, then the reflux is treated and the apnea improves as well.
There really is no specific treatment for central apnea. In this case, depending on the situation, the baby may be put on a home apnea monitor that rings whenever he/she has an episode. In this case, parents are trained to perform CPR (cardiopulmonary resuscitation) and are followed and supported by a specialized sleep apnea team. If and when the apnea resolves or improves depends on the individual situation.
Apnea of prematurity
Apnea of prematurity is sometimes treated with caffeine or similar products. These treatments are thought to work by stimulating the premature baby’s respiratory control centre. As the baby gets older, the apnea usually resolves
Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.