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What is sleep apnea?
Sleep apnea is a potentially serious disorder in which breathing is interrupted repeatedly during sleep. If left untreated, it could lead to serious complications, such as a slow heart rate and poor growth.
In the past, medical experts believed apnea was linked to a higher risk of sudden infant death syndrome (SIDS), but several studies over the last two decades have found no such link.
There are three types of sleep apnea:
- Obstructive sleep apnea (OSA), which is caused by a blockage in the upper airway
- Central sleep apnea (CSA), in which there is no blockage but the brain fails to signal the muscles to breathe
- Mixed apnea, which is a combination of obstructive and central sleep apnea
CSA is the most common type in full-term infants and larger premature babies. Smaller premature babies usually have mixed apnea. Adults and children age 1 year and older most often have OSA.
Which babies are at risk?
Any baby can have sleep apnea, but it's much more common in babies who were born prematurely. In babies born before 37 weeks of pregnancy, it's called apnea of prematurity. In babies born at 37 weeks or later, it's called apnea of infancy.
The more premature a baby is, the more likely he is to suffer from apnea.
Children with Down syndrome and other congenital conditions that affect the upper airway also have a higher incidence of sleep apnea. More than half of children with Down syndrome develop OSA.
What causes sleep apnea?
In babies, immaturity of the brain stem (which regulates breathing) or an airway obstruction is often responsible. Other possible causes include:
- Bleeding in the brain
- Exposure to drugs or poisons
- Birth defect
- Respiratory disease
- Gastrointestinal problems (like reflux)
- Imbalance in body chemistry (like incorrect amounts of calcium or glucose)
- Problems with the heart or blood vessels
What are the symptoms of sleep apnea?
Some babies with sleep apnea stop breathing for 20 seconds or longer during sleep. Others stop breathing for shorter periods and become limp, turn pale or blue, or have a slowed heart rate as they sleep.
(Keep in mind that it's normal for newborns and babies younger than 6 months to experience an irregular breathing pattern. This is called "periodic breathing" and typically starts with rapid breaths, then slower breaths, then a pause in breathing for five to 10 seconds. Then the pattern resumes with rapid breaths, and so on. Periodic breathing isn't anything to worry about, and babies usually outgrow it by the time they're about 6 months old.)
What are the dangers of sleep apnea?
Apnea can cause serious complications and, in rare cases, can be fatal – especially if the baby was born before 28 weeks gestation.
As a baby stops breathing, the oxygen level in his blood falls and the level of carbon dioxide increases. He might develop a severe drop in heart rate (bradycardia) or lose consciousness and need to be resuscitated.
How is sleep apnea diagnosed?
If your baby's doctor suspects that your baby has sleep apnea, she'll do a physical exam and various tests, including a measurement of the amount of oxygen in his blood and monitoring of his breathing and heart rate. She may also take an X-ray.
Your doctor may refer you to a sleep specialist, a pediatric pulmonologist (lung specialist), or an apnea specialist for more testing.
The test that's commonly used to diagnose sleep apnea is called a polysomnogram. This is a painless procedure done in a sleep lab under observation by trained technicians. It monitors your baby's brain waves, eye movements, breathing, and oxygen level in his blood as well as the snoring and gasping sounds he makes during sleep.
How is sleep apnea treated?
It depends on how severe it is. Your baby's doctor may suggest using a home apnea monitor to keep track of your baby's breathing and heart rate, or medication to stimulate the central nervous system.
Some children with obstructive apnea need to use a continuous positive airway pressure (CPAP) machine, which keeps the airway open by blowing air into the nose through a mask during sleep. (A CPAP machine doesn't usually relieve the symptoms of central sleep apnea.)
Fortunately, infants with sleep apnea rarely have any long-term complications from the condition, which usually goes away on its own as a child matures. Most preterm babies have no symptoms by the time they're 44 weeks from conception.
What should I do if I think my baby has stopped breathing during sleep?
Touch or nudge your baby to see if he responds. If he doesn't, call 911 immediately. (Your baby may be in danger if his forehead or body turns blue. However, it's not unusual for a baby's hands and feet or the skin around his mouth to be bluish, particularly when he's a little cold or has been crying.)
If you know how to administer infant CPR, begin emergency treatment right away and have someone else call for emergency help. If you're alone with your baby, administer CPR for two minutes, call for help, and then resume CPR until emergency help arrives or your baby starts breathing again.
Knowing how to perform infant CPR is important for all parents, but especially for parents of babies with sleep apnea. Check with your hospital or the Red Cross to find an infant CPR class in your area.