Children's Health: Apnea

Children's Health: Apnea

During sleep, everyone has brief pauses in their breathing pattern called apneas. Usually this is completely normal.

Sometimes, though, apneas may be prolonged and happen often, making the breathing pattern irregular and abnormal. Abnormal apnea might actually cause decreased oxygen levels in the body and disrupt sleep.

Types of Apnea
The word apnea comes from the Greek word meaning "without wind." Although it's perfectly normal for everyone to experience occasional pauses in breathing, apnea can be a problem when breathing stops frequently or for prolonged periods of time.

There are three types of apnea:

obstructive
central
mixed
Obstructive Apnea
A common type of apnea in children, obstructive apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids). This is most likely to happen during sleep because that's when the soft tissue at back of the throat is most relaxed. As many as 1% to 3% of otherwise healthy preschool-age kids have obstructive apnea.

Symptoms include:

snoring (the most common) followed by pauses or gasping
labored breathing while sleeping
very restless sleep and sleeping in unusual positions
daytime sleepiness or behavioral problems
Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after waking in the morning and tiredness and attention problems throughout the day. Sometimes apnea can affect school performance. One recent study suggests that some kids diagnosed with ADHD actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.

Treatment for obstructive apnea involves keeping the throat open to aid air flow, such as with adenotonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP), which is delivered by having the child wear a nose mask while sleeping.

Central Apnea
Central apnea occurs when the part of the brain that controls breathing doesn't properly maintain the breathing process. In very premature infants, it's seen fairly commonly because the respiratory center in the brain is immature.

Mixed Apnea
Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.

Conditions Associated With Apnea
Apnea can be seen in connection with:

Apparent Life-Threatening Events (ALTEs)
An ALTE itself is not a sleep disorder — it's a serious event with a combination of apnea and change in color, change in muscle tone, choking, or gagging. Call 911 immediately if your child shows the signs of an ALTE.

ALTEs, especially in young infants, are often associated with medical conditions that require treatment Examples of these medical conditions include gastroesophogeal reflux disease (GERD), infections, or neurological problems or cardiac disorders. ALTEs are frightening to observe, but can be uncomplicated and may not happen again. However, any child who has an ALTE should be seen and evaluated immediately.

Apnea of Prematurity (AOP)
AOP can occur in infants who are born prematurely (before 34 weeks of pregnancy). Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his or her own breathing normally. AOP can be obstructive, central, or mixed.

Treatment for AOP can involve the following:

keeping the infant's head and neck straight (premature babies should always be placed on their backs to sleep to help keep the airways clear)
medications to stimulate the respiratory system
continuous positive airway pressure (CPAP) — to keep the airway open with the help of forced air through a nose mask
oxygen
Premature infants with AOP are followed closely in the hospital. If AOP doesn't resolve before discharge from the hospital, an infant may be sent home on an apnea monitor and parents and other caregivers will be taught CPR. The family will work closely with the child's doctor to have a treatment plan in place.

Apnea of Infancy (AOI)
Apnea of infancy occurs in children who are younger than 1 year old and who were born after a full-term pregnancy. Following a complete medical evaluation, if a cause of apnea isn't found, it's often called apnea of infancy. AOI usually goes away on its own, but if it doesn't cause any significant problems (such as low blood oxygen), it may be considered part of the child's normal breathing pattern.

Infants with AOI can be observed at home with the help of a special monitor prescribed by a sleep specialist. This monitor records chest movements and heart rate and can relay the readings to a hospital apnea program or save them for future examination by a doctor. Parents and caregivers will be taught CPR before the child is sent home.

If You Think Your Child Has Apnea
If you suspect that your child has apnea, call your doctor. If you suspect that your child is experiencing an ALTE, call 911 immediately.

Although prolonged pauses in breathing can be serious, after a doctor does a complete evaluation and makes a diagnosis, most cases of apnea can be treated or managed with surgery, medications, monitoring devices, or sleep centers. Many cases of apnea go away on their own.

Reviewed by: Matthew Lundien, MD