Sleep Disorder Apnea
Everyone has brief pauses in his or her breathing pattern called
apnea. even your child. can have them Usually these brief stops in breathing are completely normal. Sometimes, though, apnea or other sleep-related problems can be a cause for concern. Find out what it means when your child's doctor mentions apnea.
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 for 20 seconds or longer.
There are three types of 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 children have obstructive apnea.
snoring (the most common)
labored breathing while sleeping
gasping for air
very restless sleep and sleeping in unusual positions
changes in color
Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after awakening in the morning and tiredness and attention problems throughout the day. Sometimes apnea can affect school performance. One recent study suggests that some children 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 Aden tonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP), which involves having the child wear a nose mask while sleeping.
When the part of the brain that controls breathing doesn't start or maintain the breathing process properly it's called central apnea. It's the least common form of apnea (except in very premature infants, in whom it's seen fairly commonly because the respiratory center in the brain is immature) and often has a neurological cause. An example of normal central apnea would be the short pause that occurs following a deep a sigh.
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 an event that's a combination of apnea, change in color (bluish lips or face), 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 (such as gastroesophogeal reflux [GERD], infections, or neurological disorders). ALTEs are scary to observe, but can be uncomplicated and may not happen again. However, all children who have an ALTE should be seen and evaluated immediately.
Apnea of Prematurely (AOP)
This condition 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
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.
What to Do if You Think Your Child Has Apnea
If you suspect that your child has apnea, call your child's 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. And many cases of apnea go away on their own.