Sleep Apnea in Children :
A Scary Breathing Disorder
It's scary enough when sleep apnea occurs in adults, but when sleep apnea in children happens it's even scarier.
Periodic Breathing Vs. Sleep Apnea in Babies
Before a baby is born, the mother's breathing takes care of its respiratory needs. Although the unborn baby's lungs are filled with fluid and are not ready to take in air, its respiratory muscles make breathing motions, as if "training" to take on the responsibilites of breathing after birth.
As soon as birth occurs, the normal newborn baby begins a continuous pattern of periodic breathing characterized by a succession of apneas followed by regular breathing...this is NORMAL, and does not indicate that the airway is blocked. Apneas occasionally lasting longer than 10 to 15 seconds are common during the newborn period. Apneas are more frequent and longer in premature newborns than in full-term infants. The frequency of apnea decreases with age during the first six months of life.
Sleep Apnea in Infants
While periodic breathing is a normal developmental stage, apnea--pauses in breathing accompanied by changes in the heart, blood circulation, and nervous system--can adversely affect the baby and, in some cases, may warn that the baby has an increased risk of SIDS (sudden infant death syndrome).
If your baby has prolonged (more than 10 seconds) pauses in breathing or has bluish skin, a fever, or other symptoms of illness, call the Emergency Medical Service or your pediatrician at once. Babies who turn blue during sleep and appear limp may be undergoing episodes of insufficient breathing.
As its name implies, obstructive sleep apnea in children occurs when the airway is partially blocked. The term mixed apnea refers to temporary halts in breathing due to obstruction in the upper airway as well as factors under the control of the central nervous system.
In young infants it occurs as the chest muscles involved in breathing become tired. The airways may be obstructed by a buildup of mucus or by a suppression of cough reflexes during sleep. Other factors that increase the occurrence of obstructive apnea include relaxation of the muscles (which include those of the mouth cavity and throat) during REM sleep, respiratory infection, blockage in the nose, malformation of the face or head, flexion of the neck, and lack of sleep. Apnea is also common in babies who are exposed to secondhand tobacco smoke, even before birth.
Although most sleep apneas are harmless and disappear as the baby matures or the underlying condition is treated, there are exceptions. Prolonged apneas may be a forerunner of sudden infant death syndrome.
Babies with a history of serious episodes of sleep apnea--for example, prolonged cessation of breathing that requires resuscitation--require medical investigation and, if appropriate, treatment.
A crib monitor may also be recommended for such children. This is a device that sounds an alarm if breathing stops for a predetermined number of seconds. However, for babies who are healthy and who merely have the typical "stop and start" periodic breathing of infancy, crib monitors are not necessary. Contrary to the exaggerated claims of some marketers, these devices do not help prevent SIDS in normally healthy children, and my only increase anxiety in parents who have nothing to worry about.
Sleep Apnea in Infants and SIDS
Sleep apnea in infant is sometimes implicated in sudden infant death syndrome (SIDS), also called crib death. About 10,000 infants die every year in America from SIDS.
Scientists do not know the reasons for these deaths but pediatric obstructive sleep apnea may play a role because these babies die when they are asleep and show no evidence of trauma.
On autopsy, pinpoint hemorrhages are sometimes noted in the thoracic cavity which may be caused by lack of oxygen prior to cardiac arrest and vigorous respiratory movements.
Sleep Apnea in Kids
If your child snores, you may have a reason to worry. We now know that sleep apnea children have difficulty breathing at night, and snoring is one very good sign that they may be suffering from it.
The problem of sleep apnea in children is that it has been largely overlooked, perhaps because children's daytime symptoms are less obvious than are adults' or because most sleep centers see primarily adult patients.
In the past, doctors often did not recognize sleep apnea in child until the strain from the intense respiratory efforts coupled with the lowered oxygen levels led to diminished heart funciton. Fortunately, this is uncommon. Most children with sleep apnea do not develop heart complications; this occurs mainly in children with such severe obstruction that their breathing is also impaired when they are awake.
Possible causes of sleep apnea in children are:
- Thick short neck
- Oral or facial abnormalities
- Abnormalities of the nose (such as a deviated septum)
- Nasal obstruction from allergies
- Enlarged tonsils or adenoids (most common cause in children)
If you notice sleep apnea symptoms in your child, be sure to see his or her pediatrician for testing and help.
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Cohen, George J. Guide To Your Child's Sleep. New York, New York: Villard Books, a division of Random House, Inc.: 42-43.
Ferber, Richard, M.D. Solve Your Child's Sleep Problems. New York, New York: Simon & Schuster, Inc., 1995: 201-203.
Swanson, Jennifer. Sleep Disorders Sourcebook. Detroit, Michigan: Omnigraphics, Inc., 1999: 175-176.