Infantile apnea

Last updated
Infantile apnea
Specialty Pediatric

Infantile apnea is a rare disease that is characterized by cessation of breathing in an infant for at least 20 seconds or a shorter respiratory pause that is associated with a slow heart rate, bluish discolouration of the skin, extreme paleness, gagging, choking and/or decreased muscle tone. [1] [2] Infantile apnea occurs in children under the age of one and it is more common in premature infants. [3] Symptoms of infantile apnea occur most frequently during the rapid eye movement (REM) stage of sleep. [4] The nature and severity of breathing problems in patients can be detected in a sleep study called a polysomnography which measures the brain waves, heartbeat, body movements and breathing of a patient overnight. [4] Infantile apnea can be caused by developmental problems that result in an immature brainstem or it can be caused other medical conditions. [1] [4] [5] As children grow and develop, infantile apnea usually does not persist. [4] Infantile apnea may be related to some cases of sudden infant death syndrome (SIDS) however, the relationship between infantile apnea and SIDS is not known. [3]

Contents

Cause

√ having a family history of sleep apnea. √ being overweight or obese. ✓ having certain medical conditions (cerebral palsy, Down syndrome, sickle cell disease, abnormalities in the skull or face) ✓ being born with a low birth weight. ✓ having a large tongue.

Diagnosis

Classification

There are three major categories of apnea known as central, obstructive, and mixed apnea. [1] [3] [4]

Central Apnea

Central apnea is characterized by insufficient responsiveness from respiratory centers such as the medulla, which results in poor coordination of the body systems that are necessary for breathing. [1] [4] Respiratory muscles and nerves to lose the ability to effectively receive and process signals from the brain causing respiratory efforts to cease. [4] Central apnea is quite common and can be found in healthy, full-term infants for short periods of time before breathing patterns in the infant stabilize. [4] In premature infants, central apnea is attributed to an underdeveloped respiratory system which results in decreased response to higher carbon dioxide levels and difficulty breathing. [1] Head trauma may also cause central apnea as it interferes with normal signalling of the central respiratory system, this might be present in infants who suffer from abuse so investigating patient background is an important consideration. [1]

Obstructive Apnea

Obstructive apnea occurs when the airway passages are obstructed and little to no air exchange occurs, resulting in impaired breathing. [1] [4] In some cases, it occurs when patients are born with a small airway opening. [4] Patients with obstructive apnea often have vigorous inspiratory effort but the efforts are still ineffective. [1] Normally, the muscles at the level of the throat relax and dilate while asleep in order to open up airway however, patients with obstructive apnea may have decreased neuromuscular tone of the muscles responsible for dilating the pharynx during sleep. [4] The inability of the vocal cords to move and the presence of a foreign body may also cause obstructive apnea. [1] [6] Cases of obstructive apnea are rarely found in infants that are healthy. [4]

Mixed Apnea

Mixed apnea is a combination of both central and obstructive factors. [1] The majority of premature infants with sleep apnea have mixed apnea. [4]

Epidemiology

When infants have a lower birth weight or younger gestational age, there is a greater risk of infantile apnea. [1] With the advancement of neonatal intensive care units and the greater technology available, there are more successful premature births compared to the past. [1] With the greater number of premature infants being born, there is also a greater number of children with infantile apnea. [1] [5] Approximately 85 percent of infants born with a weight less than 2.2 pounds (1 kg) experience infantile apnea within the first month after birth. [4] This risk decreases to 25 percent for infants weighing less than 5.5 pounds (2.5 kg). [4] Studies have found that almost 2% of the pediatric population experience obstructive sleep apnea. [1]

Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few minutes and occurs many times a night. A choking or snorting sound may occur as breathing resumes. Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It is often a chronic condition.

<span class="mw-page-title-main">Obesity hypoventilation syndrome</span> Condition in which severely overweight people fail to breathe rapidly or deeply enough

Obesity hypoventilation syndrome (OHS) is a condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide (CO2) levels. The syndrome is often associated with obstructive sleep apnea (OSA), which causes periods of absent or reduced breathing in sleep, resulting in many partial awakenings during the night and sleepiness during the day. The disease puts strain on the heart, which may lead to heart failure and leg swelling.

<span class="mw-page-title-main">Positive airway pressure</span> Mechanical ventilation in which airway pressure is always above atmospheric pressure

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco. A variation of the PAP system was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.

<span class="mw-page-title-main">Respiratory arrest</span> Medical condition

Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body. Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may permanently damage vital organs, especially the brain. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes.

Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, functional orthodontics, surgery, mandibular repositioning devices or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG) is a multi-parameter type of sleep study and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

<span class="mw-page-title-main">Analeptic</span> Drug class

An analeptic, in medicine, is a central nervous system stimulant. The term "analeptic" typically refers to respiratory stimulants. Analeptics are central nervous system (CNS) stimulants that include a wide variety of medications used to treat depression, attention deficit hyperactivity disorder (ADHD), and respiratory depression. Analeptics can also be used as convulsants, with low doses causing patients to experience heightened awareness, restlessness, and rapid breathing. The primary medical use of these drugs is as an anesthetic recovery tool or to treat emergency respiratory depression. Other drugs of this category are prethcamide, pentylenetetrazole, and nikethamide. Nikethamide is now withdrawn due to risk of convulsions. Analeptics have recently been used to better understand the treatment of a barbiturate overdose. Through the use of agents, researchers were able to treat obtundation and respiratory depression.

<span class="mw-page-title-main">Supine position</span> Lying horizontally with the face and torso facing up

The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.

Hypopnea is overly shallow breathing or an abnormally low respiratory rate. Hypopnea is defined by some to be less severe than apnea, while other researchers have discovered hypopnea to have a "similar if not indistinguishable impact" on the negative outcomes of sleep breathing disorders. In sleep clinics, obstructive sleep apnea syndrome or obstructive sleep apnea–hypopnea syndrome is normally diagnosed based on the frequent presence of apneas and/or hypopneas rather than differentiating between the two phenomena. Hypopnea is typically defined by a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. It commonly is due to partial obstruction of the upper airway.

Apnea of prematurity is a disorder in infants who are preterm that is defined as cessation of breathing by that lasts for more than 20 seconds and/or is accompanied by hypoxia or bradycardia. Apnea of prematurity is often linked to earlier prematurity. Apnea is traditionally classified as either obstructive, central, or mixed. Obstructive apnea may occur when the infant's neck is hyperflexed or conversely, hyperextended. It may also occur due to low pharyngeal muscle tone or to inflammation of the soft tissues, which can block the flow of air though the pharynx and vocal cords. Central apnea occurs when there is a lack of respiratory effort. This may result from central nervous system immaturity, or from the effects of medications or illness. Many episodes of apnea of prematurity may start as either obstructive or central, but then involve elements of both, becoming mixed in nature.

When we sleep, our breathing changes due to normal biological processes that affect both our respiratory and muscular systems.

<span class="mw-page-title-main">Continuous positive airway pressure</span> Form of ventilator which applies mild air pressure continuously to keep airways open

Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The application of positive pressure may be intended to prevent upper airway collapse, as occurs in obstructive sleep apnea, or to reduce the work of breathing in conditions such as acute decompensated heart failure. CPAP therapy is highly effective for managing obstructive sleep apnea. Compliance and acceptance of use of CPAP therapy can be a limiting factor, with 8% of people stopping use after the first night and 50% within the first year.

Wilson–Mikity syndrome, a form of chronic lung disease (CLD) that exists only in premature infants, leads to progressive or immediate development of respiratory distress. This rare condition affects low birth babies and is characterized by rapid development of lung emphysema after birth, requiring prolonged ventilation and oxygen supplementation. It is closely related to bronchopulmonary dysplasia (BPD), differing mainly in the lack of prior ventilatory support. All the initial patients described with Wilson–Mikity syndrome were very low birth weight infants that had no history of mechanical ventilation, yet developed a syndrome that clinically resembled BPD. Upon the death of some of these infants, autopsies showed histologic changes similar to those seen in BPD.

Pediatric advanced life support (PALS) is a course offered by the American Heart Association (AHA) for health care providers who take care of children and infants in the emergency room, critical care and intensive care units in the hospital, and out of hospital. The course teaches healthcare providers how to assess injured and sick children and recognize and treat respiratory distress/failure, shock, cardiac arrest, and arrhythmias.

<span class="mw-page-title-main">ROHHAD</span> Medical condition

Rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare condition whose etiology is currently unknown. ROHHAD mainly affects the endocrine system and autonomic nervous system, but patients can exhibit a variety of signs. Patients present with both alveolar hypoventilation along with hypothalamic dysfunction, which distinguishes ROHHAD from congenital central hypoventilation syndrome (CCHS). ROHHAD is a rare disease, with only 100 reported cases worldwide thus far.

Central sleep apnea (CSA) or central sleep apnea syndrome (CSAS) is a sleep-related disorder in which the effort to breathe is diminished or absent, typically for 10 to 30 seconds either intermittently or in cycles, and is usually associated with a reduction in blood oxygen saturation. CSA is usually due to an instability in the body's feedback mechanisms that control respiration. Central sleep apnea can also be an indicator of Arnold–Chiari malformation.

Periodic breathing is clusters of breaths separated by intervals of apnea or near-apnea. As opposed to normal breathing which is usually regular, periodic breathing is defined as three or more episodes of central apnea lasting at least 4 seconds, separated by no more than 30 seconds of normal breathing.

<span class="mw-page-title-main">Heated humidified high-flow therapy</span> Respiratory support method

Heated humidified high-flow therapy, often simply called high flow therapy, is a type of respiratory support that delivers a flow of medical gas to a patient of up to 60 liters per minute and 100% oxygen through a large bore or high flow nasal cannula. Primarily studied in neonates, it has also been found effective in some adults to treat hypoxemia and work of breathing issues. The key components of it are a gas blender, heated humidifier, heated circuit, and cannula.

Brief resolved unexplained event (BRUE), previously apparent life-threatening event (ALTE), is a medical term in pediatrics that describes an event that occurs during infancy. The event is noted by an observer, typically the infant's caregiver. It is characterized by one or more concerning symptoms such as change in skin color, lack of breathing, weakness, or poor responsiveness. By definition, by the time they are assessed in a healthcare environment they must be back to normal without obvious explanation after the clinician takes the appropriate clinical history and physical examination.

References

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  2. Choi, Hee Joung; Kim, Yeo Hyang (2016). "Apparent life-threatening event in infancy". Korean Journal of Pediatrics. 59 (9): 347–354. doi:10.3345/kjp.2016.59.9.347. ISSN   1738-1061. PMC   5052132 . PMID   27721838.
  3. 1 2 3 "Apnea, Infantile - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). Retrieved 2016-10-29.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 "Infant Sleep Apnea - Overview and Facts". www.sleepeducation.org. Retrieved 2016-11-17.
  5. 1 2 Zhao, Jing; Gonzalez, Fernando; Mu, Dezhi (2016-11-21). "Apnea of prematurity: from cause to treatment". European Journal of Pediatrics. 170 (9): 1097–1105. doi:10.1007/s00431-011-1409-6. ISSN   0340-6199. PMC   3158333 . PMID   21301866.
  6. Marcus, Carole L.; Ward, Sally L.Davidson; Mallory, George B.; Rosen, Carol L.; Beckerman, Robert C.; Weese-Mayer, Debra E.; Brouillette, Robert T.; Trang, Ha T.; Brooks, Lee J. (July 1995). "Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea". The Journal of Pediatrics. 127 (1): 88–94. doi:10.1016/S0022-3476(95)70262-8. PMID   7608817.