A sleep disorder characterized by a pause in breathing that lasts for or longer than 20 seconds in full-term infants is termed sleep apnea. If the pause in breathing is less than 20 seconds but still leads to bradycardia (reduction in heart rate) or cyanosis (bluish discoloration of the baby’s lips, nails, or skin), it can also be termed as sleep apnea (1). Partial reduction in breathing is called hypopnea (2).
Early diagnosis and treatment help avoid complications, which may affect the baby’s overall growth and development. This post explains causes, risk factors, diagnosis, treatment, and preventive measures for sleep apnea in babies.
What Are The Different Types Of Apnea In Babies?
Sleep apnea syndrome is classified into the following types depending on the underlying cause.
1. Central apnea
Central apnea occurs when the brain does not send the required signals to the body to facilitate breathing. The cause of central apnea is mostly unknown, and it is rarely seen in infants. Some researchers believe central sleep apnea occurs in premature babies or babies of mothers who smoke during pregnancy. It may also be found in babies with brain-related disorders or conditions, such as brain tumors, cerebral palsy, Chiari malformations, hydrocephalus, or brain injury (3)
2. Obstructive sleep apnea
An obstruction in the airway causes obstructive sleep apnea due to falling back of the throat’s soft tissue. Babies with floppy airways due to large adenoids, laryngomalacia, or larger tissue at the back of the throat may develop it. Obstructive sleep apnea may also occur in infants with conditions such as small jaws, Down syndrome, and Pierre Robin syndrome (3).
3. Mixed apnea
This is the most common form of sleep apnea in infants. It exhibits combined symptoms of both central and obstructive sleep apnea.
How To Tell If Your Baby Has Sleep Apnea?
- Gasping for air
- Snorting or noisy breathing
- Mouth breathing
- Night sweats
- Sleeping in awkward positions
- Unusually sleepy during the day
- Prolonged pauses in breathing that last for 20 seconds or longer
- Repeated patterns of pauses in breathing for even lesser than 20 seconds
- Low oxygen saturation levels
- Slow heartbeat
- Past history of emergency care or resuscitation
- Loss of consciousness
It is important to know that babies with sleep apnea show similar breathing disturbances during their daytime naps, too. Sleep apnea in infants is not exclusive to nighttime sleeping. Visit your baby’s healthcare provider if you suspect your baby has sleep apnea.
Is Sleep Apnea In Babies Common?
The exact prevalence and incidence of sleep apnea in babies of all age groups are unknown. In full-term infants, apnea is found in one out of 1000 babies (2) (5). Sleep apneas are more common in preterm infants because they have more REM (rapid eye movement sleep). Some researchers suggest that the incidence of apnea in preterm infants is inversely related to gestational age.
REM is a unique phase of sleep that is characterized by random and rapid eye movement and low muscle tone throughout the body. During infancy, episodes of apnea usually increase during REM sleep.
Causes And Risk Factors Of Sleep Apnea
- Premature birth
- Overweight at birth
- Acid reflux
- Small upper airway
- Enlarged adenoids or tonsils
- Family history of obstructive sleep apnea
- Certain drugs
- Certain metabolic disorders
- Underdeveloped facial features
- Down syndrome
- Pierre Robin Syndrome
- Cerebral Palsy
- Neuromuscular disease
- Lung disease
- Tumors or growth in airways
Diagnosis Of Sleep Apnea
The diagnosis of sleep apnea is made using one or more of the following methods.
1. Physical examination
The physical examination procedure could involve the following.
- Noting down noticeable signs, such as snoring, restlessness during sleep, behavioral problems, and daytime drowsiness
- Registering height and weight to rule out obesity
- Visual examination of nostrils under light to rule out visible growths
- Visual examination of the throat to check for enlarged tonsils and adenoids
- Facial assessment to rule out any underdeveloped facial structures
2. Sleep study
The American Academy of Sleep Medicine (AASM) suggests that an overnight sleep study in a sleep lab is the only way to diagnose sleep apnea in children properly. A sleep study is known as a polysomnogram.
Sensors are placed on the child’s body using tapes or adhesives to monitor brain waves, heartbeat, leg movements, eye movements, snoring, oxygen levels, carbon dioxide levels, and breathing activities during different stages of sleep. These sensors are usually attached an hour before the baby’s regular bedtime, and it is a painless process.
The readings of this test can help the doctor pinpoint the cause of sleep apnea. A family member can accompany to make the baby feel comfortable. An audio and video recording is also made to record the baby’s snoring and body movements (3) (8).
3. Nasal endoscopy
If the doctor suspects that the baby has swollen adenoids, an otolaryngologist may perform a nasal endoscopy. An endoscope is a narrow and flexible tube connected to a camera and light. The baby’s nose is sprayed using local anesthetic spray to avoid discomfort. The endoscope helps look for signs of inflammation and lets the doctor view the adenoids better (8) (9).
4. Imaging tests
If a baby is born with visibly small jaws, nostrils, or small airways, the doctor might recommend imaging tests such as X-Rays, CT scans, or MRI scans. CT scans are used to visualize hard bony structures, while MRIs may help view soft structures in the airway (8).
Complications Of Sleep Apnea
Timely diagnosis and treatment could help avoid serious complications. Sometimes, sleep apnea may cause low oxygen levels in the blood. Persistent low oxygen may cause permanent damage to the baby’s lungs and heart.
Chronic sleep apnea may lead to behavioral problems, poor growth, and slow development in some babies (6). Severe complications may include failure to thrive, metabolic alkalosis, and respiratory distress. These may be life-threatening (10).
How To Treat Sleep Apnea In Infants?
The treatment plan for sleep apnea depends on the age, symptoms, general health, and severity of the condition. Moreover, the treatment plan is based on the cause of sleep apnea.
The treatment plan of sleep apnea includes one or more of the following, depending on the cause (11).
1. Treatment of nasal allergy
Allergies may cause congestion or swelling, making the baby snore more. Your doctor may prescribe some anti-allergy medications to address nasal allergy.
2. Nasal CPAP
Nasal continuous positive airway pressure is a common and effective treatment for sleep apnea in cases where surgical correction is not possible. The CPAP device is a compressor that pushes air into a mask, and the mask has to be snugly worn over the nose. The pressure of the air prevents the tissues of the throat from collapsing during sleep.
3. Surgical management
It could consist of the following steps depending on the cause.
- Adenotonsillectomy is a corrective surgery to remove enlarged adenoids and tonsils (6).
- Craniofacial surgeries might be indicated in case of structural abnormalities (4).
- In very severe cases, a tracheostomy is done. A small hole is made in the trachea (windpipe), and a tube is inserted in the opening.
Infant sleep apnea usually resolves as the baby grows older. About 98% of preterm infants are symptoms-free by 40 weeks. Long-term complications are rare for most children with sleep apnea.
Home Care For Infants With Apnea
- Find the factors triggering your baby’s allergies and try avoiding them.
- Smoke and vehicular effluents can exacerbate apnea. Keep the baby away from second-hand smoke and pollution.
- Babies should sleep on their backs until 12 months of age.
- Pacifiers may reduce the risk of apnea.
- In some rare cases, you may place your baby on an apnea monitor to detect pauses in breathing.
- You may learn CPR to help the baby if the baby stops breathing at home. It could help you for some minutes until you receive emergency medical care.
Frequently Asked Questions
1. Does infant sleep apnea go away?
Most babies will outgrow sleep apnea as they become older and their upper airways grow larger (3). The problem of sleep apnea may persist longer in preterm babies born at less than 28 weeks of pregnancy (4).
2. Is sleep apnea life-threatening?
Severe sleep apnea may be life-threatening if left untreated. Long-lasting apnea may cause damages to the heart, brain, and other body parts (3).
3. Does sleep apnea affect babies only?
No. Sleep apnea can be seen across all age groups.
Sleep apnea in babies is not uncommon. A doctor can diagnose sleep apnea accurately. Timely diagnosis and treatment of sleep apnea in babies could result in better outcomes. If you notice erratic breathing in your baby or signs of apnea, do not hesitate to take the doctor’s opinion.
2. Infant Sleep Apnea; American Academy of Sleep Medicine
3. Sleep Apnea in Babies: Symptoms, Diagnosis and Treatment; Children’s Mercy
4. What is infant sleep apnea?; American Academy of Sleep Medicine
5. Noah P. Kondamudi, Lewis Krata, and Andrew S. Wilt,Infant Apnea; National Center for Biotechnology Information
6. Obstructive Sleep Apnea in Children;Cedars – Sinai
Eliot S. Katz, Ron B. Mitchell, and Carolyn M. D’Ambrosio,7. Obstructive Sleep Apnea in Infants; American Journal of Respiratory and Critical Care Medicine
8. Diagnosing Sleep Apnea in Children;NYU Langone Health
9. How to perform endoscopy in paediatric otorhinolaryngology?;European Annals of Otorhinolaryngology, Head and Neck Diseases
10. L.P. Singer and P. Saenger, Complications of pediatric obstructive sleep apnea;Otolaryngologic Clinics of North America
11. ,Obstructive Sleep Apnea In Children;American Thoracic Society