Diseases & Conditions


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Apnea


Brief pauses in the breathing pattern during sleep. Usually these brief breathing pauses are normal, but it can become a problem when breathing stops for more than 20 seconds. The word apnea comes from the Greek word meaning “without wind.” There are three types of apnea: obstructive, central, and mixed. In addition apnea of prematurity can be either obstructive, central, or mixed. Apnea of infancy is a type of persistent apnea of unknown origin. Obstructive Apnea An obstruction of the airway (such as enlarged tonsils and adenoids) may affect up to three percent of otherwise healthy preschoolers. This is a common type of apnea in children, especially in those who are obese. Symptoms Snoring is the most common symptom; other signs include color changes, labored breathing or gasping for air during sleep or sleeping in unusual positions. Because obstructive sleep apnea may disturb sleep patterns, these children may wake up sleepy and continue to complain of fatigue and attention problems throughout the day that may affect school performance. One recent study suggests that some children diagnosed with attention deficit hyperactivity disorder (ADHD) actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea. Treatment Obstructive apnea can be cured by keeping the child’s throat open to improve airflow. This may be done by surgically removing the tonsils and adenoids, or by providing continuous positive airway pressure (CPAP). CPAP is provided by having the child wear a nose mask while sleeping. Central Apnea This type of apnea occurs when the part of the brain that controls breathing does not properly start or maintain the breathing process. It is the least common form of apnea, although it is fairly common in very premature infants with an immature respiratory center in the brain. Often there is a neurological cause. A few short central apneas are normal, particularly after a deep breath. Mixed Apnea As its name implies, this is a combination of central and obstructive apnea commonly observed in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep. Apnea of Prematurity (AOP) Premature infants may have an immature brain or respiratory system and may not be able to regulate breathing normally. Apnea of prematurity (AOP) can be obstructive, central, or mixed. Treatment The condition can be improved by keeping the infant’s head and neck straight, giving drugs such as aminophylline, caffeine, or doxapram to stimulate the respiratory system, and providing CPAP to keep the airway open with the help of forced air through a nose mask. Apnea of Infancy (AOI) Persistent apnea of unknown origin is called apnea of infancy, and occurs in children younger than age one who were born after a full-term pregnancy. Infants with this condition can be observed at home with a special monitor prescribed by a sleep specialist that records chest movements and heart rate, relaying readings to a hospital apnea program for future examination. The apnea usually goes away on its own; if it does not cause any problems (such as low blood oxygen), it may be considered part of the child’s normal breathing pattern. Apparent Life-Threatening Events In addition to the above types of apnea, the cessation of breathing also can occur in connection with Apparent Life-Threatening Events (ALTEs). An ALTE itself is not a sleep disorder but an event that is a combination of apnea, change in color, change in muscle tone, choking, or gagging. Most ALTEs can be frightening to see, but they usually are uncomplicated and do not recur. However, some ALTEs (especially in young infants) are associated with medical conditions such as gastroesophageal reflux (GERD), infections, or neurological disorders. These medical conditions require treatment, so all children who experience an ALTE should be seen by a doctor immediately.