What is infant sleep apnea?

Infant sleep apnea is a sleep-related breathing disorder. It involves reductions and pauses in breathing that occur during an infant’s sleep. Partial reductions in breathing are called “hypopneas.” Complete pauses in breathing are called “apneas.” In infancy, the frequency of these events increases during REM sleep.

The apneas in infant sleep apnea may be central, obstructive, or mixed. Central apneas occur when your brain does not send the proper signals to the body resulting in a decrease in effort to breathe and even a complete pause in breathing. Sometimes, central apneas can occur due to a problem outside the brain. As an example, a problem in the heart’s pump function can impair circulation and the brain does not send the correct signals to breathe during an infant’s sleep. Obstructive apneas occur when soft tissue in the back of the throat collapses and blocks the airway during sleep. Mixed apneas have features that are suggestive of central and obstructive cause.

Premature infants tend to have more REM sleep than full-term infants. As a result, premature infants tend to have more sleep-related breathing disorder and apneas. The majority of apneas that occur in small premature infants are mixed apneas. Apneas that occur in larger premature infants and full-term infants tend to be central apneas.

These breathing problems can cause severe complications. The infant may not have enough oxygen in the blood. This is known as “hypoxemia.” The infant also may develop a slow heartbeat. This is known as “bradycardia.” The infant even may lose consciousness and need to be resuscitated.

Infant central sleep apnea has two general causes. It can be a developmental problem that results from an immature brainstem. It also can be a secondary problem that is caused by another medical condition.

It is common for there to be some instability in an infant’s breathing. This can be a normal part of an infant’s development. Even healthy infants may have a brief central apnea. This pause may be an isolated event. It also may occur after the child sighs or moves. The duration of these normal events is very short. They rarely last longer than 20 seconds.

Obstructive apneas are rare in healthy infants. Obstructive sleep apnea may be related to underdeveloped facial features, such as a small or pushed back chin, as well as structural airway abnormalities and low tone.

What are symptoms of infant sleep apnea?

If your infant has sleep apnea they may:

Have prolonged pauses in breathing that last 20 seconds or longer
Have patterns of repeated pauses in breathing that last less than 20 seconds
Have related problems such as low oxygen or a slow heartbeat
Have needed resuscitation or other urgent care

What are risk factors for infant sleep apnea?

Small preterm infants are most likely to have infant sleep apnea. It sometimes occurs in larger preterm or full-term infants. It is less common in infants under the age of six months.

During the first month after birth it occurs in 84 percent of infants who weigh less than 2.2 pounds. The risk decreases to 25 percent for infants who weigh less than 5.5 pounds. It is rare in full-term newborns.

In preterm infants, infant sleep apnea tends to appear between the second and seventh day of life. It is rare on the first day of life. Its presence at birth is usually a sign of another illness.

A variety of medical conditions can cause infant sleep apnea or make it worse. These problems include:

Acid reflux
Anemia
Anesthesia
Drugs
Infection
Lung disease
Metabolic disorders
Neurological problems
Seizures
Small upper airway

A small percentage of children who die from sudden infant death syndrome (SIDS) have apnea symptoms prior to death. But infant sleep apnea has not been established as a risk factor for SIDS.

How to diagnose infant sleep apnea?

You may need to take your infant to a sleep doctor. If so, then you should schedule an appointment at an accredited sleep center. Some centers specialize in helping children. A sleep doctor will review your infant’s history and symptoms. If needed, the doctor will schedule your infant for a sleep study. This kind of study is called polysomnography. It charts your child’s brain waves, heartbeat, and breathing during sleep. It also records arm and leg movements. The sleep study will reveal the nature of your infant’s breathing problem. It also will show the severity of the problem. The study requires your child to spend the night at the sleep center. A parent or guardian also will need to stay at the sleep center with the child. A sleep study is the best way to evaluate your child’s sleep. With the results of this study the doctor will be able to develop an individual treatment plan for your child.

It is also important to know if there is something else that is causing your child’s sleep problems. A sleep doctor can look for other conditions that may be involved. These include:

Another sleep disorder
A medical condition
Medication use
A mental health disorder

The doctor will need to know if your child was born premature or full-term. She will also need to know your child’s weight at birth. Inform the doctor of any complications that you or your baby had during or after delivery. Describe the problems you have observed and when you first noticed them.

How to treat infant sleep apnea?

Infants with sleep apnea may receive oxygen supplementation or need a machine to provide breathing support. They also may need treatment with medications. All of these options tend to be short-term treatments.

Infant sleep apnea tends to go away as the child grows and matures. Ninety-eight percent of preterm infants will be free of symptoms by 40 weeks after conception. The problem is more likely to persist longer in infants who were born less than 28 weeks after conception.

Any medical condition that causes infant sleep apnea or makes it worse also needs to be treated. Surgery to correct airway abnormalities may be indicated in some instances. The treatment will depend on the nature of the medical problem.

Long-term complications are rare for most children with infant sleep apnea. Problems are more likely for infants who need frequent resuscitation. Health problems also are more common if the infant sleep apnea is related to another severe medical condition.