According to statistics, 2% of parents experience apnea in newborns - a disorder in which the baby stops breathing for 20 seconds or more. Apnea occurs more often in premature babies. According to various estimates, from a quarter to a half of babies born at 37-42 weeks suffer from OSA (obstructive sleep apnea syndrome).
Norm
Uneven breathing in newborns during sleep is not always a problem. Parents should not worry if breathing stops:
- occur no more than once per hour;
- breathing in a sleeping child does not cause effort;
- the baby breathes evenly and deeply during sleep;
- holding your breath for less than 5 seconds;
- the baby’s heart does not slow down, the pulse does not subside, the skin does not change color.
If your baby’s breathing causes concern, you should find time and visit a pediatric somnologist – a doctor who treats sleep disorders.
Diagnosis of OSA
The American Academy of Pediatrics (AAP) developed clinical and practice guidelines for the diagnosis and treatment of OSA in 200013. The recommendations are accompanied by an in-depth, comprehensive review of the literature14. The AAP recommends screening for OSA in all children who snore. Despite these recommendations, not all pediatricians perform such screening. Clinical examination alone is not sufficient to identify OSA because parental findings may vary and depend on many factors, including anxiety in the family, degree of sleep disturbance in family members, frequency of nighttime awakenings from OSA, and impact on daytime functioning of family members. Outside observers often cannot clinically distinguish children who simply snore from those who have OSA. The results of examination of a child during the daytime may be completely normal, despite significant obstruction of the upper respiratory tract at night, which complicates diagnosis. All modern methods of detecting upper airway obstruction by imaging (lateral X-ray and MRI) are not dynamic and cannot reliably identify obstruction. Overnight polysomnography (PSG)15 is considered the test of choice for identifying children with OSA. If OSA is suspected, in the absence of a specialized pediatric laboratory, you can contact an adult center. However, adult diagnostic criteria cannot be used when interpreting the results. New reference values for pediatric PSG have recently been published. The lack of opportunities to examine children and the lack of standardization in the analysis and interpretation of data make it difficult to effectively treat children and determine the need and prognosis of a particular treatment method. It should also be noted that a number of research groups have developed simplified OSA testing methods for screening purposes. Portable and simplified devices include pulse oximetry, short-day polysomnography, and can be useful in identifying OSA, but they do not fully assess the disease as a whole14,16.
Kinds
Infant apnea - what is it? Experts distinguish several types of this pathology.
A baby born at term may experience the following types of apnea:
- central – short-term cessation of breathing, which occurs involuntarily in infants;
- obstructive - the child stops breathing due to obstruction (blockage) of the airways.
Premature newborns may experience:
- primary apnea - observed due to difficulty in lung function immediately after the baby is born or 3-6 months after birth;
- secondary – respiratory arrest after primary ventilation.
Secondary apnea is characterized not only by cessation of breathing, but also by a decrease in pressure and a general weakening of muscle tone. This condition can provoke the further development of complications.
Symptoms
The main alarm signal is interruptions in breathing or stopping it for more than 20 seconds. You should urgently make an appointment with a doctor if your breathing pattern does not fit into the norm, and if at least one of the following symptoms is observed:
- baby's skin becomes paler or bluer;
- cyanosis appears in the mouth and nose area due to oxygen deficiency;
- snoring (indicates an obstructive type of apnea);
- The baby suffers from restless sleep not for the first night;
- enuresis (indicates disruptions in the functions of the central nervous system);
- profuse sweating occurs during sleep;
- the child convulsively gasps for air, constantly breathes through his mouth (both in sleep and while awake);
- cannot restore smooth breathing after an attack.
Due to constant lack of sleep, the baby becomes capricious, constantly cries, and gets irritated.
The main symptoms of apnea in children born prematurely include:
- episodic interruption of breathing with pauses of 20 seconds or more;
- blue/pale skin;
- slowing of the pulse (in infants it can be heard more clearly on the shoulder or fontanelle).
Doctors are well aware of when apnea in premature babies goes away, unless there are complicating factors. This occurs by 40-45 weeks of life as the nervous and respiratory systems, as well as the respiratory control center, are finally formed.
It is more difficult to understand until what age the problem will last. Seizures can occur both in infants in the first weeks of life and in children older than six months. The prognosis is given only after a complete diagnosis.
How to recognize apnea in children?
Tips for parents: how to recognize signs of apnea in a child.
Throughout the school year, a good night's sleep should be at the top of any child's list of daily needs. But for some kids, needed rest goes beyond going to bed early. At the Chicago Allergy Research Center, Dr. Brian Rostkoff, a specialist in allergy, asthma and immunology, helps parents recognize the signs of sleep apnea in children. He does this thanks to the monitoring of children's snoring and allergic rhinitis.
Many children snore from time to time, especially if the child has a cold or is in the acute stage of bronchial asthma. At the same time, if a child has restless sleep, snores regularly, breathes through his mouth, and then feels lethargic and tired during the day, then the reason for all this may be the presence of apnea. It is emphasized that the symptoms of apnea in children are usually less obvious than the symptoms of the same disease in adults.
Warning signs that you should definitely pay attention to (may appear at the age of 2-6 years):
Night apnea symptoms: - constant snoring and mouth breathing; - labored breathing; - bedwetting (enuresis) outside the age norm; - increased sweating during sleep; - unusual positions during sleep; Daytime symptoms of apnea: - presence of allergies, bronchial asthma or recurring otitis media; - poor performance at school or difficulty concentrating on certain tasks; - behavioral or social problems; - bad mood or constant agitation, anxiety; - depression or anxiety.
Children with sleep apnea syndrome often experience other breathing difficulties. Dr. Rostkoff acknowledges that there are some children who snore regularly, but they do not necessarily have apnea. However, aggravating factors that can eventually lead to sleep apnea are enlarged tonsils and adenoids.
Dr. Rostkoff is one of the few allergy and asthma specialists who is paying deserved attention to the problem of childhood sleep apnea. He emphasizes that even if your child sleeps 10 to 12 hours a night every day, sleep apnea can cause enough change to affect mood, school performance, and overall behavior. Research confirms that middle and high school students with moderate to severe sleep apnea score lower in grades and have more difficulty focusing and concentrating in class. If you suspect your child is suffering from sleep apnea, Dr. Rostkoff recommends a thorough overnight examination of any symptoms and physical factors that could be contributing to the breathing problems. In addition to observing the size of the child's tonsils and adenoids, it is also necessary to evaluate the soft palate and uvula, tongue, bite, nasal passages and airways. Obviously, the study should be carried out at home and not disturb the child's sleep.
In conclusion, the specialist notes that addressing your child's sleep problems in the early stages will not only improve academic and social indicators, but will also be the key to developing healthy sleep habits in children in their future adulthood.
source: news-medical.net
Causes and consequences
In newborns, pathology can develop due to problems:
- with lungs or heart;
- due to disorders of the respiratory functions of the central nervous system;
- due to airway obstruction.
In premature babies, the syndrome often develops due to an immature nervous system. The reasons may also be:
- unsuccessful ventilation after primary apnea;
- birth injury;
- congenital pathologies of the heart and blood vessels;
- intrauterine infections affecting the fetal brain;
- immaturity of the laryngeal muscles;
- craniofacial pathologies;
- weak muscular corset of the upper respiratory tract.
In addition, apnea is often a complication of hereditary diseases, as well as diseases that the child has already had - meningitis, inflammation of the adenoids, asphyxia, oxygen starvation, etc.
Breathing problems are extremely dangerous for the baby's health. They can also threaten his life. When breathing stops for 20 seconds, neurons begin to die. With a longer absence of oxygen, irreversible problems begin with all vital organs - heart, lungs, bronchi.
In children older than six months, neurological problems develop with chronic apnea. The child cannot concentrate. Memory deteriorates. With hyperactivity, it is extremely difficult for a child to find contact with other children. There are problems with socialization on the playground or in the nursery.
Sleep apnea in children
Like adults, children can also experience episodes of apnea during sleep.
This is especially true for newborns, in whom symptoms are observed in 60% of cases, and in premature infants this figure reaches 90%. The main reason is the incomplete formation of the respiratory control center, which is located in the medulla oblongata. It is he who must adequately respond to the fact of a decrease in oxygen in the blood and send signals to the muscles responsible for breathing and thus ensure the inhalation of a new portion of air.
In babies, sleep apnea goes away on its own in the first month of life and does not require any treatment.
If a person has an attack of sleep apnea, he needs to be given first aid immediately. He needs to be woken up and allowed to breathe. However, this will not prevent further attacks when he falls asleep again.
If a child stops breathing, you should immediately call an ambulance, especially if the tips of the baby’s fingers and his face turn blue and the pulse slows down. The child must be awakened so that he begins to breathe on his own.
In the future, parents are recommended to purchase a special monitor that will record respiratory movements and warn that the child has stopped breathing.
Diagnostics
Sleep apnea is not a death sentence, and to understand how to treat it, it is enough to consult a doctor. Parents of a premature baby should make an appointment with a neonatologist. The rest go to a pediatrician, who will refer you to a specialist. The task of the otolaryngologist, neurologist, pulmonologist, cardiologist will be to identify the causes that provoked the disorders.
In newborns
Polysomnography is the main method that helps to identify pathology in children born at term. Diagnosis is carried out during sleep. Electrodes and sensors are connected to the baby’s body, which record the functioning of the respiratory system. The doctor visually monitors breathing pauses, their number, frequency and duration.
Additional examinations are carried out to identify the causes. For example, if you suspect:
- For obstructive apnea, anterior rhinoscopy is prescribed, which makes it possible to detect the causes of complicated nasal breathing;
- for disturbances in the functioning of the heart - ECG, ultrasound of the heart and brain;
- for pneumonia - radiography.
The doctor may also prescribe an MRI, CT scan, brain encephalogram and other examinations.
In premature babies
Most often, premature babies suffer from central apnea. Therefore, neurosonography becomes the main diagnostic method. Otherwise - ultrasound examination of the brain. The brain stem, where the respiratory center is located, is especially carefully studied. The doctor analyzes the nature and dynamics of brain processes and makes a conclusion about the presence or absence of pathologies.
If abnormalities are detected, a lumbar puncture is prescribed. With its help, they look for hemorrhages or inflammation in the brain.
Obstructive sleep apnea syndrome is much more common in children than it seems. 1–4% of children are affected by this disease, most of them between two and eight years of age. There is a high probability that over time the child will “outgrow” apnea, but even in a relatively short period of time this disease, if left untreated, can harm the growing body. Inadequate, fragmented sleep can cause problems such as enuresis, sleepwalking, growth retardation, and some hormonal disorders.
Manifestations of sleep apnea in a child during the night:
- Constant loud snoring.
- Stopping breathing, noisy intake of air. The child may wake up from a feeling of lack of air.
- Restless sleep or sleeping in an unusual position.
- Heavy sweating during the night.
Daytime signs of apnea:
- Behavioral disorders, difficulties in learning and communicating with other children.
- It is difficult for a child to get up early in the morning.
- Headaches, especially in the morning.
- Irritability, excitability, aggressiveness.
- Severe sleepiness during the day.
- Nasal voice, breathing through the mouth.
Normally, apnea episodes are less common in children than in adults.
Children's sleep experts believe that one pause in breathing per hour or an apnea/hypopnea index value of 1.5 is already exceeding the norm for children. If the index is 5 or higher, then treatment is strongly recommended. An index of 10 or higher for a child under 12 years of age indicates severe apnea. The main treatment for childhood apnea is surgical removal of the tonsils. This operation helps in more than 70% of cases of apnea in children. If surgery is not indicated or does not resolve the problem, continuous positive pressure therapy (CPAP) is used. In some cases, specially made intraoral devices (mouthguards) are also used. If a child with apnea is overweight, weight loss is strongly recommended. Undiagnosed and untreated sleep apnea can lead to increased fatigue and problems at school. A study published in the journal of the American Lung Society, CHEST, showed that children with sleep-disordered breathing were twice as likely to experience declines in academic performance. Also, children suffering from apnea are more likely to develop attention-deficit/hyperactivity disorder (OSA occurs in almost 25% of children with this disorder). Many researchers believe that sleep-disordered breathing affects the “executive functions” of the brain: cognitive flexibility, self-control, planning, and self-regulation of affect.
If you notice symptoms of sleep apnea in your child, talk to your pediatrician.
What to do for apnea: first aid
During an attack, parents should provide first aid to the baby by following simple steps:
- Take the baby in your arms, stroke or pat him on the back, rub his arms, legs, earlobes, tickle his heels or pat them.
- Spray your baby with cool water.
- To make breathing easier, place your baby on his tummy with his head turned to the side.
If the baby's breathing has not returned, perform artificial respiration:
- Place your baby on a hard surface on his back.
- Place a cushion from a sheet or towel under the shoulder blades so that the head tilts back slightly.
- Hold your head and inhale air into your mouth and nose at the same time. The air portions should be very small.
- If the child does not wake up after 6-8 breaths, perform chest compressions.
Treatment
During hospitalization, doctors perform the necessary manipulations to stabilize the baby’s condition. Premature babies are placed in an incubator. If the attacks recur there, the child is connected to a ventilator.
Medication prescriptions and clinical recommendations are made taking into account the causes of the disease. For example, to treat infant apnea caused by excessively enlarged adenoids, an ENT specialist prescribes surgery to remove them.
Prevention
Simple recommendations will help prevent the development of apnea in infancy:
- it is necessary to regularly ventilate the room where the child sleeps;
- the air in the children's bedroom should not be excessively dry;
- Before going to bed, the child should not be overheated;
- bedding must be selected correctly: a hard thin mattress, a low pillow, pillow filling and blankets made from natural materials (filling made from natural bird feathers is not acceptable);
- It is prohibited to use aerosols (both household products and perfumes) near the baby;
- tobacco smoke is strictly prohibited.
To control a child's sleep in the first months of life, it is worth placing his crib in the parents' bedroom.
