Sleep Apnea

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During sleep, everyone has brief pauses in their breathing pattern called apneas. Usually, these are completely normal.

Sometimes, though, apneas may be prolonged and happen often, making the breathing pattern irregular and abnormal. Abnormal sleep apnea might actually cause decreased oxygen levels in the body and disrupt sleep.

Types of Sleep Apnea

The word apnea comes from the Greek word meaning "without wind." Although it's perfectly normal for everyone to experience occasional pauses in breathing, sleep apnea can be a problem when breathing stops frequently or for prolonged periods of time.

The three types of sleep apnea are:

  1. obstructive
  2. central
  3. mixed

Obstructive sleep apnea

A common type of sleep apnea in children, obstructive apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids). This is most likely to happen during sleep because that's when the soft tissue at back of the throat is most relaxed. As many as 1% to 3% of otherwise healthy preschool-age kids have obstructive apnea.

obstructive sleep apnea illustration

Symptoms include:

  • snoring (the most common) followed by pauses or gasping
  • labored breathing while sleeping
  • very restless sleep and sleeping in unusual positions
  • daytime sleepiness or behavioral problems

Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after waking in the morning and tiredness and attention problems throughout the day. Sometimes sleep apnea can affect school performance. One recent study suggests that some kids diagnosed with ADHD actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.

Treatment for obstructive apnea involves keeping the throat open to aid air flow, such as with adenotonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP), which is delivered by having the child wear a nose mask while sleeping.

Central sleep apnea

Central sleep apnea occurs when the part of the brain that controls breathing doesn't properly maintain the breathing process. In very premature infants, it's seen fairly commonly because the respiratory center in the brain is immature.

Mixed sleep apnea

Mixed sleep apnea is a combination of central and obstructive sleep apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.

Conditions Associated With Sleep Apnea

Sleep apnea can be seen in connection with:

Apparent Life-Threatening Events (ALTEs)

An ALTE itself is not a sleep disorder — it's a serious event with a combination of sleep apnea and change in color, change in muscle tone, choking, or gagging. Call 911 immediately if your child shows the signs of an ALTE.

ALTEs, especially in young infants, often are associated with medical conditions that require treatment; these include gastroesophageal reflux disease (GERD), infections, or neurological problems or cardiac disorders.

ALTEs are frightening to see, but can be uncomplicated and may not happen again. However, any child who has one should be seen by a doctor for evaluation immediately.

Apnea of Prematurity (AOP)

AOP can occur in infants who are born prematurely (before 34 weeks of pregnancy). Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his or her own breathing normally. AOP can be obstructive, central, or mixed.

Treatment for AOP can involve the following:

  • keeping the infant's head and neck straight (premature babies should always be placed on their backs to sleep to help keep the airways clear)
  • medications to stimulate the respiratory system
  • continuous positive airway pressure (CPAP) — to keep the airway open with the help of forced air through a nose mask
  • oxygen

Premature infants with AOP are followed closely in the hospital. If AOP doesn't resolve before discharge from the hospital, the baby might be sent home on an apnea monitor and parents and other caregivers will be taught CPR. The family will work closely with the child's doctor to have a treatment plan in place.

Apnea of Infancy (AOI)

Apnea of infancy occurs in children younger than 1 year old who were born after a full-term pregnancy. Following a complete medical evaluation, if a cause of apnea isn't found, it's often called apnea of infancy.

AOI usually goes away on its own, but if it doesn't cause any significant problems (such as low blood oxygen), it may be considered part of the child's normal breathing pattern.

Infants with AOI can be watched at home with the help of a special monitor prescribed by a sleep specialist. This monitor records chest movements and heart rate and can relay the readings to a hospital apnea program or save them for future examination by a doctor. Parents and caregivers will be taught CPR before the baby is sent home.

If You Think Your Child Has Sleep Apnea

If you suspect that your child has sleep apnea, call your doctor. If you suspect that your child is experiencing an ALTE, call 911 immediately.

Although prolonged pauses in breathing can be serious, after a doctor does a complete evaluation and makes a diagnosis, most cases of sleep apnea can be treated or managed with surgery, medications, monitoring devices, or sleep centers. Many cases of sleep apnea go away on their own.

Reviewed by: Matthew Lundien, MD
Date reviewed: November 2011
Originally reviewed by: Aaron S. Chidekel, MD



Related Resources

OrganizationAmerican Academy of Sleep Medicine (AASM) AASM strives to increase awareness of sleep disorders in public and professional communities.
OrganizationAmerican Sleep Apnea Association (ASAA) The ASAA is dedicated to reducing injury, disability, and death from sleep apnea and to enhancing the well-being of those affected by this common disorder.


Related Articles

Common Diagnoses in the NICU Learn about common NICU conditions, what causes them, how they're diagnosed, how they're treated, and how long babies might stay in the unit.
Tonsils and Tonsillectomies Not everyone knows what tonsils do or why they may need to be removed. Knowing the facts can help alleviate the fears of both parents and kids facing a tonsillectomy.
Enlarged Adenoids Often, tonsils and adenoids are surgically removed at the same time. Though some kids need surgery, enlarged adenoids are normal in others.
Sleep and Newborns "Does your baby sleep through the night?" is one of the questions new parents hear the most. And almost always the answer is "No."
Apnea of Prematurity Apnea of prematurity (AOP) is a condition in which premature infants stop breathing for 15 to 20 seconds during sleep. It's frightening while it's happening, but AOP usually goes away on its own as a baby matures.
All About Sleep How do you get kids to bed through the cries, screams, avoidance tactics, and pleas? What if you're awakened in the middle of the night? And how much sleep do kids need?




Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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