Apneic episodes are brief interruptions in breathing that can occur during sleep. While some short breathing pauses are normal, particularly in infants, apneic episodes are characterized by longer cessations or those accompanied by concerning signs.
Types of Apneic Episodes
Apneic episodes are broadly categorized into different types, primarily distinguished by their underlying mechanisms. Obstructive sleep apnea (OSA) is the most common form, occurring when the upper airway becomes partially or completely blocked during sleep despite continued breathing efforts. This blockage typically lasts at least 10 seconds and can happen multiple times per hour.
Central sleep apnea (CSA) is a less common type where the brain temporarily fails to send signals to the breathing muscles, resulting in no respiratory effort during the pause. Mixed sleep apnea, also known as complex sleep apnea, combines features of both obstructive and central sleep apnea, involving both airway obstruction and a lack of brain signals.
Infant apnea, particularly apnea of prematurity, refers to breathing pauses in newborns, often premature. These episodes are defined as a cessation of breathing for 20 seconds or longer, or a shorter pause accompanied by a slow heart rate, bluish skin, or limpness.
Recognizing Apneic Episodes
Apneic episodes are often identified by observable signs during sleep. For adults and older children, loud snoring is a common indicator, especially if it includes pauses followed by gasping, snorting, or choking sounds as breathing resumes. Individuals may also wake up frequently during the night.
Daytime symptoms can also suggest nighttime apneic episodes. These include excessive daytime sleepiness, morning headaches, difficulty concentrating, and mood changes such as irritability or depression. These symptoms arise from fragmented sleep and reduced oxygen levels.
In infants, recognizing apneic episodes involves looking for specific changes. Parents or caregivers might notice pauses in breathing, a bluish tint to the skin or lips, paleness, or a sudden limpness in the baby. A slowed heart rate (bradycardia) can also accompany these pauses.
Causes and Risk Factors
The causes of apneic episodes vary by type. Obstructive sleep apnea typically results from the relaxation of throat muscles and tissues during sleep, allowing them to collapse and block the airway. Risk factors for OSA include:
Excess body weight (fat deposits around the upper airway)
Large neck circumference
Inherited narrow airways
Enlarged tonsils or adenoids (especially in children)
Being male
Older age
Family history
Smoking
Alcohol use
Certain medical conditions (e.g., high blood pressure, diabetes)
Central sleep apnea arises from issues with the brain’s control over breathing. This can be due to conditions affecting the brainstem, such as heart failure, stroke, or certain neurological disorders. Use of narcotic pain medications, high altitude, and sometimes positive airway pressure (PAP) therapy for obstructive sleep apnea can also lead to central sleep apnea.
Infant apnea is primarily linked to the immaturity of the central nervous system, especially in premature babies whose brain and respiratory reflexes are not fully developed. Other contributing factors include:
Infections
Metabolic imbalances (e.g., low blood sugar)
Heart problems
Issues with coordinating sucking and swallowing during feeding
Addressing Apneic Episodes
Addressing apneic episodes begins with a professional medical evaluation to accurately diagnose the specific type and severity. A sleep study (polysomnography) is a common diagnostic tool that monitors various bodily functions during sleep, including brain waves, heart rate, and breathing patterns, to identify apneic events. This analysis helps differentiate between obstructive, central, and mixed forms of apnea.
Management strategies for obstructive sleep apnea often include lifestyle changes like weight loss, which can reduce fat deposits around the airway. Positional therapy (e.g., sleeping on one’s side) can also help prevent airway collapse. Continuous Positive Airway Pressure (CPAP) machines are a primary medical device, delivering a continuous stream of air through a mask to keep the airway open. Oral appliances, which position the jaw or tongue, are another option. In some cases, surgical procedures may be considered to remove or reshape upper airway tissues or stimulate nerves controlling tongue movement.
For central sleep apnea, addressing underlying medical conditions is often the first step. Treatment may also involve adaptive servo-ventilation (ASV) or bi-level positive airway pressure (BiPAP) devices, which adjust airflow based on breathing patterns. Supplemental oxygen can also be used.
Infant Apnea Management
For infant apnea, treatment depends on the cause and severity. Mild stimulation, such as gently rubbing the baby’s back, can sometimes restart breathing. Medications like caffeine may stimulate the respiratory system, and respiratory support devices like CPAP or ventilators may be necessary for more severe cases. Close monitoring in a hospital setting is common.