Sleep apnea is a breathing disorder where a person experiences pauses or reductions in breathing during sleep. Infants can also suffer from sleep apnea. While rare in healthy, full-term babies, it is common among premature infants; almost all babies born before 28 weeks of gestation experience some form of apnea. A pause becomes a clinical concern when it lasts for 20 seconds or longer, or if a shorter pause is accompanied by a drop in heart rate or a change in skin color.
Understanding the Types of Infant Sleep Apnea
Infant sleep apnea is categorized into two classifications based on its cause, with a third category combining both.
Central Sleep Apnea (CSA)
Central Sleep Apnea (CSA) is the most frequent type seen in newborns, especially those born prematurely. This form arises when the brain fails to send the necessary signal to the breathing muscles. This failure is attributed to the immaturity of the central nervous system and the respiratory control center, which usually resolves as the infant matures.
Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea (OSA) occurs when airflow is physically blocked, even though the infant actively attempts to breathe. This blockage is commonly caused by anatomical features such as a superiorly positioned larynx, a floppy airway (laryngomalacia), or small jaws (micrognathia). While enlarged tonsils and adenoids cause OSA in older children, they are less often the culprit in newborns. OSA is characterized by the baby’s chest visibly heaving as they struggle against the closed airway.
Mixed Apnea
Mixed Apnea involves a combination of both central and obstructive events within the same episode. For example, the breathing signal might cease (central event), and when the brain attempts to restart breathing, the upper airway may collapse (obstructive event). Mixed apnea is common in smaller premature infants. Identifying the specific type of apnea is important because treatment strategies vary based on the underlying mechanism.
Identifying Observable Warning Signs
Parents are often the first to recognize the signs of breathing trouble, and their observations are important for diagnosis. Respiratory indicators during sleep are the most direct sign of a problem. Parents may notice loud, uneven snoring or noisy, labored breathing, which is unusual in healthy infants. Pauses lasting longer than 15 to 20 seconds are concerning, often followed by a choking sound or a gasp as the baby struggles to catch their breath.
Physiological indicators reflect the body’s response to insufficient oxygen. A bluish tint (cyanosis) around the lips, nose, or on the trunk is a sign of low blood oxygen levels. Excessive sweating or clamminess, particularly around the head, may occur as the baby works harder to overcome airway obstruction. A loss of muscle tone, causing the baby to go limp, or noticeable paleness require immediate medical attention.
The consequences of fragmented sleep are also seen in the baby’s behavior while awake. Behavioral indicators include unusual fussiness, irritability, or excessive sleepiness. Poor quality sleep can interfere with the infant’s ability to feed effectively, leading to difficulty gaining weight or a failure to thrive. Prompt evaluation is important to prevent long-term developmental issues.
Medical Diagnosis and Treatment
The definitive method for diagnosing infant sleep apnea is an overnight polysomnography (sleep study). This procedure is conducted in a specialized sleep center where the infant is monitored throughout the night. The study measures multiple physiological parameters, including brain waves (EEG), heart rate (ECG), eye and muscle movement, and blood oxygen levels. Sensors are placed around the chest and abdomen to differentiate between central apnea (no effort to breathe) and obstructive apnea (unsuccessful breathing effort).
Management strategies are tailored to the specific type of apnea identified. For Central Sleep Apnea, treatment focuses on supportive measures while the nervous system matures. For premature infants, the drug caffeine citrate stimulates the brain’s respiratory center, increasing the central respiratory drive and making the baby more sensitive to carbon dioxide levels. Treatment begins with a loading dose followed by a daily maintenance dose, and the medication continues until the baby is consistently free of apnea events.
For Obstructive Sleep Apnea, interventions maintain an open airway. Continuous Positive Airway Pressure (CPAP) delivers a continuous stream of pressurized air through a nasal mask, acting as an air splint to keep the airway from collapsing. For severe cases linked to anatomical issues like micrognathia or laryngomalacia, surgical options may be considered. Surgical options include mandibular distraction to enlarge the jaw or supraglottoplasty to stabilize voice box tissues. Long-term monitoring and follow-up care are essential as the infant grows and their condition evolves.