Sleep apnea is a potentially serious sleeping disorder where breathing is repeatedly interrupted during sleep. When left untreated, it can lead to some serious complications like poor growth and slow heart rate. As a baby stops breathing, the oxygen level in the blood drops and the carbon dioxide level increases, triggering a severe drop in the heart rate or loss of consciousness. Partial reductions in breathing are termed as “hypopneas” whereas complete pauses in breathing are called “apneas.”
Sleep apnea can be of three types – Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA), and Mixed Apnea. Obstructive Sleep Apnea is caused when soft tissue in the back of the throat collapses creating blockage in the upper airway whereas Central Sleep Apnea results when the brain fails to send the signal to the muscles to breathe (there is no blockage associated with CSA). Mixed Apnea is a combination of OSA and CSA. The most common type of sleep apnea in premature babies born after 32 weeks and the full-term infants is CSA. Babies born before 32 weeks usually suffer from Mixed Apnea while adults and children above one year of age usually have OSA. The frequency of these events increases during the stage of rapid eye movement (REM) sleep.
Immaturity in the brain stem or obstruction in the airway is commonly responsible for sleep apnea in babies. Other possible causes for apnea are bleeding in the brain, birth defects, respiratory diseases, exposure to poisons or drugs in the womb, infections, gastrointestinal problems like reflux, problems with the heart and blood vessels, imbalance in body chemistry, etc. Sleep apnea is most common in babies who are born prematurely. Children having Down syndrome and other conditions that may affect the upper airway have higher chances of suffering from sleep apnea.
Some kids may stop breathing for 20 seconds or more during sleep whereas others might stop breathing for shorter duration and go limp, turn blue or pale, or their heart rate may slow down. Other symptoms include heavy breathing while sleeping, snoring with snorts, pauses and gasps, sleeping in unusual positions, restless sleep, bed-wetting, behavioural problems, daytime sleeping, having trouble waking up, tiredness throughout the day, etc.
If the doctors suspect that the baby has sleep apnea, they will perform physical examinations and tests that include measuring the amount of oxygen in baby’s blood and monitoring the baby’s heart rate and breathing. An X-ray may also be taken. The doctor may refer you to a paediatric pulmonologist, a sleep specialist, or an apnea specialist for further tests and treatment. The commonly used test to diagnose sleep apnea is known as Polysomnography where the baby’s breathing, oxygen level in the blood, eye movements, brain waves, and snoring and gasping sounds is monitored while the baby remain asleep in a sleeping lab.
The treatment of sleep apnea depends upon the severity of the condition. The baby’s doctor may recommend using a home sleep apnea monitor to keep track of the baby’s sleep conditions. Medication may also be suggested in order to stimulate the central nervous system. Children with Obstructive Sleep Apnea may need to use an instrument called Continuous Positive Airway Pressure (CPAP) machine. It blows air into the nose through a mask which keeps the airway open during sleep.
In most cases, infants with sleep apnea rarely develop any long-term serious complications from the condition and it goes away on its own as the child grows up.