Sleep Apnea In Babies: Causes, Symptoms And Treatment

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Babies with sleep apnea feel drowsy and sleep in unusual positions. It disrupts the regular sleeping pattern of an infant by interfering with their breathing. Read on to know more as MomJunction gives you the causes, treatment methods, and more information on this.

What Is Sleep Apnea?

Sleep apnea is a condition where a baby stops breathing during sleep either due to the obstruction of the airway or because the breathing process is incorrect. It eventually hinders the airflow to the lungs during inhalation and impacts respiration.

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How Common Is Sleep Apnea In Babies?

Sleep apnea is the most common among children between two and six years (1) and less common in babies younger than six months. But it cannot be completely ruled out in infants of this age group (2) Overall, sleep apnea only affects about 3% children below the age of 13 years thus making it an uncommon pediatric ailment (3).

Although less common, sleep apnea could be of different kinds.

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Types Of Sleep Apnea:

Sleep apnea is of three types depending on the reason behind the obstruction:

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  • Obstructive sleep apnea is the most common form in infants and happens when the upper airway is obstructed (4). While the breathing mechanism functions properly, the airflow is hindered due to an airway constriction.
  • Central sleep apnea is a less common form of sleep apnea in babies. This occurs due to a failure of the central nervous system to regulate effective breathing mechanism. In normal breathing, the brain sends impulses to the thoracic muscles to expand and contract for inhalation and exhalation respectively. However, in central sleep apnea, the muscles fail to move adequately due to insufficient stimulus from the brain. This results in irregular, interrupted breathing (5). Unlike obstructive sleep apnea, there is no obstruction of the upper respiratory airways.
  • Mixed sleep apnea occurs when obstructive and central sleep apnea occur together.

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What Causes Sleep Apnea In Babies?

Here is a detailed explanation on the diseases or disorders that affect sleep apnea.

      • Adenoid and tonsils are both lymphatic tissues of the upper respiratory system that play an important role in fighting pathogens. However, it makes them vulnerable to infections. Infected adenoid and tonsils swell, eventually constricting the upper airway and leading to apnea. Sleep apnea due to swollen adenoids and tonsils is the most common cause of sleep apnea (6).
      • Gastroesophageal reflux disease (GERD) or acid reflux happens in infants due to their poorly-developed lower oesophageal sphincter. The sphincter does not close after food is swallowed, and the food and acid from stomach flow upwards through the esophagus to reach the throat and obstruct the airway (7).
      • Repeated chronic nasal and lung congestion causes mucus to dribble into the lower airway. It is not a cause of sleep apnoea but contributes to the symptoms. Mucus can also travel upwards from the bronchioles and accumulate around the larynx, thus significantly narrowing the airway and causing obstructive sleep apnea (8).
      • Diseases and infections affecting the nervous system may disturb the breathing mechanism that can lead to central sleep apnea. An example is a defect in the brain stem, which is a section of the brain that connects to the spinal cord. Any congenital defect here causes irregular breathing and sleep apnea.
      • Exposure to drugs and chemicals such as painkillers could induce sleep apnea as a side effect (9).

Some infants are at a higher risk of developing sleep apnea than others. Let’s understand why.

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What Are The Risk Factors For Sleep Apnea?

The following conditions and scenarios increase the risk of sleep apnea in infants:

      • Sleep apnea can run in families, and there is a higher chance of an infant developing it if a parent or another family member suffers from the condition.
      • High birth weight of the baby could lead to newborn sleep apnea. Overweight babies have a higher chance of sleep apnea as the extra fat and skin on the neck puts pressure on the airway causing obstruction.
      • Congenital physical defects in the baby’s face, neck, and parts of the mouth can exacerbate the risk of sleep apnea. For instance, babies with jaw defects may have narrow airways that could cause sleep apnea (4).
      • Some congenital genetic problems such as Down syndrome and Pierre-Robin syndrome raise the risk. Neonatal tumors in the throat or parts of the neck also aggravate the chances of apnea(12).
      • A preterm infant has poorly developed breathing mechanism. Therefore, premature babies often suffer from apnea of prematurity where the nervous system fails to regulate breathing correctly (10).
      • Infants living in higher altitudes could have periodic episodes of sleep apnea due to the thin density of air in hilly regions.

Spotting the signs of sleep apnea is essential to prevent long-term adverse effects.

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What Are The Symptoms Of Sleep Apnea In Babies?

A baby with sleep apnea will display the following symptoms (11):

      1. Snoring and snorting: These sounds while breathing along with long gasps are the most common signs.
      1. Pause in breathing: You will notice that the baby’s chest stops moving while asleep and then resumes movement after a few seconds.
      1. Sudden waking-up: Due to insufficient oxygen going to the brain, the baby may wake-up suddenly.
      1. Heavy, deep breaths: There will be a deep breathing as if the infant is finding it hard to inhale due to some obstruction in the airway.
      1. Mouth breathing: The baby breathes through the mouth due to insufficient air reaching the lungs through the nasal cavity.
      1. Sleeping in awkward positions: Babies with sleep apnea will arch their neck upwards or twist their body sideward to deal with the blocked respiratory tract. The baby will also seem restless and alternate sleeping positions often.
      1. Excessive daytime sleepiness: Poor sleep causes daytime drowsiness and lethargy. It can be more evident in older infants who would seem less energetic and playful than their peers.
      1. Concentration issues: As the baby feels sleepy all the time, he will have difficulty in paying attention during games and activities. It may almost seem like the baby suffers from attention deficit, but it is just a lack of sleep.
      1. Irritability and fussiness: You would have to deal with a fussy and cranky baby, and this behavior interferes with activities such as eating and breastfeeding.
      1. Bedwetting, nightmares, and night terrors: For unknown reasons, infants with sleep apnea display a higher incidence of bedwetting and nightmares and night terrors.

The above symptoms overlap with several other medical conditions. Therefore, take your baby to a doctor right away for a diagnosis.

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How Is Sleep Apnea Diagnosed?

A conclusive diagnosis of sleep apnea involves these methods:

      1. Physical examination: The baby’s throat is checked for any swelling in the tonsils or adenoids. Breathing is also monitored to detect any abnormalities. An X-ray might be done to check the airways. Parents are asked about the baby’s medical history such as if he had a neurological or respiratory infection and about symptoms such as snoring.
      1. Sleep study: If the doctor suspects sleep apnea, then the baby might be referred to a sleep specialist. A sleep test called polysomnography is performed in a sleep study lab. This test is the gold standard and the only definitive way to confirm the diagnosis. Essential parameters such as breathing rate, heart rate, eye movements, and oxygen and carbon dioxide levels in the blood, are recorded. A diagnosis is made after studying the various metrics and symptoms of the baby.
      1. Sleep observation at home: For younger infants and newborns, a pediatrician may suggest observation at home. Parents are provided a checklist of symptoms and instructed to observe the baby’s sleep for a designated period, such as a week. Parents tick the symptoms in the checklist (snoring, gasping, etc.), and also observe daytime symptoms such as excessive sleepiness and lethargy. The doctor makes conclusions based on the checklist after which a home polysomnography test (sleep test) is also done.

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How Is Sleep Apnea Treated?

The treatment is greatly influenced by the infant’s age and the underlying condition that has led to it. Here are a few treatment options for sleep apnea in infants (12):

      1. Antibiotic treatment for infected tonsils and adenoids: If obstructive sleep apnea is a result of infected and enlarged tonsils, then the doctor will prescribe an appropriate antibiotic treatment to relieve the swelling. Once the tissue regains its original shape, sleep apnea would be gone.
      1. Tonsillectomy and adenoidectomy: If the tonsils or adenoids are infected to the point that they cannot be effectively treated with oral medication, the doctor will perform a surgery. A tonsil extraction surgery is called tonsillectomy and removal of adenoid is called adenoidectomy (11).
      1. Craniofacial surgery: Defects in the bones of the skull can also lead to sleep apnea. A correction through a craniofacial surgery rectifies any bone defects that are obstructing the airway.
      1. Continuous positive airway pressure (CPAP) treatment: If other treatment methods do not work or are not applicable, then continuous positive airway pressure (CPAP) is used. The treatment is provided through an electronic apparatus attached to a face mask worn by the infant every night before going to bed. The device pumps air at a high pressure, which gapes the airway open, letting the baby breathe normally. The machine may have to be worn for one to four hours during sleep. The span of the CPAP treatment can vary depending on the intensity of sleep apnea. Usually, the procedure continues as long as the baby displays the symptoms (13).
      1. Changes in diet to lose weight: If the baby is heavier than normal, then the doctor could refer the baby to a pediatric dietician, who can create a diet plan to regain healthy weight.
      2. Environmental controls can also help. Avoid smoke, outdoor pollutants and indoor allergens. Treating allergic rhinitis / hay fever can be helpful to alleviate symptoms.

Treatment of sleep apnea in babies is vital to prevent any adverse effects.

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Are There Complications Of Sleep Apnea In Babies?

Yes, sleep apnea is not benign and when left untreated can lead to the following complications (8):

  1. Cardiovascular problems: Inadequate oxygen levels in the blood make the heart work harder to pump blood. It increases blood pressure and puts excessive strain on the heart. In the long term, it may cause numerous cardiovascular complications.
  2. Behavioral and skill development issues: Since the infants are fussy and irritable most of the time, they could have problems with normal behavioral development. Behavior changes also impact healthy skill development of the baby. It can make the infant miss out on crucial developmental milestones.
  3. Poor diet and growth: Lack of sleep interferes with the cycle of daily activities such as hunger. The baby may feel less hungry, eat less, thus impacting both physical and mental growth.

In some cases, the baby might stops breathing altogether. The first thing to do is to be calm and not panic. And, then do the needful.

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What Should You Do If A Baby With Sleep Apnea Stops Breathing?

Keep the following points in mind if you notice or suspect that the baby does not seem to breathe while sleeping:

      • Paused breathing is temporary. Most infants stop breathing for some time when they suffer from sleep apnea, but the pause is not longer than 20 seconds (14). Therefore, wait for 10 seconds and check if the infant has resumed breathing.
      • Nudge and change baby’s position: If the baby does not resume breathing, then nudge him gently. It should cause him to wake-up and start breathing again. You can change the baby’s position by picking him up and holding him in your arms for some time. Also, try changing the direction of his head.
      • Wake up the baby: If nothing seems to work, then wake up the baby by nudging him repeatedly and calling out his him. Waking up brings the brain into a more alert state, which can help resume breathing.
      • Perform CPR and rush to a doctor: If you cant wake your baby and they are not breathing then start CPR. Contact the ambulance immediately. If is a good idea for all new parents to know the basics of CPR.

Treatment of sleep apnea is critical to prevent the complications, but preventive measures ensure that baby does not suffer from the problem at all.

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How To Prevent Sleep Apnea In Babies?

There is no single method of preventing sleep apnea as it occurs spontaneously. Parents can still take a few steps to minimize the chances of its onset:

      • Be vigilant about the baby’s throat infections. Adenoid and tonsil enlargement is the leading cause of sleep apnea in infants. If you suspect the baby has a sore throat or trouble swallowing, then take him to a doctor right away. Shielding the baby from pathogens through good personal hygiene is also essential to prevent infections.
      • Maintain the baby’s weight within the healthy range. Older infants eat a wide variety of solid foods, including those with added sugar. Avoid infant foods with added sugar as it can make the baby gain weight rapidly.
      • Use over-the-counter sleep apnea baby monitor. When in doubt if the baby pauses while breathing, you may consider using an over-the-counter sleep apnea baby monitor. These compact devices attach to the baby’s diaper to measure the breathing rate, giving out a soft alarm sound when the baby’s breathing gets erratic. Some feature-rich versions even measure the heart rate. These monitors do not generate extensive data, but provide basic information. Follow the manufacturer’s instructions and never place the apnea monitor close to infant’s head as it is an electronic device, which could affect the brain waves. When in doubt about its usage consult a pediatrician (15). These monitors do not prevent SIDS and all the normal precautions should still be taken as if there is no monitor.

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Advances in technology are making detection and prevention of sleep apnea more accessible. The innovative mattress uses soft vibration to create regular breathing patterns (16). While the mattress is in an experimental stage and subject to governmental approval, it is still an indicator of how technology can help overcome the disease.

Most infants, including premature ones, seldom stop breathing beyond 10 seconds. Nevertheless, you need to be alert if your baby has sleep apnea. Daily monitoring of the baby’s breathing, prevention of throat infection, and timely intervention is all that your baby needs to be free of sleep apnea.

Do you have any information to share on sleep apnea? Then share it in the comments section below.