Sleep Apnea in Babies: Symptoms, Diagnosis and Treatment
Dr. Zarmina Ehsan, Children’s Mercy Sleep Center
Sleep apnea is a sleep-related breathing disorder. There are two types: obstructive sleep apnea (OSA) or central sleep apnea (CSA). Essentially, OSA is an obstruction or narrowing in the path from your nose down to the opening of your lungs (upper airway). There can be different reasons for the obstruction or narrowing, but it all results in less air (oxygen) going from the outside into your lungs. CSA is a type of sleep apnea where there is a delay in the signal from your brain telling you to breathe when you are asleep. The prevalence in infants is still unknown, but between one and five percent of all children have sleep apnea. When detected early, sleep apnea can be treated to prevent other long-term complications.
How to tell if your baby has sleep apnea
There are several signs a parent can look for when their child is sleeping to determine if they might have sleep apnea. The first thing they’ll want to do is listen to the infant’s breathing. If your child routinely pauses for breaths, gasps for air, chokes, has noisy breathing or snorts you should let your health care provider know. You should also be concerned if you hear what sounds like snoring and you hear it persistently night after night. It’s not uncommon for little ones to cry and to squirm in their bed, but infants don’t snore.
Another important thing to note is that if a child has sleep apnea, they’ll also have difficulty breathing while taking naps during the day too. Sleep apnea isn’t exclusive to night time sleeping only.
How to diagnose sleep apnea
According to the American Academy of Sleep Medicine (AASM), the only way to properly diagnose sleep apnea is to have your child participate in an overnight sleep study in a sleep lab. (At this time, the AASM has not approved home sleep testing for children.) During the sleep study, which is called a polysomnogram, sensors are placed on your child to monitor their brain waves, heartbeat and breathing activity during different sleep stages. This helps detect problems and can pinpoint the nature of the breathing problem.
Before taking your child to a sleep lab, you’ll want to make sure it’s accredited for children, because the way sleep studies are interpreted in infants and children are different from adults. Moreover, pediatric sleep labs offer the expertise of having technicians that are adept at working with children.
Causes of sleep apnea
Obstructive Sleep Apnea
OSA is usually caused when the soft tissue in the back of the throat collapses and blocks the upper airway during sleep. Infants with medical problems like craniofacial syndromes (Pierre Robin sequence, small jaws, Down syndrome), “floppy” airways due to laryngomalacia or large adenoids and big tissue at the back of their throat are at most risk.
Central Sleep Apnea
CSA is rarer. This is when the child’s brain is misfiring and not telling the body to breathe when it should. There are some concerns that children born premature or if the mother smokes during pregnancy that this can increase the risk of central sleep apnea in infants. Central sleep apnea is most commonly idiopathic (cause unknown). It can also be seen in children with neurologic insults (i.e. brain tumors, hydrocephalus and VP shunts, cerebral palsy, Chiari malformations, and brain injury).
Is sleep apnea life-threatening?
Severe sleep apnea can be life-threatening. If left untreated, it can affect the child’s sleep architecture because the brain continually wakes the child up to breath. If this happens often enough, the infant doesn't get restful sleep, which can affect functioning during the day. After time, this can cause long-term damage to the heart, brain and other parts of the body as well.
How to treat sleep apnea in infants
The treatment depends on the severity and type of sleep apnea (CSA or OSA). For OSA, some infants will need surgery, but most will outgrow it as they get bigger and their upper airway gets larger. Others may need to be treated with oxygen to provide breathing support until they can outgrow it. If the infant is four months of age or less and their sleep pattern is less-predictive, we recommend they wear a nasal cannula at all times. If the infant is older and has established a sleep pattern, then parents can take off the nasal cannula when they're awake. Other options for treatment include wearing continuous positive airway pressure (CPAP) or in rare and extreme cases, a tracheostomy.
The treatment ultimately depends on the nature of the medical problem, but the sooner the problem is diagnosed, the sooner it can be treated.
Learn more about Pediatric Pulmonology at Children’s Mercy and the Sleep Disorder Program, the only pediatric program in the region accredited by the American Academy of Sleep Medicine.
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To make an appointment with a Sleep Specialist, please call (913) 696-8518.