When a child’s uniform breathing is suddenly interrupted for 10-15 seconds or more, and then resumes, and such episodes occur several times a night, this is a serious reason for contacting a doctor with suspected infant apnea. Apnea in children is quite common, the risk of developing pathology in premature babies is especially high. Each parent should be aware of the causes, manifestations of this condition, as well as how to deal with it.

Apnea syndrome in pediatrics is a condition in which, during sleep, in infants, infants or older children, after a year, breathing stops for more than 10 seconds. Often it is accompanied by a decrease in heart rate, pallor or cyanosis of the skin. This syndrome can occur at any age. Apnea in newborns is one of the most common causes of sudden infant death syndrome.

Causes of occurrence

Apnea in newborns and in older patients is caused by various etiological factors.

The most common causes of sleep apnea in newborns are:

• Prematurity. A baby born before the 37th week of pregnancy differs from a full-term baby in the immaturity of the nervous and respiratory systems. The respiratory centers in the crumbs have not yet been formed, therefore, in premature babies, breathing of the central type occurs. 
• Anomalies in the development of the lower jaw. Too small jaw ( micrognathia ), as well as anatomical abnormalities in its structure, can cause episodes of sleep apnea in children. 
• Congenital malformations of the cardiovascular, nervous system. With abnormalities in the work of internal organs, tissue hypoxia occurs, which can provoke respiratory arrest during sleep. 
• Childbirth trauma. Intracranial, spinal injuries received during the passage of the birth canal disconnect the nerve connections between the respiratory center of the medulla oblongata and the receptors of the airways. 
• The mother’s taking drugs, certain medications, alcohol, smoking during pregnancy. Scientific studies have shown that babies are 3 times more likely to suffer from respiratory arrest in mothers who smoke during pregnancy. The negative role of narcotic and psychotropic drugs, sleeping pills, alcohol is obvious. Penetrating through the placental barrier, substances prevent the maturation of the fetal nervous system and destroy it. 

At an older age, respiratory arrest during sleep is caused by:

• Obese. Excess weight can cause respiratory arrest during sleep. Fat deposits that form in the soft palate, palatine arches, uvula, contribute to the narrowing of the lumen of the pharynx and a more pronounced collapse of the upper respiratory tract during sleep. 
• ENT pathology. Overgrown adenoids, enlarged tonsils, disturbances in nasal breathing create a mechanical obstacle to the passage of air during sleep and cause episodes of cessation of breathing. 
• Endocrine disorders. Diabetes mellitus, hypothyroidism and other diseases of the endocrine system can provoke such episodes. 
• Infections. Sometimes respiratory arrest in children can occur with high activity of the infectious process in the body: against the background of sepsis, meningitis, necrotizing enterocolitis. 
• Metabolic disorders. Electrolyte imbalance: hypomagnesemia , hypocalcemia , an increase in sodium and ammonium ions in the blood is another reason for the development of this syndrome. 
• Exposure to certain medications. Sleeping pills, some antihistamines with a pronounced sedative effect, can cause apnea in children under one year old. 

Apnea from Fenistil , a popular antihistamine in drops, can occur in premature babies and those younger than 1 month old. Therefore, the drug is not recommended for babies.

Classification

The origin of sleep apnea is:

• Central. Central mechanisms are more characteristic for newborns, especially premature infants, for infants. They can occur at any age with damage to the central nervous system, craniocerebral, spinal injuries. They are caused by oppression or immaturity of the respiratory center, blockade of the passage of impulses from peripheral receptors to the brain. 
• Obstructive . Occur when the upper respiratory tract is compressed, blocked. The obstructive type of apnea occurs with the pathology of the ENT organs in childhood, obesity, lymphoproliferative diseases , tumors and cysts in the pharyngeal region. 
• Mixed. This species is characterized by signs of manifestations of the other two groups. 

Development mechanism

During sleep, the general muscle tone decreases, including the tone of the pharyngeal muscles. The airway clearance is somewhat narrowed in healthy children, but it is not critical – these physiological phenomena do not interfere with the passage of air, and the quality of sleep does not suffer.

An excessive decrease in the muscle tone of the structures of the upper respiratory tract or the presence of obstruction in them leads to a complete collapse of the pharynx, the development of an episode of acute suffocation. It lasts from 10-30 seconds or more. In the blood, the concentration of oxygen sharply decreases, the sympathetic nervous system is activated, and the pressure rises. The stress response “wakes up” the brain, which regains control over the pharyngeal muscles – inhalation occurs. This is how apnea develops along the obstructive path.

If the pathogenesis of the disorder is central, then there are no obstacles to the passage of air in children, the pathological process is localized in the central nervous system itself, which is not able to adequately control the act of breathing during sleep.

Clinical picture

The leading symptom of an apnea episode is lack of breathing, chest excursions for 10-15 seconds. In some cases, if the child’s breathing is accompanied by snoring, parents note episodes of its cessation, and after some time, an increased resumption of the snoring sound. These “silent” sleep episodes are apnea.

The longer the periods of respiratory arrest (up to 40-50 seconds), the worse the consequences for the body: episodes cause sudden death syndrome or cause brain damage due to prolonged hypoxia.

Such pauses in respiratory activity per night can occur more than 100-150 times, their number and duration affect the night sleep, its phasing , and the general condition of patients.

Other symptoms for which this pathology can be suspected are:

• Snoring in a dream.
• Feeling of lethargy, weakness in the morning, despite the fact that the child slept a sufficient amount of time at night. Children are especially moody, whiny in the morning after waking up.
• Tendency to fall asleep in the middle of the day at school.
• Headaches in the morning.
• Increased irritability, restlessness, hyperactivity .
• Memory impairment, attention deficit.
• Nocturnal urinary incontinence ( enuresis ).
• Increased physical activity during sleep.
• Teeth grinding ( bruxism ).
• Conversations in a dream.
• Delayed psychomotor development.

If alarming symptoms appear, parents should contact their child’s doctor for examination and treatment.

Treatment

All premature infants with low body weight in the first 10 days should be monitored for the risk of episodes of respiratory arrest: cardiac and respiratory activity is monitored around the clock, oxygen in the blood is measured using sensors for newborns. When stops are identified, their origin is determined, if these are secondary episodes, the cause of their occurrence should be eliminated, if possible.

Treatments for respiratory arrest in infants and older are:

• Tactile stimulation method. The baby is laid on a rocking bed, an oscillating water mattress. Tactile stimulation is one of the first elements of emergency care for apnea in a child at home. 
• Creation of pressure in the nasal passages. Breathing with nasal cannulas significantly reduces the incidence of apnea. 
• Oxygen therapy . Special “head caps” and “funnels” are used to increase the concentration of O2 in the inhaled air. 
• Drug therapy. Effective in some cases of development of pathology of central or mixed genesis. Theophylline or caffeine, Etimizol , Pentoxifylline , Instenon are used exclusively on the recommendation of a doctor and in strictly prescribed dosages corresponding to the age of the child. 

Primary resuscitation at home

Parents whose children have had at least one episode of respiratory arrest during sleep should know the algorithm of actions aimed at providing first aid in case of prolonged apnea.

If there are two parents at home, it is necessary to distribute responsibilities: one calls for medical assistance, the other conducts resuscitation measures.

If there is only one adult with the baby, the call of the health workers should be carried out in parallel with the emergency care.

The child should be placed on his back on a horizontal surface, examine the oral cavity to avoid obstruction of the respiratory tract with a foreign object. If no foreign objects are found in the mouth, tactile stimulation should be carried out quickly: shake the child, pinch, mechanically rub the ears, palms, and feet.

If, after these manipulations, the patient’s breathing has not been restored, it is necessary to proceed with cardiopulmonary resuscitation: do artificial respiration, while simultaneously performing an indirect heart massage. As soon as the episode of lingering apnea has passed, you should call an ambulance and clearly report what happened.