Signs of sleep apnea or sleep-disordered breathing in babies

Any new parent knows that “sleeping like a baby” is a more complicated phrase than it sounds. Most of the challenges that come with babies’ sleep come from the fact that babies are new at just about everything, and are only just learning how to catch some Zs.

In some cases, though, babies have trouble sleeping for the same reason some adults do: sleep disorders that can make it physically impossible to get a full night’s sleep. One sleep disorder that can affect babies as well as adults is sleep apnea.

What is sleep apnea or sleep-disordered breathing?

Sleep apnea is a condition characterized by interrupted breathing while sleeping. This typically means paused breathing, or extremely shallow breaths. Pauses in breathing during sleep are actually a normal part of sleep, but the pauses involved with sleep apnea, which might last 20-40 seconds or more, are not normal or healthy. Apnea can be caused either by a breathing obstruction or by failure of the brain to signal the body to breathe. In some cases, children can have both problems.

When sleep apnea occurs in newborns, especially premature babies, it’s usually caused by immature signals in the brain. In older children, it’s usually caused by an obstruction. The most common airway obstructions are swollen tonsils or adenoids.

Obstructive sleep apnea appears most commonly in children between 2 and 6 years old, when the tonsils and adenoid are largest in relation to the size of the airway, but it can occur at any time. The American Academy of Pediatrics estimates that, including undiagnosed cases, around 2% of children are affected by sleep apnea at some point in their lives.

What are the symptoms of sleep apnea or sleep-disordered breathing?

Since sleep apnea is defined by a pause in breathing, this pause is the first symptom that appears, but often snoring is the sign that parents notice first. Other signs of sleep apnea are generally the results of disordered breathing and attempts of the body to breathe in enough oxygen.

  • Unusual body position: Older babies and children may sleep in odd-looking positions, if those positions allow them to breathe better.
  • Frequent waking: Babies and children with sleep apnea may wake often during the night, if they’re waking themselves up with their own uneven breathing.
  • Perspiration: Children with sleep apnea may sweat a lot during sleep.
  • Mouth breathing: Children whose apnea is caused by a blockage in the airway may breathe through their mouths often, since they may find it easier to breathe this way. They may also gasp for air.
  • Effects of poor sleep: Frequent wakings and restless sleep from sleep apnea can cause children to feel tired and irritable during the day, can make it difficult to wake children in the morning, and can eventually lead to behavior problems, difficulty concentrating, extra sleep during the day, and even poor growth and weight gain and high blood pressure. Once potty-trained, children who have sleep disorders are also more likely to have accidents during the night.

Who is at risk for developing sleep apnea or sleep-disordered breathing? 

Any child can develop sleep apnea, but there are a few factors that can make children more likely to experience it.
  • Premature birth: The more prematurely a baby is born, the more likely it is for apnea to occur soon after birth, since both the brain and the body may not be quite prepared to support breathing outside of the womb. As premature babies grow, they grow out of being any more at risk for apnea than any other children.
  • Weight: Children who are overweight are more likely to experience sleep apnea.

How is sleep apnea or sleep disordered breathing diagnosed?

First, children with sleep apnea are generally evaluated by an Ear, Nose and Throat specialist, who will help work out the right treatment option for their specific case.

Most children will also undergo a sleep study (or polysomnography), a test where they sleep in a special clinic. During this test, children are connected to many tiny, painless wires over the scalp, chest and feet. These wires tell doctors about brain activity, eye movement, oxygen and carbon dioxide levels, heart rate and breathing, the flow of air through the mouth and nose, snoring, body muscle movements, and chest and belly movement during sleep.

What are the treatment options for sleep apnea? 

Depending on the cause and the severity of an apnea or sleep-disordered breathing, there are a few different treatment options.
  • Surgical correction: In the case of an obstruction, it may be possible to remove the obstruction through a surgical procedure.
  • Nasal prongs or CPAP: A facial mask attached at the nose during sleep can be used to treat apnea non-surgically. Depending on the type of apnea, the mask may be recommended for lifelong use, or just temporarily, until the underlying cause of the apnea has been resolved.

Sleep apnea can be a serious condition with long-term effects if left untreated because pauses in breathing deprive the brain of oxygen which can be detrimental over time. On the other hand, it’s also fairly common, and once it has been diagnosed, treatment can help get babies back to sleeping like babies – with only the normal distractions and interruptions that implies.

Snoring, gasping, pauses in breathing, or constant motion in sleep can all be signs of apnea or sleep-disordered breathing, and are reasons to contact your healthcare provider.

  • Carolyn M. D’Ambrosio, Eliot S. Katz, Ron B. Mitchell. “Obstructive Sleep Apnea in Infants.” American Journal of Respiratory and Critical Care Medicine. 185(8): 805-816. Web. April 15 2012.
  • Jason B. Kirkness, et al. “A Nasal Cannula Can Be Used to Treat Obstructive Sleep Apnea.” American Journal of Respiratory and Critical Care Medicine. 176(2): 194-200. Web. July 2007.
  • “Apnea and Bradycardia.” Emory Department of Pediatrics. Emory University, 2016. Web.
  • “Could My Child Have Sleep Apnea?” Sleep Foundation. National Sleep Foundation, 2016. Web.
  • “Obstructive Sleep Apnea.” Children’s Hospital of Philadelphia. Children’s Hospital of Philadelphia, 2016. Web.
  • “Obstructive Sleep Apnea.” Kids Health. Nemours Foundation, 1995-2016, Web.
  • “Sleep Apnea Detection.” Healthy Children. American Academy of Pediatrics, November 21 2015. Web.
  • “Sleep apnoea.” Great Ormond Street Hospital for Children. Great Ormond Street Hospital for Children NHS Trust, July 2005. Web.
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