How To Diagnose Infant Sleep Apnea
You may need to take your infant to a sleep doctor. If so, then you should schedule an appointment at an accredited sleep center. Some centers specialize in helping children. A sleep doctor will review your infants history and symptoms. If needed, the doctor will schedule your infant for a sleep study. This kind of study is called polysomnography. It charts your childs brain waves, heartbeat, and breathing during sleep. It also records arm and leg movements. The sleep study will reveal the nature of your infants breathing problem. It also will show the severity of the problem. The study requires your child to spend the night at the sleep center. A parent or guardian also will need to stay at the sleep center with the child. A sleep study is the best way to evaluate your childs sleep. With the results of this study the doctor will be able to develop an individual treatment plan for your child.
It is also important to know if there is something else that is causing your childs sleep problems. A sleep doctor can look for other conditions that may be involved. These include:
- Another sleep disorder
- Medication use
- A mental health disorder
The doctor will need to know if your child was born premature or full-term. She will also need to know your childs weight at birth. Inform the doctor of any complications that you or your baby had during or after delivery. Describe the problems you have observed and when you first noticed them.
Sleep Apnea And Seizures
âThere is a correlation between sleep apnea and seizures, but it is not clearly understood,â David Nazarian, MD, Medical Director at My Concierge MD, tells WebMD Connect to Care. âSleep apnea can cause a decrease in oxygen levels in our bodies and thus interfere with the brainâs normal electrical activity.â
Sleep apnea is commonly diagnosed in people with epilepsy. According to Nazarian, nearly 40 percent of epilepsy patients also have sleep apnea.
âPeople who have epilepsy and sleep apnea are more likely to have a seizure during the night than people without sleep apnea,â Nazarian explains. âNot getting enough sleep or poor quality of sleep can trigger an episode of seizure in people who suffer from epilepsy disorders. It is very important to get adequate sleep if you have a diagnosis of epilepsy.â
Nazarian further notes that âseveral studies suggest that untreated obstructive sleep apnea facilitates seizures in susceptible patient populations, particularly older individuals.â
To avoid these complications, it is crucial to have your sleep apnea diagnosed and treated as soon as possible.
âIf sleep apnea is treated in time, one sleeps soundly and experiences fewer episodes of constant arousals and awakenings during sleep,â George Samuel, MD and Medical Advisor at WhatASleep, tells WebMD Connect to Care. âAs the brain recovers from chronic sleep deprivation, the malfunctions that lead to seizures may become less common.â
Relationship Between Obstructive Sleep Apnea Disorder & Down Syndrome
Down syndrome is a genetic chromosome disorder where an infant is born with an extra copy of the 21st chromosome. The condition is caused by the abnormal division of cells which results in additional copies of the genetic chromosome material. Down Syndrome results in your infant’s delayed development, both physical and intellectual. Babies with Down Syndrome have a 50-100% chance of having OSA. If your infant has Down Syndrome and has not shown any signs of OSA, it may develop as he grows older. Also, infants with Down syndrome have large tongues, jaw, tonsils and adenoid tissues. The enlargement of these parts causes blockage at night when muscles relax.
One reason why OSA is common in infants with Down syndrome is that their brain fails to send signals to the muscles responsible for breathing. Failure to send these signals leads to reduced breathing which in turn frequently arouses the baby to wake up and breathe.
Additionally, infants with Down syndrome are predisposed to catching infections such as chronic rhinorrhea , sinus infections, and nasal congestions because they have small noses. With a congested nose, it becomes difficult for the infant to breathe during the day, let alone during the night. Since it is challenging to detect OSA in infants with Down syndrome, consult a sleep specialist or an otolaryngologist.
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Consequences Of Untreated Obstructive Sleep Apnea In Children
May 16, 2017 by Sound Sleep Health
Obstructive sleep apnea is a very serious medical condition, affecting an estimated 25 million adults in the United States, according to the American Academy of Sleep Medicine. However, the possibility of children developing sleep apnea is often overlooked. Individuals of any age can develop sleep apnea, and the consequences for children differ somewhat from those seen in adults. Learning about the symptoms of obstructive sleep apnea can ensure that your child gets an accurate diagnosis and appropriate treatment options.
Diagnosing Sleep Apnea In Children
Experts at Hassenfeld Childrens Hospital at NYU Langone employ a variety of resources to diagnose sleep apnea in infants and children. Sleep apnea is a chronic condition in which breathing pauses from time to time during sleep as a result of a partial or complete blockage in the airway. These pauses can last for a few seconds or longer, interrupting normal breathing and sleep patterns.
Sleep apnea can occur at any point during childhood, from infancy through adolescence. It is most common in young children who have tonsillitis or adenoiditisenlargement of infection-fighting tissues in the back of the nasal cavity and throatcaused by infections or allergies.
When swollen, tonsils and adenoid tissue can block a childs small airways. Being overweight also increases the risk of sleep apnea in children, because extra tissue in the airway can block air flow.
Children with unusual facial anatomy, such as small nostrils, a cleft lip or palate, a small jaw, or choanal atresiain which the cartilage that separates the nasal passages doesnt form properly during the babys developmentmay have difficulty breathing through one or both nostrils. In most instances, choanal atresia causes a blockage in only one nostril. However, in infants with a blockage in both nasal passages, the condition can be life threatening.
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Tests To Find The Cause Of Apnea
Tests might be done to find the cause for your baby’s apnea episodes. During the tests the nurses will watch your baby closely and write down his or her activities. We need to know what happens before, during and after the periods of apnea. That is why your baby might need tests. We need to find out what causes the apnea so we can give your infant proper care.
Who Is At Risk For Obstructive Sleep Apnea
All pregnant women have an increased risk of obstructive sleep apnea because higher levels of estrogen during pregnancy can cause the mucus membranes in your nose to swell, leading to nasal congestion. As you work harder to breathe, the lining of your airway can swell too, constricting airflow.
This chain of events can make sleep apnea somewhat common while youre expecting. About 8 percent of pregnant women enrolled in a study developed symptoms at mid-pregnancy.
If youre overweight, obese or gained too much weight during pregnancy, youre particularly at risk of obstructive sleep apnea. Extra tissue in your neck can block your airway and make it harder to breathe at night. Moms-to-be with gestational diabetes are also at higher risk.
Other reasons your airway may collapse or become blocked during sleep include congestion caused by allergies or illness, along with certain physical attributes: a receding chin, enlarged adenoids, a large tongue, a deviated septum or an above-average neck circumference.
Pathophysiology Of Obstructive Patterns In Infancy
OSA is characterized by increased upper airway resistance during sleep. The airwaynarrowing may be due to craniofacial abnormalities, soft tissue enlargement, and/orneuromotor dysregulation . Airway collapse occurs when theairway wall pressure exceeds the luminal pressure. In infants without laryngealabnormalities, the site of airway obstruction has been measured with multiplepressure transducers and found to be retropalatal in 52% and retroglossal in 48%. Neck position appears to be animportant determinant of airway collapsibility in infants. Neck flexion of 1530degrees increases collapsibility by 45 cm H2O, whereas neck extensiondecreases collapsibility by 34 cm H2O . These changes are sufficient to be an important determinant ofairway patency during tidal breathing. By contrast, neck rotation appears to havelittle influence on airway collapsibility or respiratory pattern in most infants.
Airway closure in infants may occur as a passive or active process producingdifferent polysomnographic patterns that are predicated on the predominantunderlying pathophysiology:
What Are The Treatments
If the primary care physician identifies any airway disturbances during sleep, a referral to an otolaryngologist should be done to determine if a sleep study and/or surgical intervention is needed. Non-invasive treatment options include a continuous positive airway pressure machine and weight loss.
Removal of enlarged tonsils and adenoids is the first line surgical treatment. In individuals with Down syndrome, because of their midface hypoplasia and contracted nasopharynx, even mildly enlarged tonsil and adenoids may have a greater than expected effect in regards to airway obstruction. If the tonsils and adenoids do not appear enlarged, it has been suggested that a sleep study should be done to confirm that the individual does not have sleep apnea.
Although tonsillectomy and adenoidectomy is the most common initial surgical intervention, studies have shown that persistent obstructive sleep apnea after T& A is possible and more common in individuals with Down syndrome. Further interventions may be needed, both surgical and medical. All of these studies illustrate the need for post-operative evaluation of patients with Down syndrome for residual sleep apnea after T& A surgery with a post-operative sleep study or polysomnogram. Because of the higher rate of respiratory complications after removal of the tonsils and adenoids in individuals with Down syndrome, overnight observation in the hospital after this surgery is also recommended.
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> > > Are You Making These 3 Mistakes When Putting Your Baby To Rest
Heres something important to keep in mind, particularly since we tend to fall into an all-or-nothing trap when were dealing with the subject of sleep.You can reduce the strength of any particular sleep association by making sure it is only present some of the time when your baby is falling asleep.If, for example, you nurse your baby to sleep some of the time, rock your baby to sleep some of the time, and try to put your baby to bed just some of the time when hes sleep but awake, hell have a hard time getting hooked on any sleep association.Sleep experts stress that the feeding-sleep association tends to be particularly powerful, so if you can encourage your baby to fall asleep without always needing to be fed to sleep, your baby will have an easier time learning how to soothe himself to sleep when he gets a little older.Most babies are ready to start practicing these skills around the three- to the four-month mark. Can Baby Sleep Overnight in Moses Basket for My Baby
Healthy Lifestyle Changes To Prevent Sleep Apnea
If you are concerned about having risk factors for developing sleep apnea, ask your doctor to recommend healthy lifestyle changes, including eating a heart-healthy diet, aiming for a healthy weight, quitting smoking, and limiting alcohol intake. Your doctor may recommend that you sleep on your side and adopt healthy sleep habits such as getting the recommended amount of sleep.
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When To See A Doctor
Snoring and heavy breathing in children aren’t always signs of sleep apnoea but persistent snoring is something to watch out for. If your child has a cold or infection that is causing a blocked nose, the problem could go away once they are feeling better. However, if your child seems otherwise healthy, unusual or noisy breathing while they are sleeping should be investigated. It could be a sign of sleep apnoea, or of another respiratory condition such as an allergy or asthma. You might also want to see a doctor if your child seems to have a sleep problem, as this could be caused by sleep apnoea or another issue that can be solved with your doctors advice. Sometimes a child who seems to be a very light sleeper or who keeps waking up during the night will actually be suffering from sleep apnoea, which is stopping them from enjoying a full night’s sleep.
What Are The Signs Of Central Sleep Apnea
Signs of central sleep apnea occur when your child is transitioning in or out of sleep or after a temporary change in brain activity levels during sleep. Some of these signs may be due to obstructive sleep apnea.
These signs can include:
- a pause in breathing followed by loud gasping with return to normal breathing pattern
- difficulty staying asleep
- snoring with extra effort to breathe during sleep
- waking up feeling short of breath
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What Causes Obstructive Sleep Apnoea
OSA can occur for many reasons, both in adults and in children. In children, the most common cause is enlarged tonsils and/or adenoids, which can partially block the airway.
OSA is reported in between one and three per cent of children however it is diagnosed much more commonly in children with specific conditions, for example obesity, sickle cell disease, Down syndrome and others.
What Are The Warning Signs Of Sleep Apnea
If you have a partner, he or she may hear your loud snoring and sudden gasps for air caused by OSA before you do. Still, the toll that restless sleep and decreased oxygen takes may become more noticeable to you during the daytime.
If you often fall asleep while reading, watching TV, working at the computer or sitting in traffic, or if youre feeling especially irritable, impatient and forgetful, its definitely time to talk to your practitioner.
Other signs of OSA include waking up with a sore throat or dry mouth, nighttime sweating and a decreased libido. And people with apnea often experience morning headaches too. So if you find yourself popping a Tylenol as soon as you get out of bed, consider sleep apnea as a possible culprit.
To diagnose sleep apnea, your doctor will evaluate your signs and symptoms and examine your mouth, nose and throat.
He or she may also refer you to a sleep specialist for another test called a polysomnography. This study done at home or in a lab will measure your airflow, breathing patterns, blood oxygen levels and other factors while you sleep to confirm a case of sleep apnea.
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How Is Obstructive Sleep Apnoea Treated
The decision to start treatment is made on a case-by-case basis once OSA has been confirmed. Surgery to remove the adenoids and/or the tonsils is the most common treatment for paediatric OSA. This procedure can usually be done at a local hospital although some children have risk factors which may mean that this procedure will need to be done in a specialist unit with intensive care facilities.
If removal of the adenoids and/or tonsils is not indicated or if surgery does not fully resolve the symptoms then Positive Airway Pressure therapy may be used. This requires the patient to wear a mask over the nose while a positive pressure is applied from a ventilator to keep the airway open while asleep.
Other treatments may include the use of a nasopharyngeal airway which acts as a splint to maintain an open airway and keep the tongue from falling back. This treatment is predominantly used in children less than one year of age.
Another alternative treatment is the use of nasal steroids or montelukast to clear any inflammation of the nasal passage. Orthodontic procedures may also be appropriate including mandibular advancement to move the jaw forward.
Children with OSA who are overweight or obese are strongly encouraged to follow a weight management program, including nutritional advice, exercise regime, and behavioural recommendations .
What Causes Central Sleep Apnea In Children
Central sleep apnea can occur for a variety of reasons in children. It is important to note that a few central apnea events during sleep is considered normal. Central sleep apnea has been associated with rare genetic disorders in children, such as congenital central hypoventilation syndrome. It may also be present when children have health conditions that interfere with parts of the central nervous system that controls breathing.
Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Services National Institutes of Health the Nations biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including sleep apnea. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.
What Is Apnea Of Prematurity
Apnea of prematurity is when a premature baby:
- pauses breathing for more than 15 to 20 secondsor
- pauses breathing for less than 15 seconds, but has a slow heart rate or low oxygen level
After they’re born, babies must breathe continuously to get oxygen. In a premature baby, the part of the central nervous system that controls breathing is not yet mature enough for nonstop breathing. This causes large bursts of breath followed by periods of shallow breathing or stopped breathing.
Apnea of prematurity usually ends on its own after a few weeks. Once it goes away, it usually doesn’t come back. But no doubt about it it’s frightening while it’s happening.
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