Sleep apnea is a potentially life-threatening disorder in which a child's breathing stops intermittently during sleep. There are three types of sleep apnea: obstructive sleep apnea caused by airway obstruction; central sleep apnea, during which the airways remain open, but the brain stops sending signals to the respiratory muscles and their work is suspended; and mixed apnea, combining the signs of the first two types.
Infants most often have central sleep apnea. And in adults and babies older than a year - obstructive. Children with and other birth defects affecting the upper respiratory tract are more susceptible to respiratory disorders. More than half of children with Down syndrome have obstructive sleep apnea.
Which children are most at risk?
Sleep apnea can develop in any child, but babies are more likely to experience the problem. If a we are talking about babies born before 37 weeks of gestation, this is called apnea of prematurity. In term babies, this disorder is called neonatal apnea.
The earlier the baby is born, the higher the likelihood that he will suffer from sleep apnea.
What are the reasons for stopping breathing during sleep?
In children, the immaturity of the central nervous system is most often to blame. Other possible reasons include cerebral hemorrhage, poisoning drugs or poisons, birth defects, infections, respiratory problems, problems gastrointestinal tract(such as), an imbalance of minerals in the body (for example, the wrong amount of calcium or glucose), and problems with the heart and blood vessels.
What are the symptoms of sleep apnea?
During sleep, children with sleep apnea stop breathing (laboratory studies have found that in infants, breathing stops last 20 seconds or longer, and in older children it lasts 10 seconds). When breathing is restored, the child may sigh or sob sharply. When breathing stops, the baby's skin may become bluish.
Do not forget that it is completely normal for babies under 6 months to have the so-called. You have probably noticed that sometimes babies breathe quickly, then breathing becomes less frequent, there is a pause of about 15 seconds - and then normal breathing is restored.
AT this case nothing to worry about. Periodic breathing in babies takes up to 5% of the time allotted for sleep. In premature babies, this figure increases to 10%.
If the baby has apnea already in the hospital, doctors will likely want to monitor him before he is discharged home. Be sure to talk to your doctor if you are concerned about your baby's breathing.
What is the danger of stopping breathing in a dream?
Apnea is a potentially dangerous disorder that can be fatal. As breathing stops, the oxygen content in the blood drops and the level carbon dioxide increases. Because of this, the baby's heart rate can drop significantly. This condition is called bradycardia.
Toddlers who experience prolonged pauses in breathing (a life-threatening condition) repeatedly are at greater risk of serious complications from sleep apnea.
How is respiratory arrest diagnosed?
If your child's doctor suspects sleep apnea, they will order a variety of procedures, including testing the amount of oxygen in the blood, checking breathing and heartbeat, and x-rays.
Your doctor may refer you to a sleep specialist (sleep specialist), pediatric pulmonologist (lung specialist), or sleep apnea specialist.
The test that is usually done to diagnose sleep apnea is called a polysomnogram. During the procedure, monitoring electromagnetic waves, which emits the brain of a sleeping child, for the movements of his eyes, for breathing and the level of oxygen in the blood at moments of difficult breathing.
Most often, a polysomnogram is performed in a hospital under the continuous supervision of a somnologist. It is also possible to conduct surveillance at home using portable devices. But usually it does not give such accurate results as a laboratory procedure. Both options are painless.
As an alternative, you can connect the baby to a home cardiorespiratory monitor that records respiratory contractions (chest movements) and monitors the work of the heart using an ECG. Such a monitor can be used for several days, weeks and even months.
How is apnea treated?
It depends on how severe your child's sleep apnea is. Your doctor may advise you to monitor your baby's breathing and heart rate using a portable monitor. And he can prescribe drugs that stimulate the activity of the central nervous system.
Some children with obstructive sleep apnea need a CPAP machine (treatment using forced air pressure). With the help of a mask, air is supplied to the baby’s nose during sleep, so his airways remain open. Unfortunately, the symptoms of central sleep apnea are usually not relieved by CPAP therapy.
What should I do if I think my child has stopped breathing while sleeping?
Touch your baby or gently shake him to see if he reacts or not. If there is no response, call an ambulance. Also, a signal that the baby is in danger is the bluish color of his forehead and torso (do not confuse with the blue of the arms, legs or skin around the mouth, which happens quite often).
If you know how to spend, start acting, and let someone close call the ambulance. If at this point you are alone with the child, perform CPR for two minutes, then call an ambulance and continue resuscitation until the doctors arrive or the baby begins to breathe.
In children, as well as adults, there may be a cessation of lung activity and respiratory arrest during sleep. This phenomenon is called apnea. It can last from a few seconds to 2-3 minutes. Apnea in children is more common if the baby is not full term or was born too small. Over time, if the baby was born without pathologies, this phenomenon goes away on its own. But in some cases, treatment is required, up to surgery.
There are many causes of sleep apnea in children. These include:
- Prematurity or low birth weight. In this case, the respiratory center may be underdeveloped, and this causes the rhythm of breathing to go astray.
- Congenital pathologies in the respiratory system that make breathing difficult.
- Ingestion of amniotic fluid into the respiratory tract during childbirth.
- Overheating of the child's body. If the baby is too wrapped up or left out in the sun, he can overheat and stop breathing.
- Snoring in a dream. In children of any age, snoring during sleep can cause sleep apnea.
- Obesity. Older children who are overweight tend to snore during their sleep, which can affect the rhythm of their breathing.
- Head injury during childbirth or at a later time.
- Depression of the respiratory center by drugs.
- Poisoning chemicals.
- Infectious lesions of the brain.
- Narrowing of the airways in the upper section.
- Obstruction of the nasopharynx.
- The presence of enlarged tonsils or adenoids.
- Allergic reactions.
- Heredity.
Whatever the cause, sleep apnea in children can result in sudden cardiac arrest, leading to imminent death. Therefore, parents need to know what to do if such a condition occurs.
Features of manifestation and signs of apnea in children
Symptoms of sleep apnea in children differ little from those in adults. But, if in adults breathing returns with noise, in children, especially in premature babies, apnea stops quietly and may go unnoticed. And if the attack drags on, and there are no adults nearby, the child may die.
Therefore, you should not leave a sleeping baby unattended. It is important to know how apnea manifests itself. Its symptoms are as follows:
- Restless sleep, the baby coughs in a dream, breathes through the mouth.
- The chest freezes on inhalation, more often on exhalation, respiratory movements stop.
- The child's face turns blue, especially around the lips.
- The pulse becomes rare, thready.
- With a prolonged attack, cramps of the limbs may occur. This symptom often wakes up the mother who has fallen asleep nearby and serves as a salvation for the baby at night.
Sleep apnea in children can last only a few seconds, but this can be enough to lose the baby. Therefore, premature babies after childbirth are placed in special boxes and support breathing with the help of apparatus.
Types of apnea in children
In both children and adults, there are three types of apnea - central, obstructive and mixed.
Central
Apnea of this type occurs due to a reason located in the central nervous system. It occurs when the brain is damaged or the respiratory center is underdeveloped.
May occur with meningitis, stroke, brain injury, infectious diseases, helminthic invasions, poisoning and other lesions affecting the central nervous system.
It can manifest itself only by cessation of breathing and blue skin. Therefore, children with such pathologies should not be left unattended.
obstructive
This type occurs when something interferes with the airways. This may be the ingress of amniotic fluid during childbirth, an abundance of mucus during a cold, spasms of the upper respiratory tract, tongue retraction, or the inhalation of a foreign object.
A small child may fall asleep with a small toy or candy in their mouth. If parents are inattentive, he may die from suffocation in his sleep. Apnea of this type may be accompanied by restlessness and convulsions.
mixed
This is a type of apnea that combines the previous two. With brain problems, any blockage in the airways can lead to the death of the baby, because the brain does not fight and does not help the child cope with the attack.
Diagnostics
The diagnosis of "sleep apnea in children" is made on the basis of the clinical picture and anamnesis of the pathology. If attacks occur frequently and last more than 40 seconds, a deeper examination is necessary. To do this, various activities are performed during the child's sleep.
For example, special sensors are placed on the body to detect the presence of apnea and its type. This is called cardiorespiratory monitoring. It can be carried out not necessarily in the clinic, but also at home by calling a specialist with equipment.
Also gives nice results polysomnograph examination. This is a special device that issues status information to the computer. of cardio-vascular system and work of the respiratory center. It calculates the time of sleep and the frequency of awakenings from an incorrect respiratory rhythm, as well as the nature of apnea.
First aid
Sleep apnea in children can end tragically if the mother is not around or she is fast asleep. If the problems are related to the central nervous system, the baby may simply not start breathing again, and the mother may not notice anything right away.
Mortality from sleep apnea in children under one year old is quite high. There are no exact statistics on this, because doctors cannot always determine the exact cause of death of a child in a dream. But, nevertheless, sudden cessation of breathing is a fairly common phenomenon, and if no one was nearby at the time of the attack, death occurs in a few minutes.
Normally, breathing is allowed to stop for no more than 10 seconds. If the baby does not breathe for longer, this is already a pathology. Therefore, even before the birth of the baby, the mother should be trained in artificial respiration and heart massage for newborns in case of sudden cardiac or respiratory arrest. In the future, this can come in handy and save the life of the baby.
If an infant has an apnea attack for any reason and the baby stops breathing, the mother should not panic, grab the baby and shake it. This can lead to injury, and then he will suffer for the rest of his life. Mothers should try to wake up the baby, massage the limbs and earlobes. This will speed up blood circulation, and breathing can resume.
If this does not help, you need to call an ambulance and immediately begin chest massage and artificial respiration. But before that, you need to make sure that the respiratory passages are free, and there is nothing extraneous in them.
Artificial respiration is done taking into account the fact that his lungs are much smaller than those of an adult. Therefore, it is impossible to inhale a lot of air into it, this can lead to injury to the lung and its rupture. So the baby will not be saved, but rather, on the contrary, he may never wake up.
After an attack, the baby must be examined in a hospital to find out the cause of the occurrence and determine methods for treating apnea.
Treatment
To begin treatment of apnea in children, the attending physician must determine the type of pathology and know the exact cause of the occurrence. It depends on what measures will be taken in the future.
Medical
If a child has signs of prematurity and apnea attacks appear, he, like all premature babies, is placed in special boxes. Here he is on artificial ventilation lungs. In boxing are created greenhouse conditions so that the baby is comfortable, and that the thermal regime of the small organism is not violated. Great attention is also paid to moisture, so that the delicate skin of the baby does not dry out.
It can stay there until all underdeveloped functions are restored, and the body learns to breathe on its own. During this time, the child is comprehensively examined and treated for identified deviations from the norm.
In order for him to gain the desired weight, he is given vitamin therapy. In case of insufficiency of respiratory activity, the doctor prescribes drugs that contain aminophylline, which helps to restore breathing.
Surgical
The intervention of a surgeon is required when a child has polyps, adenoids, or the tonsils need to be removed.
IVL
Artificial ventilation of the lungs is carried out for newborn premature babies who are not able to breathe on their own. And also it is shown to children and adults with various pathologies that depress the respiratory center.
oxygen therapy
Treatment consists in enriching the blood with oxygen. This is done with the help of inhalations or in special pressure chambers. Recently, oxygen drips have become popular. It is carried out under the supervision of a physician and with constant monitoring of the general condition.
CPAP therapy
This type of therapy is prescribed for severe cases of childhood sleep apnea. For him, a special apparatus "Cipap" is used, which has a mask, with the help of which normal air pressure is maintained in the child's lungs. The mask is put on the baby during sleep to prevent respiratory arrest.
Prevention
Sleep apnea in children under one year of age can be prevented. If the child was born without pathologies, it is enough to follow some simple rules:
- The baby should be laid on its side. Small children often spit up the contents of the stomach, and this eliminates the risk of blockage of the airways.
- A child under one year old should not sleep on feather beds or soft pillows. In his crib there should be an elastic dense mattress covered with a diaper. Pillows and under the head are excluded. Instead, a folded towel, diaper or pillowcase is placed.
- It is necessary to observe the thermal regime of the baby. You can not wrap him too tightly so that he does not get hot. Cold is also not welcome. In the room where the baby sleeps, there should be no drafts, the temperature should be average and maintained constantly the same.
- Breastfeeding is better breast milk, this develops the baby's muscular apparatus in the nasopharynx. By sucking the breast, the child learns to breathe correctly. You can not overfeed the child, otherwise he will have excess weight, and the risk of apnea will increase.
- Important proper care for a sick chest. If he catches a cold or has a head injury, he must be constantly monitored. It is necessary to protect infants from contact with infectious patients so that they do not catch a dangerous infection.
- Head injury must not be allowed. Remove all foreign objects from the crib that the baby can hit and get hurt. When the child begins to walk around the room, arrange the room so that there is no danger of injury. It is better to lay a carpet on the floor so that the baby does not hit so hard when falling.
- Do not leave a small child for a long time with older children, especially in big company. When there are many children, they forget about the younger ones, run and frolic. They can push or drop the baby and not even notice it. And at night, the baby may experience sleep apnea.
- If your baby has night snoring, you need to take measures to combat this. For young children, snoring is not a normal phenomenon and it signals the presence of a deviation from the norm. This applies not only to infants, but also to older children.
- Do not allow young children to play with small objects and toys that break into small parts.
- Avoid contact with harmful chemicals, detergents and medical preparations. If the child is prescribed medication, you need to make sure that they are suitable for him. Do not exceed the indicated dosage and duration of administration. Do not take expired medicines.
- Ventilate the room regularly and do not allow smoking near the baby.
- In order for parents to be able to calmly go about their business and not be constantly at the baby’s crib, experts have developed a special device that is attached to a shirt and tells when bouts of the syndrome occur.
To preventive measures also applies correct mode mother before the baby is born. She must register on time, visit doctors regularly and strictly follow all their recommendations. She must eat properly so that the child gains the desired mass and does not lag behind in development. There should be no stress and big physical activity so that the baby is not born prematurely.
After birth, doctors should regularly monitor the baby and record all deviations from the norm. In the event of an apnea syndrome, the pediatrician should immediately send the baby for examination. If the family had apnea syndrome in older children or adults, you need to carefully monitor the baby and, if necessary, take treatment.
Often doctors cannot find out the cause of sudden respiratory arrest. There are frequent cases when absolutely healthy child suddenly dies in his sleep. And in most cases, everything happens due to an oversight of the parents. To prevent this from happening, parents must take full responsibility for caring for their baby. Do not leave her unattended and remember that up to a year there is nothing more important than her health and well-being.
When a child’s regular 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 to consult a doctor with suspicion of childhood apnea. Apnea in children is quite common, especially the risk of developing pathology in premature infants. Each parent should be aware of the causes, manifestations of this condition, as well as ways to deal with it.
Sleep apnea syndrome in pediatrics is a condition in which, during sleep, infants, infants or older children stop breathing for more than 10 seconds after a year. Often it is accompanied by a slowing of the heartbeat, pallor or cyanosis. skin. This syndrome can occur at any age. Apnea in newborns is one of the most common causes of sudden infant death syndrome.
Causes
Apnea in newborns and in older patients is caused by various etiological factors.
Most common causes 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 are not yet formed, therefore, in premature babies, respiratory arrest of the central type occurs.
- Anomalies in the development of the lower jaw. Too small jaw (micrognathia), as well as anatomical violations of its structure, can cause episodes of sleep apnea in children.
- Congenital malformations of the cardiovascular, nervous system. In case of anomalies internal organs tissue hypoxia occurs, which can provoke respiratory arrest during sleep.
- Birth 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 respiratory tract receptors.
- Mother's drug use, some medicines, alcohol, smoking during pregnancy. Scientific studies have shown that mothers who smoke during pregnancy are 3 times more likely to suffer from respiratory arrest. The negative role of narcotic and psychotropic drugs, sleeping pills, and alcohol is obvious. Penetrating through the placental barrier, substances prevent the maturation of the fetal nervous system and destroy it.
At an older age, pauses in breathing during sleep are caused by:
- obese. Being overweight can cause you to stop breathing during sleep. Fat deposits, formed 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., enlarged tonsils, nasal breathing disorders 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 endocrine system capable of provoking such episodes.
- Infections. Sometimes respiratory arrest in children can occur with a 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.
- The impact of certain drugs. Sleeping pills, some antihistamines, which have a pronounced sedative effect, can cause sleep apnea in children under one year old.
Read also related
Modern methods of snoring treatment with the help of surgical intervention
Apnea from Fenistil, a popular antihistamine drops, can occur in premature babies, as well as those younger than 1 month old. Therefore, the drug is not recommended for infants.
Classification
According to the origin of sleep apnea, there are:
- Central. The central mechanisms are more typical for newborns, especially premature ones, for infancy. They can occur at any age with damage to the central nervous system, craniocerebral, spinal injuries. They are caused by inhibition or immaturity of the respiratory center, blockade of the passage of impulses from peripheral receptors to the brain.
- Obstructive. Occurs when compression, overlap of the upper respiratory tract. Obstructive type of sleep apnea occurs in the pathology of the ENT organs in childhood, obesity, lymphoproliferative diseases, tumors and cysts in the pharynx.
- Mixed. This species is characterized by signs of manifestations of the other two groups.
Development mechanism
During sleep, the overall muscle tone decreases, including the tone of the muscles of the pharynx. The lumen of the respiratory tract narrows somewhat 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 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 pressure rises. The stress response "wakes up" the brain, which regains control of the pharyngeal muscles - inhalation occurs. This is how apnea develops along an obstructive path.
If the pathogenesis of the disorder is central, then there are no obstacles for 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 the absence 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 termination, and after some time, an increased resumption of the snoring sound. Such "silent" episodes of sleep are sleep apnea.
