Stopping breathing in a sleeping child, or sleep apnea, can be the result of a variety of reasons, ranging from the characteristics of age-related physiology to serious diseases caused by genetic mutations. Depending on the nature of the disorders, childhood apnea:
- not dangerous to the baby’s health, and therefore does not require any measures;
- threatens the child’s life and/or leads to mental retardation, frequent headaches during wakefulness, and the development of hyperreactivity syndrome;
- disappears on its own or after proper treatment, or... persists for life.
Below you will find more detailed information about the etiology of apnea in infants and young children, possible consequences and modern approaches to solving the problem.
Apnea in children under one year of age: why it occurs, dangerous or not dangerous
Due to insufficient morphological and functional development of the respiratory system of a child born prematurely, he often has respiratory arrests for 20 seconds or more (pauses can be shorter), accompanied by a slow heart rate (bradycardia) and a decrease in the level of oxygen in the blood.
Apnea in premature infants is one of the most common disorders that require the newborn to be in the intensive care unit under constant medical supervision. The earlier the child was born, the more often the episodes of apnea occur and the longer their duration.
The danger of apnea of prematurity is not only the risk of sudden death due to the fact that breathing does not resume, but also the insufficient supply of oxygen to the brain tissue. A set of special measures eliminates this problem.
Neonatologists cope with apnea of prematurity using CPAP machines and masks for infants working under special programs
As a rule, the respiratory system and the mechanisms for regulating its work in prematurely born newborns are fully formed and rebuilt by 37-40 weeks from the day of conception. That is, by the time the child would have been born if the mother had carried him to term. However, in very premature infants, apnea often occurs in a later period.
Episodes of sleep apnea in full-term infants under one year of age also occur and may be a normal variant. In the first year of life, short-term pauses in breathing during night sleep should not alarm parents if:
- their number does not exceed one episode per hour;
- the baby breathes effortlessly, deeply and evenly;
- apnea lasts no more than 5 seconds;
- the child does not show anxiety, his heartbeat does not slow down, and his skin does not appear blue.
However, if you notice that during sleep your baby stops breathing for some period of time, it is best and most correct to find the opportunity to undergo a special examination - polysomnography. Or, at a minimum, get an appointment with a specialized “sleep specialist” - a pediatric somnologist.
Diagnosis of sleep apnea
Relatives can recognize apnea. To do this, you need to use a stopwatch to measure the duration of breathing pauses.
The doctor determines the patient's body weight. With apnea, its index (BMI) is greater than 35 (second degree obesity); neck girth exceeds 40 cm; blood pressure is above 140/90.
Patients undergo consultation with an otolaryngologist; pathologies of the ENT organs can be identified.
A polysomnographic study helps provide a reliable picture of the course of the disease - a long (eight-hour) recording of electrical potentials and respiratory activity. By analyzing the polysomnography recording, the specialist calculates the number and duration of apnea episodes.
Genetic pathologies are one of the causes of childhood sleep apnea
More frequent and prolonged episodes of sleep apnea in children under one year old born at term are usually associated with certain genetic abnormalities:
- CVCAHV (congenital central alveolar hypoventilation syndrome),
- SMA (spinal muscular atrophy),
- PWS (Prader-Willi syndrome), etc.
Genetic disorders that provoke apnea also occur in premature babies; in this case, it is very important to correctly determine the cause of respiratory arrest.
“Bad” genes can be inherited or appear spontaneously during fetal development for as yet unknown reasons.
Perhaps in the not too distant future, genetic engineering will give doctors the opportunity not only to promptly detect, but also to correct genetic abnormalities in the fetus during pregnancy or after the birth of a child. However, at present, the “wrong” set of genes cannot be “fixed.” And pathologies such as, for example, SVCAHV, which cannot be corrected with drugs, can cause the death of a child during sleep (the so-called Ondine syndrome), which requires special measures and supportive therapy throughout life.
Newborns with SVCAH usually undergo surgery, during which a hole is created in the trachea and a special tube is installed - a tracheostomy. During sleep (and in severe cases, during wakefulness), a ventilator is connected to it. After reaching the age of 6-7 years, the tracheostomy can be removed, and the child can be transferred to non-invasive mechanical pulmonary ventilation.
Tracheostomy in a girl with Ondine syndrome
However, recently, more and more neonatologists, including leading Russian specialists, are inclined to the possibility of initially using non-invasive methods of ventilation in children with mild forms of mutations. Fortunately, modern, compact, silently operating, intelligent devices, equipped with special masks that can be easily adapted to the facial structure of a particular baby, make it possible to solve this problem.
For example, a case of successful treatment in the Russian Federation of a twin girl with “Ondine syndrome” using non-invasive hardware methods from birth is described. The child was born in the Perinatal Center of the Clinic of the Institute of Perinatology and Pediatrics of the Federal State Budgetary Institution "National Medical Research Center named after. V. A. Almazov" premature, but experienced doctors under the guidance of Ph.D. Natalya Aleksandrovna Petrova, quickly determined that stopping breathing during sleep is not associated with the immaturity of the respiratory system, but with SVCAHV, which was confirmed by molecular genetic diagnostics.
Several years have passed since then, during which the child grew up, keeping up with his sister and peers in development. Currently, the main problem for Varya and her family is the need to monitor the operation of the device and the girl’s condition every night. According to Dr. Petrova, “...in our country, social support for these people is still insufficient. In many countries, patients with Ondine syndrome are assigned a night nurse who helps monitor breathing during sleep. In Russia...it is necessary to improve the awareness of the medical community about this disease, gain experience in ventilation at home and thereby ensure normal living conditions for the child...”
Thanks to the “smart” device and specialists from St. Petersburg, Varya did not need surgery
It should be added that hypoventilation of the central type may not be congenital, but appear at a later age (from 1.5 to 9 years), accompanied by obesity, hypothalamic and autonomic dysfunction (ROHHAD syndrome).
Apnea in children with genetic diseases is very dangerous, but with the right approach its consequences can be minimized and the child’s life can be made as comfortable as possible.
Fortunately, hereditary and other gene abnormalities that lead to sleep apnea in children are extremely rare. What cannot be said about such a common diagnosis as adenoids. Pathologically overgrown nasopharyngeal tonsils interfere with the passage of air through the respiratory tract of a sleeping child, as a result of which he snores, breathes convulsively and unevenly, with stops. These children are diagnosed with obstructive sleep apnea syndrome (OSA) and are treated by ENT doctors.
Main symptoms
Parents do not always know that their child snores (they sleep in another room, etc.). Sometimes a series of snoring is interrupted by pauses (apnea). Since in children these disorders occur during REM sleep, they may go unnoticed.
Nocturnal snoring symptoms:
- breathing is difficult, as if the child is struggling to breathe;
- restless sleep, with continuous movements and startled awakenings;
- tendency to sleep in atypical positions: sitting, hugging a pillow, etc.;
- profuse sweating during sleep.
Daytime symptoms include excessive sleepiness and changes in behavior (shyness, social isolation, hyperactivity, aggressiveness, difficulty concentrating, etc.).
Snoring leads to impaired psychomotor development, which is accompanied by poor school performance, frequent distractions (“empty episodes”), etc.
When snoring, the child's growth is also delayed. In the most severe cases, there may be a tendency to fatigue, shortness of breath and even heart failure.
Respiratory disturbances during sleep can also affect the development of certain structures. Thus, problems arise with poor dental occlusion due to changes in the development of the lower jaw. This occurs due to the constant increase in respiratory effort during sleep. This is important because some orthodontic treatments aimed at correcting poor occlusion worsen respiratory distress during sleep, creating vicious cycles.
One in 10 children who snore have sleep apnea. This condition is characterized by temporary pauses in breathing and is one of the most alarming causes of snoring. The child experiences breathless periods of more than 10 seconds during sleep. This may be repeated several times during the night. The result is difficulty eating, loss of memory, skills, and deterioration in concentration. Due to lack of oxygen, there is a risk of developing heart problems, so medical intervention is required.
Obstructive apnea in children with adenoids: causes, danger, treatment approaches
Almost all children have adenoids, but if they are small in size (first degree), they practically do not interfere with the passage of air through the respiratory tract of a sleeping child, and OSA does not occur.
At the same time, obstructive apnea syndrome of varying severity develops in 50% of children with larger adenoids. In the second degree, at the time of the deep phase of sleep, hypertrophied tonsils cover more than half of the lumen of the airways; in the third or fourth degree, they block them completely.
During sleep, large adenoids can almost completely block the access of air to the airways
- Always remember that your snoring child with adenoids has a 50% risk of stopping breathing forever one night!
Therefore, children's snoring, especially uneven snoring, accompanied by wheezing inhalation, increased movements of the chest and its depression, periodic stops in breathing, is a reason to immediately contact a specialist for advice and a special examination.
Case from medical practice:
Moscow somnologists drew attention to a video filmed by the mother of 3-year-old Maxim M. from Kaliningrad. The woman was desperately looking for an opportunity to help her son - and she was absolutely right. As it turned out, the baby was literally between life and death. With one look at the sleeping child, specialists immediately determined a severe degree of obstructive sleep apnea, which was confirmed by polysomnography. The examination revealed 140 (!) episodes of respiratory arrests per hour. Since OSA was caused by adenoids that relapsed after traditional surgery, ENT doctors joined in the treatment: Professor Rusetsky Yu.Yu. and candidate of medical sciences Latysheva E.N. The boy underwent endoscopic removal of the adenoids, after which the problem completely disappeared.
| The chest is deformed, sinks when sighing, the mouth is open, the child snores heavily, breathes with difficulty, breathing stops on average every 2 minutes | The child does not snore, breathes evenly, constantly, calmly, through the nose, the chest is not deformed |
Sleeping Maxim before and after surgery
In general, when treating children with adenoids, ENT doctors adhere to the following rules:
- Grade 1 – no removal required.
- Grade 2 – examination is necessary to determine the presence of OSA and its severity.
- Grade 3-4 – surgery is indicated.
OSA can also develop in children with a pathological structure of the respiratory tract, for example, with a deviated nasal septum, cleft palate, hypertrophy (enlargement) of the root of the tongue, etc. In this case, as with severe adenoids, they resort to surgery.
In addition to polysomnography, SLIP endoscopy helps to decide on the choice of treatment tactics. During this study, the child is put into a light, close to natural, medicated sleep. After which, using a thin probe, his upper respiratory tract is examined to determine the presence of obstacles and determine their location.
Prevention of sleep disorders
Apnea is a serious disorder. Clinical symptoms increase gradually, subsequently leading to disability.
Apnea is often accompanied by snoring. Therefore, disease prevention is recommended for everyone who snores.
The risk of sleep apnea can be significantly reduced by changing your lifestyle:
- Refusal of bad habits (as a last resort, alcohol is allowed, but no later than 5 hours before bedtime);
- Measures aimed at reducing weight;
- Avoidance of sleeping pills and tranquilizers;
- Sleeping on your side (helps reduce stress on the abdominal muscles);
- Creating comfortable conditions in the sleeping area (reducing the brightness of light, the volume of extraneous sounds);
- Avoid reading before bed;
- Complete relaxation before bed (massage, meditation);
- Timely treatment for allergies and colds;
- Regular walks in the fresh air (at least half an hour a day);
- Limiting foods containing sugar.
Compliance with the recommendations will significantly reduce the likelihood of apnea syndrome and contribute to improving the quality of life in general.
First aid for a child who has stopped breathing
It may happen that the baby stops breathing for more than 30 seconds, in which case there is a risk of death, especially in newborns. Parents need to know how to behave in such a case in order to save the life of their child.
The most important thing is not to panic! Seconds count, so put your emotions aside and act. Take the baby in your arms, shake him slightly, run your finger along the spine from bottom to top. Massage your ears, palms and feet. Wipe your face with cold water. If after these manipulations the child does not breathe, proceed to artificial respiration.
Place the baby on a hard surface, tilt his head slightly back. Pinch your nose and gently exhale into your baby's mouth. Excessive exhalation can cause lung injury, be careful. Take 5-10 breaths. Then do a closed heart massage; for newborns, use the index and middle fingers, act carefully so as not to break the baby’s ribs. It is better to learn this procedure in advance before becoming parents.
While one parent is resuscitating the baby, the other should call an ambulance. If you find yourself alone with this situation, perform resuscitation and call an ambulance at the same time.
