Pediatric apnea syndrome is a condition in which sleep has stopped for more than 10 seconds in infants, babies, or older children after a year. 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.
Apnea in newborns and in older patients is caused by various etiological factors.
The most common causes of apnea in newborns are:
- Prematurity A baby born before the 37th week of pregnancy differs from a full-term immaturity of the nervous and respiratory systems. Respiratory centers in crumbs are not yet formed, therefore, in premature babies, respiration of the central type occurs.
- Abnormal development of the lower jaw. Too small jaw (micrognathia), as well as anatomical disorders of its structure can cause episodes of sleep apnea in children.
- Congenital defects of the cardiovascular, nervous system. When abnormalities of the internal organs, tissue hypoxia occurs, which can cause respiratory arrest in sleep.
- Injuries at birth. Intracranial, spinal injuries received during the passage of the birth canal, divide the neural connections between the respiratory center of the medulla oblongata and the receptors of the respiratory tract.
- Mother taking drugs, certain drugs, alcohol, smoking during pregnancy. Scientific studies have shown that in mothers who smoke during pregnancy, babies are 3 times more likely to suffer from respiratory failure. The obvious negative role of narcotic and psychotropic drugs, sleeping pills, alcohol. Penetrating through the placental barrier, substances inhibit the maturation of the nervous system of the fetus and destroy it.
At a later age, sleep apnea caused by:
- Obese. Excessive weight can cause breathing stops during sleep. Fat deposits that form in the soft palate, palatine arches, tongue, 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 of nasal breathing create a mechanical obstacle to the passage of air in a dream and cause episodes of cessation of breathing.
- Endocrine Disorders. Diabetes mellitus, hypothyroidism and other diseases of the endocrine system can provoke similar 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: hypomagnesaemia, hypocalcemia, an increase in blood sodium ions, ammonium – another reason for the development of this syndrome.
- Exposure to certain drugs. Sleeping pills, some antihistamines that have a pronounced sedative effect, can cause apnea in children up to a year.
Apnea from Fenistil, a popular antihistamine drug in drops, can occur in premature babies, as well as under 1 month. Therefore, the drug is not recommended for infants.
By origin of sleep apnea are:
- Central. More characteristic are the central mechanisms for newborns, especially premature, for infancy. May occur at any age with damage to the central nervous system, traumatic brain, spinal injuries. Caused by inhibition or immaturity of the respiratory center, blockade of the passage of impulses from peripheral receptors to the brain.
- Obstructive. Occur with compression, overlap of the upper respiratory tract. Obstructive type of apnea occurs in the pathology of the ENT organs in childhood, obesity, lymphoproliferative diseases, tumors and cysts in the throat area.
- Mixed For this kind of characteristic signs of the manifestations of the other two groups.
In the process of sleep, the general muscle tone decreases, including the tone of the muscles of the pharynx. The lumen of the airways is somewhat narrowed in healthy children, but 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 the complete collapse of the pharynx, the development of an episode of acute asphyxiation. It lasts from 10-30 seconds and more. In the blood, the concentration of oxygen decreases sharply, the sympathetic nervous system is activated, and the pressure rises. The stressful reaction “wakes up” the brain, which regains control over the pharyngeal muscles – inhalation occurs. This is how apnea develops along the obstructive pathway.
If the pathogenesis of the central disturbance, 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.
The leading symptom of an apnea episode is the lack of breathing, chest excursions for 10-15 seconds. In some cases, if the child’s breathing is accompanied by snoring, the parents notice episodes of its termination, and after some time an enhanced resumption of the snoring sound. Such “dumb” sleep episodes are apnea.
The longer the periods of respiratory arrest (up to 40-50 seconds), the worse the consequences for the body: the episodes cause sudden death syndrome or cause brain damage due to prolonged hypoxia.
Such stops of respiratory activity during the night can occur more than 100-150 times, their number and duration affect night sleep, its phaseiness, and the general condition of the patients.
Other symptoms that can be suspected of this pathology are:
- Snoring in a dream.
- Feeling of lethargy, brokenness in the morning, despite the fact that the child slept a sufficient amount of time at night. Children are especially capricious, tearful 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.
- Bedwetting (enuresis).
- Increased motor activity in sleep.
- Teeth grinding (bruxism).
- Talk in a dream.
- Delayed psychomotor development.
If there are any disturbing symptoms, parents should consult the baby with the pediatrician for examination and treatment.
All preterm infants with low birth weight in the first 10 days should be monitored for the risk of respiratory failure episodes: cardiac and respiratory activity is monitored around the clock, oxygen content in the blood is measured using sensors for newborns. If stops are detected, their origin is determined, if these are secondary episodes – if possible, the reason for their occurrence should be eliminated.
Treatment methods for respiratory arrest in infants and older are:
- The method of tactile irritation. Toddler laid on a swinging bed, oscillating water mattress. Tactile stimulation is one of the first elements of emergency care in case of apnea in a child at home.
- Creating pressure in the nasal passages. Breathing with the nasal cannula significantly reduces the incidence of apnea.
- Oxygen therapy. Special “headcaps”, “funnels” are used to increase the concentration of O2 in the air we breathe.
- Drug therapy. Effective in some cases of development of pathology of the central or mixed genesis. Theophylline or caffeine, Etimizol, Pentoxifylline, Instenon is used exclusively on the recommendation of a doctor and in strictly prescribed dosages that are appropriate for the child’s age.
Primary resuscitation at home
Parents whose children have at least once observed a cessation of breathing in their sleep should know the sequence of actions aimed at providing first aid for prolonged apnea.
If there are two parents at home, it is necessary to distribute duties: one calls for medical care, the other carries out resuscitation.
If there is only one adult with the baby, the call for health care providers should be carried out in parallel with the emergency care.
The child should be placed on his back on a horizontal surface, inspect the oral cavity in order to avoid obstruction of the respiratory tract with a foreign object. If no foreign objects are found in the mouth, tactile stimulation should be quickly carried out: shake the child, pinch, mechanically rub the ears, palms, feet.
If after these manipulations the patient’s breathing has not recovered, it is necessary to proceed to cardiopulmonary resuscitation: to do artificial respiration, while simultaneously conducting an indirect heart massage. As soon as the episode of prolonged apnea is over, you should call an ambulance and clearly report what happened.