Sleep Apnea in Babies – Symptoms, Causes and Treatment

Parents need to be cautious when it comes to the health of their newborn. The first few months after birth are crucial, so the parents must look out for all signs about their baby’s health. The baby has important growth milestones in the first few months, so it is essential to ensure that their growth is not hindered. Acquiring awareness about a serious disorder called sleep apnea is essential as it requires careful observation and identification. Sleep apnea in babies is a condition where their breathing pauses during sleep, sometimes for a few seconds or longer. While it might sound alarming, understanding the signs and causes can help you take the right steps to keep your little one safe and healthy. In this article, we will walk you through everything you need to know about newborn sleep apnea.

What Is Sleep Apnea?

An interruption of breathing while sleeping is called sleep apnea (1). It is a potentially harmful condition and can cause serious complications when not treated at the right time. In infants, sleep apnea can lead to slow heart rate and poor growth (2). A partial interruption in breathing is called hypopneas whereas a complete pause in breathing is termed apnea.

Types of Sleep Apnea

Sleep apnea in babies can present in different forms. Some cases occur due to physical obstructions, while others result from issues with the brain’s ability to regulate breathing. It can be categorised into three types (3):

1. Obstructive Sleep Apnea

This type of apnea occurs when the upper airway is blocked due to the soft tissue at the back of the throat collapsing.

2. Central Sleep Apnea

Central apnea could occur due to a problem in the heart or brain, where the body stops its effort to breathe. There is no blockage in the brain, but it fails to send signals to the muscles to breathe.

3. Mixed Apnea

As the name suggests, it is a combination of central and obstructive apnea. It is a form of apnea that is most commonly observed in small, premature infants.

Can Babies Have Sleep Apnea?

Yes, babies can have sleep apnea, though it is uncommon in full-term infants. It is more frequently seen in premature babies, especially those born before 37 weeks (4). In such cases, it is referred to as apnea of prematurity, whereas in full-term infants, it is called apnea of infancy. The condition usually resolves on its own as the baby grows, but if it persists beyond infancy, an underlying medical issue may be the cause.

Causes of Sleep Apnea in Babies

Sleep apnea could be due to several reasons. Some of the causes of sleep apnea are (5) (6):

• Relaxing the muscles during sleep. Our muscles relax when we sleep, but in case of obstructive sleep apnea, the muscles relax more than required, thus collapsing the airway and making it hard to breathe. Enlarged tonsils and adenoids are also the causes of obstructive apnea.
• Family history of apnea
• Overweight
• Down’s syndrome
• Cerebral palsy
• Deformity in the mouth, jaw and throat structure
• Comparatively longer neck
• A large tongue that can fall back and block the airway while sleeping

In babies, there could be a few other reasons causing sleep apnea.

• Bleeding in the brain
• Respiratory disease
• Gastrointestinal problems like reflux
• Infection
• Seizures
• Imbalance in the chemistry of the body like abnormal amounts of calcium or glucose in the body
• Exposure to harmful and toxic chemicals

Symptoms of Sleep Apnea in Babies

A parent needs to be conscious at all times to observe any signs of sleep apnea in newborns. They need to be extra careful when it is about premature or underweight babies. According to the American Academy of Sleep Medicine, interruption in breathing up to 15 seconds is normal and is called periodic breathing. Periodic breathing is not a symptom of apnea. However, an increase in the time of breathing pauses is an alarming sign.

Here are the signs of sleep apnea in babies that parents should be careful about (4) (5):

• The skin turning blue: The forehead and body of the infant turning blue indicate that the blood oxygen levels are low. Note that sometimes, the skin around the baby’s mouth or the feet may turn bluish if the baby has a cold or has been crying.
• Gasping: It happens after a long cessation of breathing. Due to the immaturity of the respiratory system in premature babies, the brain fails in sending signals to the muscles to breathe. This is a clear indication of central sleep apnea.
• Limpness: Limp muscles are a serious effect of apnea. The limpness of muscles occurs due to an extreme reduction in the oxygen level in the blood.
• Slow heart rate: Infants with apnea have a slower heart rate, causing a condition called bradycardia, which may lead to sudden unconsciousness.

Which Babies Are at the Risk of Having Sleep Apnea?

Any baby can have apnea, but it is a more common condition in premature babies. The longer the time gap of premature birth, the higher is the risk of apnea. In babies born before 37 weeks of pregnancy, the condition is called apnea of prematurity (7). In babies born at 37 weeks or later, it is called apnea of infancy. As per reports, around 84 per cent of underweight babies who weigh less than 1 kilogram have a risk of apnea. The risk reduces to 25 per cent among babies who weigh around 2.5 kilograms at birth.

Down’s syndrome and congenital conditions can also affect the upper airway, thus causing sleep apnea. Most of the children with Down’s syndrome suffer from sleep apnea as well (8).

Complications

Sleep apnea is a serious health condition, especially in premature infants. In rare cases, it may be fatal. In this condition, as the baby stops breathing, the oxygen level in the blood drops and the level of carbon dioxide increases. This could also lead to a drop in the heart rate and cause unconsciousness.

How Is Baby Sleep Apnea Diagnosed?

Upon suspecting a sleeping disorder, the baby needs to be taken to a sleep specialist. The child’s doctor will conduct some examinations before referring to a paediatric pulmonologist. Measuring the oxygen level in the blood, monitoring the heart rate and checking the breathing are some of the tests.

Another test that is conducted to diagnose apnea is a polysomnogram. This requires keen observation of the baby while asleep, and is conducted in the sleep lab by technicians. This observation is done to capture brain waves, heartbeat and breathing pattern, revealing the nature of the breathing problem. It is a painless procedure (4) (8).

Treatment for Infant Sleep Apnea

Depending on the severity of the apnea, the doctor will prescribe medication for the baby. In the case of enlarged tonsils and adenoids, a throat or ENT specialist has to be consulted. In some cases of obstructive apnea, a continuous positive airway pressure machine is used for some time (6) (8). A baby sleep apnea monitor could also be used for infants who require cardio-respiratory monitoring for a variety of problems that affect breathing.

Most of the babies with infant sleep apnea are relieved of this condition as they grow, but apnea of prematurity might persist longer.

Note: Parents of babies with sleep apnea should learn how to perform CPR (Cardiopulmonary resuscitation). Discuss this with your doctor and learn it so you can be prepared for an emergency.

When to Call a Doctor?

In the case of babies with premature birth and underweight issues, the parents need to be extra cautious. When an interruption of breathing is for more than 15 seconds, and the baby does not respond to gentle nudging, call a doctor immediately.

FAQs

1. Are there any home remedies or preventive measures for sleep apnea in newborns?

While medical treatment is essential for diagnosed cases, parents can take preventive measures such as ensuring the baby sleeps in a safe position (on their back), maintaining a healthy weight, and keeping nasal passages clear. Regular paediatric checkups can also help detect any breathing concerns early.

2. Can pacifiers help reduce the risk of sleep apnea?

Yes, using a pacifier during sleep may help keep the airway open and reduce the risk of obstructive sleep apnea. Pacifiers are also associated with a lower risk of Sudden Infant Death Syndrome (SIDS).

3. Will my baby need surgery for sleep apnea?

Surgery is only considered if the cause of sleep apnea is a physical obstruction, such as enlarged tonsils or adenoids. In most cases, non-surgical treatments like CPAP (Continuous Positive Airway Pressure) therapy or oxygen support are preferred (6).

Even though neonatal sleep apnea is a serious condition, proper steps at the right time can help parents treat this condition in their newborn. Careful observation and consultation are mandatory for the right guidance and treatment procedure.

References/Resources:

1. National Heart, Lung, and Blood Institute – What Is Sleep Apnea?

2. Cleveland Clinic – Obstructive Sleep Apnea in Children

3. Cleveland Clinic – Sleep Apnea

4. Sleep Foundation – Sleep Apnea in Infants and Newborns

5. Children’s Mercy Sleep Center – Sleep Apnea in Babies: Symptoms, Diagnosis and Treatment

6. Nemours KidsHealth – Obstructive Sleep Apnea

7. Nemours KidsHealth – Apnea of Prematurity

8. American Academy of Pediatrics – Sleep Apnea in Children: Detection & Treatment

Also Read:

Snoring in Infants
Apnea Monitor
How to Handle Your Baby Crying at Night
Baby Sleeps With Mouth Open
Baby Sleep Problems & Ways to Deal with Them

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