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What is it?

Primary sleep apnea of infancy is a sleep related breathing disorder. It involves reductions and pauses in breathing that occur during an infant’s sleep. Partial reductions in breathing are called “hypopneas.” Complete pauses in breathing are called “apneas.” In infancy the frequency of these events increases during the stage of rapid eye movement (REM) sleep.

The apneas in primary sleep apnea of infancy may be central, obstructive or mixed. Central apneas occur when your body decreases or stops its effort to breathe. This results from a problem in the brain or in the heart. Obstructive apneas occur when soft tissue in the back of the throat collapses and blocks the airway during sleep. Mixed apneas involve a central apnea that is directly followed by an obstructive apnea.

The majority of apneas that occur in small premature infants are mixed apneas. Apneas that occur in larger premature infants and full-term infants tend to be central apneas.

These breathing problems can cause severe complications. The infant may not have enough oxygen in the blood. This is known as “hypoxemia.” The infant also may develop a slow heartbeat. This is known as “bradycardia.” The infant even may lose consciousness and need to be resuscitated.

Primary sleep apnea of infancy has two general causes. It can be a developmental problem that results from an immature brainstem. It also can be a secondary problem that is caused by another medical condition.

It is common for there to be some instability in an infant’s breathing. This can be a normal part of an infant’s development. Even healthy infants may have a brief central apnea. This pause may be an isolated event. It also may occur after the child sighs or moves. The duration of these normal events is very short. They rarely last longer than 20 seconds. Obstructive apneas are rare in healthy infants.

Who gets it?

Small preterm infants are most likely to have primary sleep apnea of infancy. It sometimes occurs in larger preterm or full-term infants. It is less common in infants under the age of six months.

During the first month after birth it occurs in 84 percent of infants who weigh less than 2.2 pounds. The risk decreases to 25 percent for infants who weigh less than 5.5 pounds. It is rare in full-term newborns.

In preterm infants, primary sleep apnea of infancy tends to appear between the second and seventh day of life. It is rare on the first day of life. Its presence at birth is usually a sign of another illness.

A variety of medical conditions can cause primary sleep apnea of infancy or make it worse. These problems include:

• Acid reflux
• Anemia
• Anesthesia
• Drugs
• Infection
• Lung disease
• Metabolic disorders
• Neurological problems
• Seizures
• Small upper airway

A small percentage of children who die from sudden infant death syndrome (SIDS) have apnea symptoms prior to death. But primary sleep apnea of infancy has not been established as a risk factor for SIDS.

How do I know if I have it?

1. Does your infant have prolonged pauses in breathing that last 20 seconds or longer?
   
   
2. Does your infant have patterns of repeated pauses in breathing that last less than 20 seconds?
   
   
3. Does your infant have related problems such as low oxygen or a slow heartbeat?
   
   
4. Has your infant needed resuscitation or other urgent care?

If your answer to any of these questions is yes, then your child might have primary sleep apnea of infancy.

Do I need to see a sleep specialist?

You may need to take your infant to a doctor who is a sleep specialist. If so then you should schedule an appointment at an accredited sleep disorders center. Some centers specialize in helping children. A sleep specialist will review your infant’s history and symptoms. If needed, the doctor will schedule your infant for an overnight sleep study. This kind of study is called a polysomnogram. It is the best way to evaluate your child’s 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 child’s sleep problems. A sleep specialist can look for other conditions that may be involved. These include:

• Another sleep disorder
• A medical condition
• Medication use
• A mental health disorder

What will the doctor need to know?
The doctor will need to know if your child was born premature or full-term. He or she will also need to know your child’s 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.

Will I need to take any tests?
An infant who has persistent breathing problems during sleep may need an overnight sleep study. This study is called a polysomnogram. It charts your child’s brain waves, heartbeat, and breathing during sleep. It also records arm and leg movements. The sleep study will reveal the nature of your infant’s 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.

How is it treated?

Infants with primary sleep apnea of infancy may need a machine to provide breathing support. They also may need treatment with medications. Both of these options tend to be short-term treatments.

Primary sleep apnea of infancy tends to go away as the child grows and matures. Ninety-eight percent of preterm infants will be free of symptoms by 40 weeks after conception. The problem is more likely to persist longer in infants who were born less than 28 weeks after conception.

Any medical condition that causes primary sleep apnea of infancy or makes it worse also needs to be treated. The treatment will depend on the nature of the medical problem.

Long-term complications are rare for most children with primary sleep apnea of infancy. Problems are more likely for infants who need frequent resuscitation. Health problems also are more common if the primary sleep apnea of infancy is related to another severe medical condition.

Reviewed by Norman R. Friedman, MD
Updated August 31, 2007