Apnea- A Breathing Disorder
June 13, 2008
Everyone has brief pauses in his or her breathing pattern called apnea - even your child. Usually these brief stops in breathing are completely normal. Sometimes, though, apnea or other sleep-related problems can be a cause for concern. Apnea, defined as cessation of breathing
resulting in pathological changes in heart rate and oxygen saturation, is a common occurrence
especially in preterm neonates. It is due to immaturity of the central nervous system (apnea of prematurity) or secondary to other causes such as metabolic disturbances etc. Secondary causes of apnea should be excluded before a diagnosis of apnea of prematurity is made.
Types of Apnea
The word apnea comes from the Greek word meaning “without wind.” Although it’s perfectly normal for everyone to experience occasional pauses in breathing, apnea can be a problem when breathing stops for 20 seconds or longer.
There are three types of apnea:
· obstructive
· central
· mixed
Ø Obstructive Apnea:
A common type of apnea in children, obstructive apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids). This is most likely to happen during sleep because that’s when the soft tissue at back of the throat is most relaxed. Symptoms include:
· snoring (the most common)
· labored breathing while sleeping
· gasping for air
· very restless sleep and sleeping in unusual positions
Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after awakening in the morning and tiredness and attention problems throughout the day. Sometimes apnea can affect school performance. One recent study suggests that some children diagnosed with ADHD actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.
Ø Central Apnea
When the part of the brain that controls breathing doesn’t start or maintain the breathing process properly it’s called central apnea. It’s the least common form of apnea (except in very premature infants, in whom it’s seen fairly commonly because the respiratory center in the brain is immature) and often has a neurological cause. An example of normal central apnea would be the short pause that occurs following a deep a sigh.
Ø Mixed Apnea
Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.
Associated features of Apnea:
· Loud snoring
· Morning headaches
· Non-refreshing sleep
· A dry mouth upon awakening
· Chest retraction during sleep in young children (chest pulls in)
· High blood pressure
· Overweight
· Irritability
· Change in personality
· Depression
· Difficulty concentrating
· Excessive perspiring during sleep
· Heartburn
· Reduced libido
· Insomnia
· Frequent nocturnal urination (nocturia)
· Restless sleep
· Nocturnal snorting, gasping, choking (may wake self up)
· Rapid weight gain
· Confusion upon awakening
Treatments involved for curing Apnea:
· The non-surgical treatments for apnea include behavior therapy, medications, dental appliances, continuous positive airway pressure, bi-level positive airway pressure, and auto-titrating continuous positive airway pressure.
· The surgical treatments for apnea include nasal surgery, palate implants, uvulopalatopharyngoplasty, tongue reduction surgery, genioglossus advancement, maxillo-mandibular advancement, tracheostomy, and bariatric surgery.
Summary:
Apneas usually occur during sleep. When an apnea occurs, sleep is disrupted. Sometimes this means the person wakes up completely, but sometimes this can mean the person comes out of a deep level of sleep and into a more shallow level of sleep. Apneas are usually measured during sleep. The sudden decreases in oxygen levels that occur with sleep apnea place a burden on the cardiovascular system, which must work harder in an attempt to deliver sufficient oxygen to all tissues. This strain causes the development of high blood pressure in approximately half of those suffering from sleep apnea, and this increases the risks of stroke and heart failure. Thus Apnea should not be treated as normal but should be diagnosed and treated appropriately.
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