Apnea, Infantile

Apnea, Infantile

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Apnea, Infantile is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Infantile Sleep Apnea

Disorder Subdivisions

  • Central Apnea
  • Diaphragmatic Apnea
  • Obstructive Apnea
  • Upper Airway Apnea
  • Mixed Apnea

General Discussion

Apnea is a term used to describe the temporary absence of spontaneous breathing. Infantile apnea occurs in children under the age of one year. Apnea may occur because of neurological impairment of the respiratory rhythm or obstruction of air flow through the air passages. The symptoms of infantile apnea include the stoppage of breathing during sleep, an abnormal bluish discoloration to the skin (cyanosis) and sometimes an unusually slow heartbeat (bradycardia). Infantile apnea may be related to some cases of sudden infant death syndrome. Episodes of apnea may decrease with age. However, several forms of adult sleep apnea also exist.

Symptoms

The symptoms of infantile apnea include the temporary cessation of breathing; an abnormal bluish discoloration of the skin, lips, and mouth (cyanosis), and/or an unusually slow heartbeat (bradycardia). Serious apnea is defined as the cessation of breathing during sleep for longer than 10 to 15 seconds.



Infantile sleep apnea may occur in several forms. The normal rate of respiration is regulated by groups of nerve cells in the brain. They control the rhythm of breathing in response to changing oxygen levels in the blood (respiratory drive). In central apnea, the respiratory drive is low and, during apneic episodes, there are no chest movements and no air passes through the mouth or nostrils. In this form of the disease, the brain does not send adequate signals to the diaphragm and lungs. Breathing stops and does not resume until the oxygen-starved brain sends impulses to the diaphragm and lungs.



In obstructive apnea (upper airway apnea), the airway is blocked and breathing may become difficult. Blockage may occur for a variety of reasons including collapse of the soft tissues of the throat. In this form of apnea, chest movements are present, but there is no air flow into the lungs. When breathing resumes, infants may make a loud "snorting noise" and become aroused from sleep. Obstructive apnea does not involve the cessation of breathing; rather, the affected infant struggles to breath and has increased respiratory effort.



Central apnea followed by or together with obstructive apnea is known as mixed apnea.



Some research indicates that in many cases the symptoms of infantile apnea may decrease with advancing age.

Causes

The exact cause of infantile apnea is not known. It may occur as the result of a combination of environmental and developmental factors (multifactoral). In extremely rare cases, central infantile apnea may be familial and affect more family members than would otherwise be expected.

Affected Populations

Infantile apnea affects males and females in equal numbers and occurs in children less than 1 year old. Infants who are born prematurely tend to experience episodes of apnea (apnea of prematurity).

Standard Therapies

To help prevent the potentially severe complications of infantile apnea, home apnea and cardiac monitors can alert a parent or caregiver to an episode of symptoms. These devices should be purchased only under the advice of a physician who is knowledgeable about the safety and effectiveness of apnea and cardiac monitors. Treatment may sometimes include the administration of drugs that stimulate the respiratory system (i.e., theophylline or caffeine). Parents and caregivers should be knowledgeable in lifesaving techniques such as cardiopulmonary resuscitation (CPR). In some infants, overheating should be avoided to possibly help reduce the frequency of apneic episodes. The infant should sleep in a supine position, unless he/she has obstructive sleep apnea or gastroesophageal reflux.



If the symptoms of infantile apnea are severe, the drug aminophylline or another xanthine medication may be prescribed. Oxygen may be supplied as needed. For those infants with obstructive or mixed apnea, a medical device known as a continuous positive airway pressure (CPAP) may be used to assist regular breathing. A mask is placed on the infant's nose and is connected through a tube to the CPAP device. This machine forces air through the tube at low pressure that is sufficient to keep the infant's upper airway open and to allow air to enter the lungs.

Investigational Therapies

Studies are ongoing to determine the causes of and new therapies for infantile apnea. Some drugs (e.g., primidone, etc.) are being studied for use in the treatment of this disease in infants who are resistant to theophylline. More studies are needed to determine the long-term safety and effectiveness of these drugs for the treatment of infantile apnea.



Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOKS

Cecil Textbook of Medicine, 19th Ed.: James B. Wyngaarden and Lloyd H. Smith, Jr., Editors; W.B. Saunders Co., 1992. Pp. 454, 2066-67.



The Merck Manual, 16th Ed.: Robert Berkow, Editor; Merck Research Laboratories, 1992. Pp. 1973, 1986.



Harrison's Principles of Internal Medicine, 12th Ed.: Jean D. Wilson, et al., Editors; McGraw-Hill, Inc., 1991. Pp. 1119-21.



Nelson Textbook of Pediatrics, 14th Ed.: Richard E. Behrman, Editor; W.B. Saunders Co., 1992. Pp. 462-63, 1043-44.



Pulmonary Diseases and Disorders, 2nd Ed.: Alfred P. Fishman, Editor; McGraw-Hill Book Company, 1988. Pp. 1363-69.



Principles of Neurology, 5th Ed.: Raymond D. Adams and Maurice Victor, Editors; McGraw-Hill Information Services Company, 1993. Pp. 343-45.



Dictionary of Medical Syndromes, 3rd Ed.: Sergio I. Magalini, Sabina C. Magalini, and Giovanni de Francisci, Editors; J.B. Lippincott Company, 1990. Pp. 819-20.



JOURNAL ARTICLES

The Use of Primidone in Neonates with Theophylline-Resistant Apnea. C.A. Miller, et al.; Am J Dis Child (Feb 1993; 147(2)). Pp. 183-86.



Association of Postoperative Apnea, Airway Obstruction and Hypoxemia in Former Premature Infants. C.D. Kurth, et al.; Anesthesiology (Jul 1991; 75(1)). Pp. 22-26.



Breathing Pattern Abnormalities in Full Term Asphyxiated Newborn Infants. P. Sasidharan; Arch Dis Child (Apr 1992; 67(4 Spec No)). Pp. 440-42.



Caffeine or Theophylline for Neonatal Apnea? J.E. Scanlon, et al.; Arch Dis Child (Apr 1992; 67(4 Spec No)). Pp. 425-28.



Obstructive, Mixed and Central Apnea in the Neonate: Physiologic Correlates. N.N. Finer, et al.; J Pediatr (Dec 1992; 121(6)). Pp. 943-50.



Apnea Spells, Sudden Death and the Role of the Apnea Monitor. T.G. Keens, et al.; Pediatr Clin North Am (Oct 1993; 40(5)). Pp. 897-911.



National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Pediatrics 1987, 79:292-99.



American Thoracic Society. Standards and Indications for Cardiopulmonary Sleep Studies in Children. Am J Respir Crit Care Med 1996; 153:866-78.



Blanchard PW, Aranda JV. Pharmacotherapy of respiratory control disorders. In: Beckerman, Brouillette, Hunt (eds.). Respiratory control disorders in infants and children. Baltimore, Williams, and Wilkins, 1992; 352-370.



FROM THE INTERNET

Online Mendelian Inheritance in Man (OMIM). Victor A. McKusick, Editor; Johns Hopkins University, last edit date 3/31/93. Entry Number 107640.

Resources

First Candle-SIDS Alliance

1314 Bedford Avenue

Suite 210

Baltimore, MD 21208

Tel: (800)221-7437

Email: info@firstcandle.org

Internet: http://www.firstcandle.org



American Sleep Association

1610 14th Street NW

Suite 300

Rochester, MN 55901

Tel: (507)287-6006

Fax: (507)287-6008

Email: asda@millcomm.com

Internet: http://www.sleepassociation.org/



Tri-State Sleep Disorders Center

1275 E. Kemper Rd.

Cincinnati, OH 45246

Tel: (513)671-3101

Fax: (513)671-4159

Tel: (800)838-4322

TDD: (311)111-6111

Email: ggaz@tristatesleep.com

Internet: http://www.tristatesleep.com



American Sleep Apnea Association

6856 Eastern Ave NW

Suite 203

Washington, DC 20012

USA

Tel: (202)293-3650

Fax: (202)293-3656

Email: asaa@sleepapnea.org

Internet: http://www.sleepapnea.org



NIH/National Institute of Neurological Disorders and Stroke

P.O. Box 5801

Bethesda, MD 20824

Tel: (301)496-5751

Fax: (301)402-2186

Tel: (800)352-9424

TDD: (301)468-5981

Internet: http://www.ninds.nih.gov/



NIH/National Institute of Child Health and Human Development

31 Center Dr

Building 31, Room 2A32

MSC2425

Bethesda, MD 20892

Fax: (866)760-5947

Tel: (800)370-2943

TDD: (888)320-6942

Email: NICHDInformationResourceCenter@mail.nih.gov

Internet: http://www.nichd.nih.gov/



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



For a Complete Report

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