Sleep apnea in infants

Sleep apnea in infants: When a breathing pause is dangerous

Infant breathing is irregular, and short pauses are a normal characteristic. However, when these breathing stops become too long, it is called apnea and may be a sign of serious medical problems. It is important to clearly distinguish safe periodic breathing, typical for newborns, from pathological apnea, which requires immediate medical attention. This condition is one of the most concerning respiratory symptoms in infants.

Periodic breathing vs. Apnea: Key differences

• Periodic breathing (normal): This cycle consists of a series of rapid inhalations followed by a pause lasting up to 10-15 seconds. After the pause, breathing resumes spontaneously. During such a stop the child does not change skin color, and heart rate remains stable. This phenomenon is related to the immaturity of the respiratory center in the brain and usually disappears by 3-4 months.
• Apnea (pathology): This is a breathing stop that lasts 20 seconds or longer. Apnea is also diagnosed if the pause is shorter but accompanied by alarming symptoms: skin cyanosis or a significant slowing of heart rate (bradycardia).

Types and causes of apnea in infants

Apnea in infants occurs in two main types:

1. Central apnea: The most common type in infants. It occurs when the respiratory center in the brain “forgets” to send a signal to the breathing muscles. This reflects deep immaturity of the nervous system and is most often seen in preterm children.
2. Obstructive apnea: Occurs when the airways are mechanically blocked despite the respiratory center sending signals. Causes may include enlarged tonsils, inflammatory swelling, or other anatomical features.

In term infants, apnea can be a symptom of serious diseases such as severe infections (sepsis, meningitis), severe reflux (when stomach contents cause laryngeal spasm), neurological or cardiac problems. Any episode of true apnea requires thorough examination in a hospital setting. Adhering to the rules of safe sleep is critically important for all infants.