What is Apnea?

Introduction

Infants who are referred to a medical specialist for assessment and possible home apnea monitoring considerations have usually experienced either one, some or all of the following breathing anomalies:

All of the above effects can be visually disturbing to parents who have little experience of these conditions. This may lead to over anxiety with the parents who resort to very frequent checks of their sibling.

 

So what is apnea in infants?

Apnea simply means 'not breathing' and has been expanded into definitions such as those given below:

Apnea - Cessation of respiratory air flow. The respiratory pause may be central or diaphragmatic (i.e. no respiratory effort), obstructive (usually due to upper airway obstruction), or mixed. When short in duration (15 seconds or less) central apnea can be normal at all ages.

Pathological apnea - A respiratory pause is abnormal if it is prolonged (20 seconds or more) or associated with cyanosis (bluish appearance), abrupt marked pallor or hypotonia (limp muscle tone), or bradycardia (heart beat outside expected limits).

Periodic Breathing - A breathing pattern in which there are three or more respiratory pauses of greater than 3 seconds duration with less than 20 seconds of respiration between pauses. Periodic breathing can be a normal event.

Apnea of Prematurity (AOP) - Periodic breathing with Pathological apnea in a premature infant. AOP usually ceases by 37 weeks gestation (menstrual dating), but occasionally persists to several weeks past term.

Asymptomatic Premature Infants - Preterm infants who either never had AOP or whose AOP has resolved.

Symptomatic Premature Infants - Preterm infants who continue to have pathological apnea at the time when they would otherwise be ready for discharge

Apparent Life Threatening Event (ALTE) - an episode that is frightening to the observer and that is characterised by some combination of apnea, colour change, marked change in muscle tone (limpness), choking or gagging.

Apnea of Infancy (AOI) - An unexplained episode of cessation of breathing for 20 seconds or longer, or a shorter respiratory pause associated with bradycardia, cyanosis, pallor, and/or marked hypotonia. The terminology "apnea of Infancy" generally refers to infants who are greater than 37 weeks gestational age at the onset of pathological apnea. AOI should be reserved for those infants for whom no specific cause of ALTE can be identified.

Sudden Infantile Death Syndrome (SIDS) - the sudden death of any infant, which is unexplained by history and in which a thorough postmortem examination fails to demonstrate an adequate explanation of cause of death.

 

Should we be using an apnea monitor?

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