Sleep apnea in children: what is it and how to treat the pathology

Apnea in children can be a serious cause of sleep problems. This pathology often occurs in young children. However, sometimes older patients are also affected. To cope with the anomaly and avoid serious health consequences, you need to see a doctor and undergo a comprehensive examination.

The essence of the violation

This term refers to a child stopping breathing for at least 20 seconds. Also, the duration of the attack may be shorter, but additional manifestations occur - a significant slowdown in the heart rate, a decrease in the amount of oxygen in the blood.

It is worth considering that short pauses in breathing lasting 5-10 seconds are often observed in newborn babies. They also affect patients aged 3-6 years. The severity of the disorder directly depends on the maturity of the child’s body. The most common phenomenon is apnea in premature babies.

Classification and reasons

There are several types of pathology. Each of them is characterized by different development mechanisms and provoking factors.

Central apnea

This pathology is characterized by disruption of the functioning of the respiratory center. During an episode of apnea, the muscle tissues that are responsible for breathing do not receive the necessary impulse needed to move them.

The main causes of sleep apnea in children include the following:

1. Premature birth;
2. Birth injuries to the spinal cord or brain;
3. Low blood glucose;
4. Violation of gas exchange;
5. Infectious diseases of a viral or bacterial nature;
6. Epileptic seizures;
7. Taking certain medications;
8. Blood poisoning;
9. Electrolyte imbalance;
10. Bronchopulmonary dysplasia;
11. Arrhythmia;
12. Hyperbilirubinemia;
13. In some situations, idiopathic apnea is diagnosed. In this case, doctors cannot determine the exact cause of the problems.

Premature birth Birth injuries Epileptic seizures Infectious diseases Blood poisoning Bronchopulmonary dysplasia Arrhythmia Hyperbilirubinemia

Obstructive apnea

Respiratory arrests are caused by obstruction of the respiratory system. If the air flow is disrupted, a change in the movements of the chest is observed. The main reasons for this deviation include the following:

• Pathological increase in the size of the tongue;
• Delayed development of cartilage and bone tissue;
• Increase in the size of the tonsils;
• Cleft lip;
• Laryngospasm - accompanied by involuntary contraction of the muscles of the larynx;
• Excess weight;
• Congenital narrowing of the airways;
• Problems in the functioning of the posterior laryngeal muscle - may be caused by paralysis or traumatic injuries;
• Robin's syndrome - in this case, there is insufficient development of the lower jaw and tongue.

The obstructive form of the pathology can be observed in children of different ages. Most often, the anomaly is diagnosed at 2-8 years of age.

Mixed

Initially, central apnea occurs, but gradually obstruction of the airways develops. The main causes of pathology include the following:

1. Heart diseases;
2. Glucose and calcium deficiency;
3. Hypothermia and overheating;
4. The impact of alcohol and drugs that a woman takes during pregnancy.

This form of apnea occurs quite rarely, but it is very difficult to diagnose and treat.

Risk factors

There are certain factors that greatly increase the risk of apnea. The risk group includes children with an abnormal structure of the skull or internal organs.

Also, provoking factors include the following:

• Prematurity. In such children, the nervous and respiratory systems are not fully formed. After birth, babies are often placed in special incubators. This allows you to monitor the parameters of temperature, breathing, and pulse. Thanks to this, it is possible to protect the child from negative consequences and identify the causes of apnea.
• Deviations in the structure of the respiratory organs, nose, jaw. This can lead to air obstruction, which increases the likelihood of developing apnea.
• An increase in the size of the tonsils, the appearance of polyps and adenoids. All these formations lead to difficulties with air flow. If such anomalies are detected, you should immediately consult a doctor.
• Overweight. Sleep apnea is often caused by excess weight. Fatty tissue leads to compression of the pharynx, which leads to breathing problems.
• Deviations in the functioning of the cardiovascular and digestive systems. Apnea develops especially often in newborns with reflux.
• Mineral imbalance. Another common cause of respiratory arrest.
• Birth injuries and diseases, intracranial injuries, Down syndrome. Children with such pathologies are much more likely to experience symptoms of apnea.

Clinical picture

Any symptoms of apnea in children require attention from adults. The following signs indicate problems:

1. Uneven and intermittent breathing in a child, coughing, snoring and other sounds during sleep;
2. Increased sweating at night, which indicates discomfort;
3. Stiffness of the chest during inhalation;
4. Mouth breathing - this symptom is constantly present and indicates a lack of oxygen;
5. Unnatural body positions during sleep - this is due to the need to open the larynx as much as possible;
6. Difficulty swallowing food - this sign indicates the presence of barriers in the respiratory tract;
7. Enuresis at night is evidence of disturbances in the functioning of the nervous system.

Some people confuse apnea with periodic breathing, which is normal for babies younger than 6 months. The key difference is the duration of the attack. Periodic breathing is characterized by a pause of up to 10 seconds, and the baby himself is able to monitor the inhalations and exhalations.

Diagnostics

To identify problems, parents should monitor their child's sleep behavior. However, for a more accurate diagnosis, you should consult a doctor. Using special cameras and electrodes, the following parameters can be recorded:

• Electrical changes in brain cells;
• Activity of masticatory muscles;
• Duration of the rapid eye movement stage;
• Blood oxygen content;
• Frequency of breathing;
• Work of the heart;
• Respiratory flow activity.

Diagnostics must be carried out under the strict supervision of specialists. In addition, the baby should be examined by specialized doctors - a neurologist and an otolaryngologist. You may also need to consult an endocrinologist.

First aid

Prolonged episodes of respiratory arrest often lead to asphyxia, which poses a threat to the baby’s life. In such a situation, the speed and coordination of the parents’ actions influences the prognosis.

You should immediately call an ambulance in the following situations:

1. Reducing heart rate parameters to 90 beats;
2. Blue discoloration of the nasolabial triangle and limbs;
3. Involuntary drooping of limbs.

If the skin turns blue, a decrease in oxygen levels in the blood can be suspected. First, you should help the baby through tactile stimulation. To do this, it is recommended to run your finger along the back, massage the chest, limbs, and ears.

If these measures do not produce results, you should start artificial respiration:

• Place the child on a flat surface;
• Assess the condition of the respiratory tract, raise the chin, tilt the head back if the tongue sinks;
• Cover the baby's mouth and nose with your lips, firmly fixing the head;
• Inhale and 2 gentle blows lasting no more than 2 seconds;
• If there are no movements of the chest, the manipulation is repeated, changing the position of the head;
• If chest movements appear, you should try to feel the pulse - this is done above the elbow;
• If there is a pulse, continue manipulations.

If it is not possible to detect a pulse, you need to start cardiac massage. For this purpose, 2 fingers should be applied to the middle of the chest - this is done just below the nipples. Then you need to perform 5 sharp presses lasting 3 seconds. The chest should sag a couple of centimeters. After this, you need to alternate between 1 insufflation and 5 presses.

The listed manipulations should be performed before the ambulance arrives. If such symptoms of apnea appear, the child is subject to mandatory hospitalization.

Treatment methods

A little snoring is not harmful. In such a situation, it is recommended to follow a wait-and-see approach. Quite often, with the development of the skull bones and an increase in the lumen of the respiratory organs, problems disappear. However, doctors recommend polysomnography every year.

If the diagnosis is confirmed, active therapy is indicated. It is aimed at combating obstruction and insufficient ventilation of the airways. It is imperative to eliminate the causes that provoked the development of apnea.

Surgical intervention

This method of treatment is used when congenital or acquired pathologies of the respiratory system appear.

Common operations that are performed in this situation include the following:

1. Tonsillectomy – the indication for such an intervention is hypertrophy of the tonsils;
2. Correction of the nasal septum – used for its curvature;
3. Adenoidectomy – performed when the adenoids are significantly enlarged.

In difficult situations, the following types of interventions can be carried out:

1. Tracheostomy – indicated for obstructive pathologies and insufficient development of the respiratory tract;
2. Uvulotomy is the cutting off of the tongue.

The effectiveness of surgical treatment methods is at the level of 75-100%. One and a half months after surgery, respiratory functions are re-evaluated.

CPAP therapy

This is an effective way to treat sleep apnea in children. The essence of this technique is to constantly maintain high air pressure in the organs of the respiratory system. Thanks to this, it is possible to avoid vibration and collapse of their walls. The technique is used if there are no indications for surgery.

During therapy, the baby is put on a mask with a hose through which the air produced by the compress is supplied. The procedure must be permanent. The device is used during daytime and nighttime sleep.

The doctor selects the parameters of air pressure and humidity. This depends on the body weight and age of the patient. Parents should adhere to the specialist's recommendations. The duration of therapy can range from several months to several years. In particularly difficult situations, the device has to be used for life.

Unconventional methods

Such methods are most often used to treat apnea in children after one year, since most procedures cannot be performed on infants. It is worth considering that folk remedies should be used in addition to the main methods of treatment. This can only be done after consulting a doctor.

The most effective means include the following:

• Cabbage juice with honey. To prepare the drink, you need to dissolve a small spoon of honey in a glass of fresh juice. This remedy should be given to the child before bedtime. The course of treatment is 1 month.
• Moisturizing the sinuses. To do this, you should use a saline solution. Thanks to a simple procedure, it will be possible to clear the nose and respiratory tract of mucous secretions. For preparation, it is recommended to use sea salt: take 200 ml of warm water for 1 small spoon.
• Sea buckthorn oil. This product has pronounced bactericidal and wound-healing properties. To achieve good results, you need to inject 3-5 drops of the product into each nasal opening. This must be done before bed.

Cabbage juice with honey Salt solution Sea buckthorn oil

Possible consequences

If treatment is not started in time, apnea can provoke dangerous changes in the child’s body. Periodic pauses in breathing cause a lack of oxygen. Such attacks can be repeated from 5 to 100 times per night. The result is a fairly long period of oxygen starvation.

At this time, all internal organs experience hypoxia. And first of all, the functioning of the brain is disrupted. This entails the development of various anomalies and leads to dangerous diseases.

The main complications of apnea include the following:

1. Attention deficit disorder, hyperactivity. This condition is accompanied by problems with concentration, increased activity, and uncontrollability of the baby.
2. Hypertonic disease. When there is a lack of oxygen, the body's compensatory mechanisms are activated, which provokes increased blood circulation. This causes a periodic increase in pressure. Constant fluctuations in parameters provoke wear and tear of the heart muscle.
3. Arrhythmia. Nutrient deficiency in the heart leads to disruption of automaticity. This negatively affects the heart rhythm, which leads to the appearance of atrial fibrillation.
4. Heart diseases. In children suffering from apnea, the likelihood of developing ischemia and heart failure increases significantly. Against the background of these anomalies, the threat of strokes and heart attacks subsequently increases.

Stopping breathing during sleep causes chronic sleep deprivation. This causes daytime sleepiness, which significantly increases the likelihood of traumatic injury.

Prevention

To minimize the risk of apnea in a child, you should follow these recommendations:

• Stop smoking during pregnancy;
• Avoid using the pillow for children under 2 years of age;
• Make sure that the baby does not sleep on his stomach;
• Maintain the correct humidity and temperature parameters in the children's room;
• Monitor your child's breathing during sleep;
• If signs of apnea occur, consult a doctor immediately.

Apnea is a common problem that most often occurs in childhood. To cope with this disorder, you need to consult a doctor in a timely manner. The specialist will prescribe informative diagnostic tests and, based on their results, select adequate therapy.

Source: https://hrapguru.ru/lechenie/apnoeh-u-detej.html

Apnea in children: types and causes of the syndrome, first aid for attacks, treatment in hospital and at home

Childhood apnea often occurs after childbirth and may develop later in life. This leads to a lack of developmental dynamics, negatively affects the body’s structures, and in special cases threatens the child’s life.

What is an apnea attack?

The main cause of apnea in children born prematurely is the underdevelopment of the respiratory control center. This is a collection of cells of the nervous system - neurons that ensure the coordinated functioning of the respiratory muscles, adapting them to internal and external changes. As the nervous system develops, by 40-45 weeks, apnea attacks are eliminated in most cases.

In children born at full term, as well as those older than 1 year, apnea attacks mainly occur due to airway obstruction. This may be a consequence of congenital disorders and internal pathologies of the body. In these cases, careful monitoring and elimination of possible causes are required.

Particularly at risk are children with a gestational age of less than 34 weeks, weighing less than 2.5 kg, with birth injuries and congenital disorders of the central nervous system. The consequences of apnea attacks can be irreversible. Complete cessation of breathing disrupts the heart rhythm, which can cause death.

Types and causes of apnea

There are several types of apnea, which have different development mechanisms and causes that provoke episodes of respiratory arrest.

Central

Disturbance in the functioning of the central respiratory center. During an attack, the respiratory muscles do not receive impulses that stimulate their movement.

Causes:

• prematurity;
• brain and spinal cord injuries during childbirth;
• hypoglycemia (low blood glucose levels);
• hypoventilation of the alveoli of central origin (disorders of gas exchange);
• epilepsy;
• viral and bacterial infections;
• pharmacological drugs taken by the mother or child;
• anemia;
• arrhythmia;
• bronchopulmonary dysplasia;
• hyperbilirubinemia;
• electrolyte disturbances;
• sepsis.

Central apnea of ​​the idiopathic type is very rare. This diagnosis is made when it is impossible to determine the cause of the syndrome.

Obstructive

Attacks occur due to airway obstruction. The disruption of air flow is accompanied by characteristic movements of the chest.

Causes:

• macroglossia (abnormal enlargement of the tongue);
• laryngospasm (involuntary contraction of the muscles of the larynx);
• cleft lip;
• achondroplasia (slow growth of cartilage and bones);
• dysfunction of the posterior laryngeal muscle (injury, paralysis);
• enlarged tonsils;
• obesity;
• stridor (congenital narrowing of the airways);
• Robin's syndrome (underdevelopment of the tongue and lower jaw).

OA is observed in all age groups. The peak of the disease occurs between the ages of 2 and 8 years.

Mixed

Initially, central apnea appears, which develops into airway obstruction.

Causes:

• heart pathologies;
• overheating, hypothermia of the body;
• deficiency of calcium and glucose in the body;
• the influence of drugs and alcohol used by the mother during pregnancy.

This type of apnea occurs rarely, but is difficult to diagnose and treat.

Signs of sleep apnea in children

While holding your breath, short-term hypoxia develops, causing the child to suddenly wake up. This is accompanied by severe fear, which provokes a strong release of adrenaline into the bloodstream, which irritates the nervous system and disrupts sleep functions.

Characteristic symptoms of apnea:

• snore;
• lack of breathing for 10 seconds or more;
• mouth breathing;
• sweating;
• restless sleep;
• headaches during the day;
• decrease in development dynamics.

A child who is constantly sleep-deprived develops chronic fatigue and becomes moody and irritable. Appetite is impaired, weight and general activity decrease.

Episodes of apnea in many cases occur during REM sleep, which accounts for only 25% of the total time, and therefore often go unnoticed. Against this background, the main warning signs are snoring and disruption of the child’s behavior during the day.

From the video you can learn by what signs apnea can be recognized and why snoring during sleep is so dangerous.

Possible consequences

Regardless of the type of apnea, pathological changes occur in the child’s body. With periodic lack of breathing, oxygen deficiency occurs. Depending on the cause, such episodes can be repeated 5-100 times per night, which adds up to an impressive period of up to 4 hours.

All this time, the structures and organs of the body suffer from a lack of oxygen, and primarily the brain. This leads to pathological disorders in the body and the formation of serious diseases.

Complications of apnea:

• Attention deficit and hyperactivity.

This syndrome manifests itself in the child's difficulty concentrating, hyperactivity, impulsiveness and uncontrollability.

During oxygen deficiency, the body activates compensatory mechanisms, increasing blood circulation. This leads to an increase in blood pressure, which is periodic. Constant changes in rhythm lead to wear and tear of the heart structures.

• Lack of nutrition of the heart muscle disrupts automatism, which immediately affects the rhythm of heart contractions, and atrial fibrillation develops.
• A child with apnea has a high risk of developing coronary disease, heart failure, and against the background of these pathologies, heart attack and stroke.
• Chronic lack of sleep leads to daytime sleepiness, which significantly increases the rate of injury.

Diagnosis of the disease in infants

During the collection of anamnesis, the child’s behavior during sleep and during the day, the presence of chronic pathologies and hereditary diseases are clarified. An assessment is carried out to determine the degree of obesity, and the neck diameter is measured. After this, the child is examined by an otolaryngologist to determine possible pathologies of the ENT organs.

Polysomnography plays a major role in making a diagnosis. For this purpose, special equipment is used, which makes it possible to record all body functions that are significant for diagnosis during sleep.

The procedure combines:

• analysis of electrical processes in the brain;
• study of heart function;
• registration of eyeball movement;
• analysis of electrical activity of the chin muscles;
• pulse oximetry;
• respiratory flow data recording;
• control of chest movements;
• analysis of the child's behavior during sleep.

Detailed data allows obtaining electrodes attached to the patient's body and video recording cameras with infrared illumination. The procedure is carried out in a specialized medical institution under the constant supervision of medical personnel.

Treatment of newborn children in a hospital

Children with a gestational age of 28-37 weeks are placed in special incubators, where conditions similar to those in the womb are created for them. Children are monitored around the clock by neonatologists; special devices record all changes in their bodies. During episodes of apnea, doctors receive a signal through sensors and, depending on the situation, determine what type of help the baby needs.

Therapeutic assistance:

• Stimulation of the respiratory center.

In mild episodes of apnea, breathing is easily restored using tactile stimulation. These are light blows to the body with a finger, heels or back. Some hospitals have incubators with a vibration system.

For repeated and prolonged breath holdings, a ventilator (artificial lung ventilation) is used. For this purpose, special masks and bags are used.

This is oxygen inhalation, used for severe hypoxia in the child’s body.

• Pharmacological drugs.

Medicines are used for severely recurrent episodes of apnea without an identifiable cause. These are drugs from the methylxanthine group: theophylline and caffeine.

This is a helper method. It is used for obstructive or mixed apnea to prevent the collapse of the upper respiratory tract.

If there are no intraventricular hemorrhages, bronchopulmonary dysplasia and retinopathy, episodes of apnea in newborns generally cease by 36 weeks. If it is possible to monitor heart rate and respiratory rate at home, newborns are discharged. Monitoring is continued until 45 weeks, and if there are no respiratory arrests, it is stopped.

Treatment of apnea in childhood and school age

Once the diagnosis is confirmed, active treatment begins, which is aimed at eliminating obstruction and hypoventilation of the respiratory tract, eliminating the causes of apnea. Treatment for apnea depends entirely on the form of the syndrome and the cause of the respiratory dysfunction.

Surgical methods

Surgical correction of the problem is the first choice in the presence of congenital or acquired airway abnormalities.

Basic operations:

• tonsillectomy (for hypertrophy of the tonsils);
• adenoidectomy (removal of adenoids);
• correction of the nasal septum.

Rarely, only in extremely difficult cases:

• tracheostomy (for congenital and acquired obstructive anomalies, underdevelopment of the respiratory tract);
• uvulotomy (cutting off the tongue).

The effectiveness of surgical intervention is on average 75-100%. Breathing is re-evaluated 1-1.5 months after surgery.

CPAP therapy

The essence of this method is to constantly maintain increased air pressure in the respiratory tract. This prevents the walls of the airways from collapsing and vibrating. This method is used in the absence of indications for surgery.

During treatment, before bedtime, a mask is put on the child, combined with a hose through which the air produced by the compressor is supplied. It is important to adhere to continuous therapy, using the device during night and daytime sleep.

After interrupting the procedures, problems with holding your breath return within a few days. CPAP therapy allows you to eliminate the symptoms of apnea and prevent the consequences of hypoxia until the facial skeleton is fully developed.

The doctor regulates the humidity and air pressure based on the age and weight of the child. Parents need to fully adhere to these instructions and ensure that procedures are continued and correct. The duration of therapy varies from several months to several years. In difficult cases, the device will have to be used for the rest of your life.

First aid for episodes of apnea

You should urgently call an ambulance if your child:

• the limbs, the wings of the nose, the edges of the lips turned blue;
• heart rate below 90 beats per minute;
• legs and arms hang down involuntarily.

Blue discoloration (cyanosis) of the skin indicates a decrease in oxygen levels in the blood (asphyxia). First you need to try to help the child using tactile stimulation. This is running a finger along the back along the spine, massaging the ears, arms, legs and chest. If the measures do not help, begin artificial respiration.

To do this you need:

• place the child on a horizontal surface;
• check the airway, lift the chin and move the head back when the tongue sinks;
• wrap your lips around the baby’s nose and mouth, holding the head tightly;
• inhale half the volume and make 2 smooth inhalations with a duration of no more than 2 seconds;
• if there is no movement of the chest, repeat the procedure, changing the position of the head;
• after the chest begins to move, you should try to feel the pulse on the inside of the arm above the elbow;
• continue the procedure if there is a pulse;

If there is no pulse, begin cardiac massage. To do this, place 2 fingers on the middle of the chest slightly below the nipple line. After this, you need to press sharply 5 times within 3 seconds. The chest should bend by 1.5–2 cm. Next, alternate 1 inflation and 5 compressions.

Procedures continue until emergency doctors arrive. After such manifestations of apnea, hospitalization of the child is indicated.

Prevention

Nutrition should be balanced with a daily intake of vitamins and macroelements. It is important to think about the emotional background and try to avoid emotional stress.

For a child with apnea syndrome, it is necessary to provide conditions that reduce the risk of episodes of respiratory arrest.

Basic Rules:

• weight control;
• timely treatment of respiratory diseases, endocrine and neurological disorders, allergies;
• refusal to eat 3 hours before bedtime;
• preparing an optimal place to sleep (semi-rigid mattress, small pillow);
• sleep on your side, supporting the spine and head at the same level as possible;
• air humidification in the bedroom (optimum 50-60%);
• optimal physical activity with a predominance of aerobic exercise (cycling, running, swimming, sports games, walks in the fresh air).

The prognosis of actively developing apnea is not good; increasing clinical symptoms can lead to disability in adulthood.

The death rate for people with severe forms of the syndrome is 4.5 times higher than for healthy people. Therefore, the future health of the child depends entirely on the coordinated and correct actions of the parents, seeking medical help and fully supporting all the doctor’s recommendations.

Source: https://dozhdalis.ru/apnoe-u-detey.html

Apnea in children: causes and methods of treating pathology

Apnea syndrome in pediatrics is a condition in which during sleep in infants, infants, or older children after one year of age, breathing stops for more than 10 seconds. It is often accompanied by a decrease in heart rate, pallor or cyanosis of the skin. This syndrome can occur at any age. Apnea in newborns is one of the most common causes of sudden infant death syndrome.

Causes

Apnea in newborns and in older patients is caused by various etiological factors.

The most common causes of apnea in newborns are:

• Prematurity. A baby born before the 37th week of pregnancy differs from a full-term baby in the immaturity of the nervous and respiratory systems. The baby's respiratory centers are not yet formed, so premature infants experience central respiratory arrest.
• Anomalies of the development of the lower jaw. Too small a jaw (micrognathia), as well as anatomical disorders of its structure, can cause episodes of sleep apnea in children.
• Congenital malformations of the cardiovascular and nervous system. If there are abnormalities in the functioning of internal organs, tissue hypoxia occurs, which can provoke respiratory arrest during sleep.
• Injuries during childbirth. Intracranial and spinal injuries received during the passage of the birth canal disconnect the nerve connections between the respiratory center of the medulla oblongata and the respiratory tract receptors.
• The mother's use of drugs, certain medications, alcohol, and smoking during pregnancy. Scientific studies have shown that mothers who smoke during pregnancy have babies 3 times more likely to suffer from respiratory arrest. The negative role of narcotic and psychotropic drugs, sleeping pills, and alcohol is obvious. Penetrating through the placental barrier, substances prevent the maturation of the fetal nervous system and destroy it.

At older ages, sleep apnea is caused by:

• Obesity. Excess weight can cause sleep apnea. Fatty deposits that form in the soft palate, palatine arches, and uvula contribute to a narrowing of the lumen of the pharynx and a more pronounced collapse of the upper respiratory tract during sleep.
• ENT pathology. Enlarged adenoids, enlarged tonsils, and nasal breathing disorders create a mechanical obstacle to the passage of air during sleep and cause episodes of cessation of breathing.
• Endocrine disorders. Diabetes mellitus, hypothyroidism and other diseases of the endocrine system can provoke such episodes.
• Infections. Sometimes respiratory arrest in children can occur due to high activity of the infectious process in the body: against the background of sepsis, meningitis, necrotizing enterocolitis.
• Metabolic disorders. Electrolyte imbalance: hypomagnesemia, hypocalcemia, an increase in sodium and ammonium ions in the blood is another reason for the development of this syndrome.
• Exposure to certain medications. Sleeping pills and some antihistamines, which have a pronounced sedative effect, can cause apnea in children under one year of age.

Enuresis - what is it and how to get rid of bedwetting

Apnea from Fenistil, a popular antihistamine in drops, can occur in premature babies, as well as those younger than 1 month. Therefore, the drug is not recommended for use in infants.

Classification

According to the origin of sleep apnea, there are:

• Central. Central mechanisms are more typical for newborns, especially premature infants, and infancy. They can occur at any age with damage to the central nervous system, traumatic brain injury, or spinal injury. They are caused by depression or immaturity of the respiratory center, blockade of the passage of impulses from peripheral receptors to the brain.
• Obstructive. Occurs when there is compression or blockage of the upper respiratory tract. The obstructive type of apnea occurs with pathology of the ENT organs in childhood, obesity, lymphoproliferative diseases, tumors and cysts in the pharynx.
• Mixed. This species is characterized by signs of manifestations of the other two groups.

Development mechanism

During sleep, general muscle tone decreases, including the tone of the pharyngeal muscles. The lumen of the airways narrows somewhat even in healthy children, but this is not critical - these physiological phenomena do not interfere with the passage of air, and the quality of sleep does not suffer.

An excessive decrease in muscle tone in the structures of the upper respiratory tract or the presence of obstruction in them leads to complete collapse of the pharynx and the development of an episode of acute suffocation. It lasts from 10-30 seconds or more.

The oxygen concentration in the blood sharply decreases, the sympathetic nervous system is activated, and blood pressure increases. The stress response “awakens” the brain, which restores control over the pharyngeal muscles - inhalation occurs.

If the pathogenesis of the disorder is central, then there are no obstacles to the passage of air in children; the pathological process is localized in the central nervous system itself, which is not able to adequately control the act of breathing during sleep.

Clinical picture

The leading symptom of an episode of apnea is the absence of breathing and chest excursions for 10-15 seconds. In some cases, if the child’s breathing is accompanied by snoring, parents note episodes of its cessation, and after some time an increased resumption of the snoring sound. Such “silent” sleep episodes are apneas.

The longer the periods of respiratory arrest (up to 40-50 seconds), the worse the consequences for the body: episodes cause sudden death syndrome or cause brain damage due to prolonged hypoxia.

Such stops in respiratory activity can occur more than 100-150 times per night, their number and duration affect nighttime sleep, its phase, and the general condition of patients.

Other symptoms that may indicate this pathology are:

• Snoring in your sleep.
• Feeling lethargic and tired in the morning, despite the fact that the child slept a sufficient amount of time at night. Children are especially capricious and whiny in the morning after waking up.
• Tendency to fall asleep in the middle of the day, at school.
• Headaches in the morning.
• Increased irritability, restlessness, hyperactivity.
• Memory impairment, attention deficit.
• Bedwetting (enuresis).
• Increased motor activity during sleep.
• Teeth grinding (bruxism).
• Talking in your sleep.
• Delayed psychomotor development.

If alarming symptoms appear, parents should take their baby to a pediatrician for examination and treatment.

Treatment

All low birth weight preterm infants should be monitored for respiratory arrest episodes in the first 10 days by monitoring cardiac and respiratory activity around the clock and measuring blood oxygen levels using neonatal monitors. When stops are identified, their origin is determined; if these are secondary episodes, the cause of their occurrence should be eliminated if possible.

Methods of treating respiratory arrest in infants and older children are:

• Tactile stimulation method. The baby is placed on a rocking bed, an oscillating water mattress. Tactile stimulation is one of the first elements of emergency care when apnea occurs in a child at home.
• Creating pressure in the nasal passages. Breathing with nasal cannulas significantly reduces the incidence of apnea.
• Oxygen therapy. Special “head caps” and “funnels” are used to increase the concentration of O2 in the inhaled air.
• Drug therapy. Effective in some cases of development of pathology of central or mixed origin. Theophylline or caffeine, Etimizole, Pentoxifylline, Instenon are used exclusively on the recommendation of a doctor and in strictly prescribed dosages appropriate to the child’s age.

Primary resuscitation at home

• Parents whose children have had at least one episode of sleep apnea should know the algorithm of actions aimed at providing first aid for prolonged apnea.
• If there are two parents at home, it is necessary to distribute responsibilities: one calls for medical help, the other carries out resuscitation measures.
• If there is only one adult with the baby, calling paramedics should be carried out in parallel with emergency care.

The child should be placed on his back on a horizontal surface, and the oral cavity should be examined to avoid obstruction of the airways by a foreign object. If no foreign objects are found in the mouth, you should quickly carry out tactile stimulation: shake the child, pinch, mechanically rub the ears, palms, feet.

If even after these manipulations the patient’s breathing has not been restored, it is necessary to begin cardiopulmonary resuscitation: perform artificial respiration while simultaneously performing chest compressions. As soon as the episode of prolonged apnea has passed, you should call an ambulance and clearly report what happened.

Source: https://neuromed.online/apnoe-u-detey/

Sleep apnea in children: symptoms, causes, types, possible dangers, treatment, prevention

Apnea syndrome is a pathology characterized by short-term cessations of breathing lasting more than 10-15 seconds. As a rule, this phenomenon is observed during night sleep, and the frequency of occurrence can reach 100 stops per hour .

Sleep apnea in children is a potentially dangerous condition that leads to neurological problems, heart disease, pathologies of the respiratory and endocrine systems, and in some cases, death.

Causes

The following conditions can cause sleep apnea:

• injuries and tissue damage to the brain and spinal cord;
• primary failure of the respiratory center;
• structural features of the bones of the skull and jaw (short neck, small lower jaw, narrow nasal passages);
• hypertrophy of the soft tissues of the palate (increase in the size of the tonsils, palatine tongue);
• underdevelopment of the laryngeal muscles;
• disorders of the upper respiratory tract caused by inflammatory and tumor processes;
• obesity;
• diseases of the endocrine and cardiovascular systems;
• metabolic disorders (primarily glucose, calcium, magnesium and amino acids);
• systemic infections (meningitis, septicemia, pneumonia);
• autoimmune pathologies;
• overheating, hypothermia.

Those at risk for the syndrome include:

• people with a hereditary predisposition to sleep apnea;
• premature babies;
• children with congenital abnormalities that are accompanied by changes in the nervous system and maxillofacial anatomy (Down syndrome, “cleft lip”);
• infants suffering from gastrointestinal diseases and reflux;
• crumbs that appeared during complicated childbirth, triggered by injury or prolonged hypoxia.

Most often, pathological respiratory arrests during sleep are observed in children under one year of age.

Kinds

Apnea is classified according to its etiology. There are three types of syndrome:

1. Central. It is provoked by primary and secondary disorders of the central nervous system (less commonly, the spinal cord). Most often, this type of pathology affects children who have suffered brain injuries, have genetic diseases and were born before 34 weeks (due to underdevelopment of the nervous system).
2. Obstructive. Stopping breathing in obstructive apnea syndrome is caused by obstacles to the passage of air through the nasopharynx. The cause of narrowing of the airways may be the specific anatomy of the jaw or nasal passages, neoplasia, macroglossia (large tongue size), hypertrophy of the palatal tissues, inflammation of the tonsils and adenoids, and an increase in fat in the laryngopharynx area . Obstructive syndrome is more common in adult patients.
3. Mixed. Occurs in the presence of several predisposing factors. Disorders of the nervous system in this case are usually secondary and associated with pathologies and defects of internal organs or systemic infections.

The most favorable prognosis is typical for obstructive apnea. When mechanical obstacles to the passage of air are removed, breathing stops stop.

Symptoms

In order to promptly detect apnea and prevent dangerous complications, you need to know the signs of apnea and the rules of first aid. Parents should be wary if their child exhibits the following symptoms:

• chest immobility for 10 seconds or more;
• the habit of breathing through the mouth in the absence of nasal breathing problems (for example, a runny nose);
• bruxism (grinding of teeth during night sleep);
• cyanosis (blue discoloration of the skin caused by hypoxia);
• shortness of breath, whistling, coughing, snoring accompanying breathing during sleep;
• daytime drowsiness, lethargy;
• in newborn babies - breast refusal;
• restless sleep, frequent awakenings and active movements during rest;
• profuse night sweats;
• in children over 5 years old - frequent urge to urinate (more than 2 awakenings per night) or, on the contrary, too deep sleep, causing urinary incontinence (enuresis).

In addition to external symptoms, you need to pay attention to the child's heart rate (pulse). A decrease in heart rate in combination with other suspicious signs is a reason to diagnose apnea.

The lower limit of a child's normal heart rate during sleep is:

• up to 1 year - 90 strokes;
• from 1 to 2 years - 80 strokes;
• from 3 to 5 years - 65 strokes;
• from 6 to 11 years - 58 strokes;
• over 12 years old - 50 strokes.

Apnea most significantly affects the course of rapid eye movement (REM) sleep, so it is best to monitor symptoms in the pre-dawn hours, when the duration of the REM phase is maximum. If one or more signs of the syndrome are detected, you should immediately contact your local pediatrician.

Complications and consequences of sleep apnea

Lack of maintenance therapy is dangerous for the child's life.

Some researchers have suggested a relationship between sleep apnea and sudden infant death syndrome in children younger than 1 to 2 years of age.

An increased risk of death is not the only complication of the pathology. Possible consequences of oxygen deprivation during sleep also include:

• neurological disorders;
• deterioration of concentration and memory;
• problems with socialization (for example, with enuresis);
• frequent nightmares, dyssomnia;
• arrhythmia;
• heart failure;
• loss of strength, apathy;
• increased blood pressure.

Diagnostics

Diagnosis of sleep apnea in children includes the following steps:

• taking anamnesis;
• consultation with a pediatrician, neurologist, otolaryngologist, dentist, somnologist, cardiologist and other specialized specialists;
• polysomnography or cardiorespiratory study to determine sleep structure, respiratory activity, heart rate, blood oxygen saturation, number and duration of breathing pauses during sleep;
• differential diagnosis of the causes of sleep apnea (endoscopy of the upper respiratory tract, MRI, blood biochemistry).

First aid

If several symptoms of apnea are detected in an infant, breathing has stopped for more than 30 seconds in a child of any age and there is no response to attempts to wake up, you should immediately call an ambulance.

First aid for apnea includes the following actions:

• take the child in your arms and gently wake him up, if he does not wake up, shake him;
• lightly stroke the back and feet from top to bottom;
• vigorously rub the area of ​​the ears, sternum and limbs;
• splash cool water on your face.

If primary measures are ineffective, the child must be given artificial respiration and closed cardiac massage before the arrival of the medical team.

Treatment

The following methods are used to treat sleep apnea:

1. Surgical. Obstacles to air flow in the respiratory tract are surgically removed. For this purpose, tracheostomy, strengthening of the soft palate, removal of tonsils and adenoids, correction of the nasal septum, excision of polyps and other tumors can be performed.
2. Mechanical. With the help of special devices (mouth guards), the position of the lower jaw changes and the airways are cleared .
3. Medication. Medicines are used to eliminate the root cause of obstructive apnea (for example, chronic inflammatory process) and to treat central and mixed syndrome. For the central etiology of respiratory disorders, long-acting theophyllines (Retard), stimulants of blood circulation in brain tissue (Cinnarizine) and weak sedatives (Valerianahel) are prescribed.
4. CPAP therapy. To prevent hypoxia, a special device is used that supplies air under pressure into the respiratory tract, preventing narrowing of the laryngopharynx.
5. Diet therapy and correction of sleep patterns. Stabilizing the daily routine and nutrition can be used both for weight loss and for normalizing the child’s general condition.

In severe cases of the syndrome, accompanied by prolonged cessation of breathing, the patient can be connected to a ventilator until the condition stabilizes.

Prevention

To prevent apnea syndrome it is necessary:

• promptly treat inflammatory diseases of the nasopharynx;
• minimize the risk of facial injuries and compensate for existing defects using methods suggested by the doctor;
• monitor the child’s diet and daily routine;
• avoid overheating and hypothermia (room temperature should be 20-22 ℃);
• select a sleeping place according to the child’s age (up to 2 years of age, it is recommended to abandon pillows and install a crib within the reach of parents);
• Do not place newborns on their stomachs.

Maintaining a healthy lifestyle during pregnancy and after giving birth also reduces the likelihood of developing sleep apnea.

Source: https://faza-sna.com/deti/terapiya-apnoe