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From apnea of infancy to obstructive sleep apnea syndrome in the young child
1Stanford University Sleep Research Center, Calif.
Insights
Infants experiencing apparent life-threatening events (ALTE) may develop obstructive sleep apnea syndrome (OSAS). Early recognition through snoring and breathing effort monitoring is crucial for timely intervention.
Area of Science:
- Pediatrics
- Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea syndrome (OSAS) and snoring are well-documented in children and adults.
- Apparent life-threatening events (ALTE) in infants can present with complex respiratory symptoms.
Purpose of the Study:
- To identify a subgroup of infants presenting with ALTE who subsequently develop obstructive sleep apnea syndrome (OSAS).
- To explore early diagnostic markers and potential causes of OSAS in infants with ALTE.
Main Methods:
- Prospective case series of 25 infants with ALTE, followed for OSAS development.
- Comparison with two other ALTE infant groups with short-lived symptoms.
- Utilized esophageal pressure monitoring (Pes) and nasal continuous positive airway pressure (CPAP) as diagnostic aids.
Main Results:
- All 25 index cases were diagnosed with OSAS by age five.
- Index cases showed a higher incidence of family history of OSAS and early snoring.
- Pes measurements suggested increased respiratory effort during sleep in index cases.
Conclusions:
- A subset of infants with ALTE may represent an early manifestation of OSAS.
- Early snoring, family history, and increased respiratory effort (Pes) are potential indicators.
- Anatomical factors contributing to upper airway resistance may underlie infant OSAS.
Abstract:
Obstructive sleep apnea syndrome (OSAS) and heavy snoring during sleep, without sleep apnea, has been well described in children and adults. We report a case series of 25 full-term infants, prospectively obtained from a database of nearly 700 "apparent life-threatening event" (ALTE) cases, who presented between 3 weeks and 4 1/2 months of age an ALTE and who progressively developed more florid symptomatology and polygraphic findings. All of them were classified as OSAS patients by five years of age. These index cases are compared with two other ALTE infant groups followed in parallel during the first year of life but whose symptoms were short-lived. The index cases presented more frequently a positive family history of OSAS and an early report of snoring or noisy breathing during sleep. Usage of an esophageal balloon to monitor esophageal pressure (Pes) and usage of nasal continuous positive airway pressure (CPAP) as a test may help in the early recognition of these infants, who appear to make more effort to breathe during sleep, based on the indirect evidence of Pes measurements. It is suggested that anatomic features, including a small posterior airway space leading to an abnormal degree of upper airway resistance, may be the cause of the symptoms presented by these infants. Considering the parental anxiety generated by persistence of symptoms after the first year of life in ALTE infants, recognition of this subgroup is important.