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Brief airway obstructions during sleep in infants with breath-holding spells
A Kahn1, E Rebuffat, M Sottiaux
1Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Belgium.
Insights
Infants experiencing breath-holding spells often have underlying sleep breathing issues, including airway obstructions and altered sleep patterns. These findings suggest an immature breathing control system may be the root cause.
Area of Science:
- Pediatrics
- Sleep Medicine
- Neonatology
Background:
- Breath-holding spells are common in infants.
- The underlying causes, particularly related to sleep breathing, are not fully understood.
Purpose of the Study:
- To investigate if infants with breath-holding spells exhibit breathing disorders during sleep.
- To compare sleep patterns and breathing characteristics between infants with and without breath-holding spells.
Main Methods:
- Compared 71 infants with breath-holding spells to 71 age-matched controls.
- Utilized overnight sleep monitoring and analyzed sleep stages, arousals, and apneas.
- Assessed airway obstruction, snoring, sweating, and response to ocular compression.
Main Results:
- Breath-holding infants showed less stage III sleep, more indeterminate sleep, increased arousals, and more sleep-stage changes.
- Airway obstructions were more frequent and longer-lasting in breath-holding infants.
- Infants with breath-holding spells exhibited increased sweating and water evaporation.
Conclusions:
- Infants with breath-holding spells frequently have sleep-disordered breathing, particularly airway obstructions.
- These findings suggest a common immature breathing control mechanism underlies both breath-holding spells and sleep breathing issues.
Abstract:
We investigated the possibility that infants with breath-holding spells have breathing disorders during sleep. Seventy-one breath holders with a median age of 14 weeks were selected from a well babies clinic because of their histories: 34 infants without loss of consciousness, and 37 with loss of consciousness (21 of the latter had had cyanotic spells, 14 pallid spells, and 2 combined cyanotic and pallid spells). For each breath holder, one control infant without a history of breath holding was chosen from the same clinic. All infants were healthy and had no known cause of disrupted breathing during sleep. Their histories indicated that the breath holders were covered with sweat during sleep (p = 0.005) or wakefulness (p = 0.006) significantly more often than were the control infants. The infants were studied during a one-night monitoring session, and the 142 sleep recordings were analyzed without knowledge of the history. The breath holders had significantly less nonrapid eye movement (stage III) sleep, more indeterminate sleep, more arousals, and more sleep-stage changes than the control infants had. Central apneas were evenly distributed in the two groups. Airway obstructions were found in 41 breath holders and six control infants; the obstruction lasted longer in the breath holders. The infants with airway obstruction during sleep snored more often (p = 0.023) and sweated more (p = 0.035) during sleep. The water evaporation rate, measured on the forehead with an evaporation meter, was significantly greater in the breath holders (p = 0.001). Ocular compression induced longer asystoles in the infants with pallid syncopes than in either those with cyanotic syncopes (p = 0.036) or those without loss of consciousness (p = 0.031). We conclude that the obstructed breathing during both wakefulness and sleep could be related to a common immature breathing control.