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Mechanisms of obstructive sleep apneas in infants
A Kahn1, J Groswasser, M Sottiaux
1Pediatric Sleep Unit, University Children's Hospital, Brussels, Belgium.
Insights
Infants with obstructive sleep apnea experience breathing difficulties during sleep and feeding. Risk factors include prematurity, male sex, excess weight, and airway abnormalities.
Area of Science:
- Pediatrics
- Sleep Medicine
- Otolaryngology
Background:
- Infants with obstructive sleep apnea (OSA) exhibit symptoms like snoring, labored breathing, and sweating during sleep.
- During wakefulness and feeding, affected infants may show breath-holding spells and impaired breathing/swallowing coordination.
- Associated issues include poor weight gain, growth difficulties, and recurrent ear infections.
Purpose of the Study:
- To describe the clinical characteristics and contributing factors of obstructive sleep apnea in infants.
- To elucidate the physiological mechanisms and anatomical correlates of upper airway obstruction during sleep in infants.
Main Methods:
- Cinefluoroscopy was used to visualize airway dynamics during sleep apneas.
- Analysis of sleep stages (REM, NREM) and arousal patterns associated with obstructed breathing.
- Review of associated conditions, anatomical abnormalities, and environmental factors.
Main Results:
- Cinefluoroscopy revealed approximation of tongue and hypopharyngeal tissues, obliterating the airway space during apneas.
- Obstructed breaths predominantly occurred during REM and light NREM sleep, linked to reduced total sleep time and frequent arousals.
- Obstructive sleep apnea is more prevalent in preterm infants, term neonates, males, and infants with excess body weight.
Conclusions:
- Obstructive sleep apnea in infants is multifactorial, involving upper airway anatomical abnormalities, impaired neuromuscular control, and superimposed factors.
- Risk factors include prematurity, male gender, obesity, congenital anomalies, and certain genetic syndromes.
- Environmental influences such as sleep position and sedative use can exacerbate airway obstruction.
Abstract:
During sleep, infants with obstructive sleep apneas are characterised by snoring, laborious breathing, and profuse sweating. During wakefulness, they may have breath-holding spells, and during feeding, difficult breathing and swallowing coordination. Abnormal weight, difficult growth, and recurring ear infections may also develop. During sleep apneas, cinefluoroscopy shows approximation of tongue and hypopharyngeal tissues, with an obliteration of the air space. The obstructed breaths occur mainly in REM, and light NREM sleep, associated with total short sleep time, and frequent arousals. Preterm infants, and term neonates are more prone to obstructive apneas than older healthy infants. Apneas are more frequently seen in boys and in case of excess in body weight. Obstructive apneas are frequently associated with upper airway anatomic abnormalities: malformations, soft tissue infiltration, and neurologic lesions impairing muscle contractions. Alterations of the autonomic nervous control may induce airways obstructions. Contributing factors include mucopolysaccharide storage disease, hypothyroidism, or Down's syndrome. Superimposed factors may occur, such as nasal obstruction, secretions in the airways, or tissue edema. Pressure- and chemo-sensitive reflexes may also favor obstruction. Environmental factors also contribute to the development of sleep apneas: body position, neck flexion, sleep deprivation, or the effects of sedative drugs.