What Is Pediatric Central Sleep Apnea?

There are several clinical presentations of CSA, including periodic breathing, apnoea, snoring, gasping, hyperactivity restless sleep, and daytime sleepiness. 

The prevalence of Central sleep apnoea (CSA) in healthy children is thought to be about 4–6%. 

The classification of CSA can be depending on the hypercapnia or no hypercapnia based on CO2 level in the wakefulness stage and physiologic, idiopathic, or secondary CSA with the underlying disease condition. 

In healthy children CSA is rare but if happened needs extensive investigation to find out the exact underlying condition and also offer treatment accordingly.

Untreated sleep apnea leads to long periods of disturbed sleep resulting in chronic daytime fatigue. Some children also develop hyperactivity, causing them to be misdiagnosed as attention deficit/hyperactivity disorder (ADHD).

Causes of pediatric central apnea

  • Intracranial malformation
  • intracranial tumor
  • Prader-Willi syndrome
  • Down syndrome
  • Epilepsy
  • Spinal injury
  • congenital hypoventilation syndrome
  • central nervous system disease
  • Traumatic brain injury and drug poisoning etc.

Diseases in the central nervous system, such as viral encephalitis, bacterial encephalitis, and tuberculous encephalitis damage the child's respiratory center.

For newborn babies, usually due to premature birth or low birth weight, the child's respiratory center is not fully developed, and the lungs are not fully developed, which leads to central apnea in the child. As the child's age gradually increases and the child's respiratory system gradually matures, the symptoms of apnea will gradually improve.

Therapy

Whole night polysomnography is the standard test for the diagnosis of central sleep apnoea in children. Five central events per hour are considered clinically significant.

The doctor will make a diagnosis based on the examination of the young child and give a suitable treatment plan. For example, neurodevelopmental assessments, endocrine tests, genetic tests, echocardiograms, etc.

Long-term apnea and hypopnea may have adverse effects on children's intelligence, growth, and development.

For intracranial malformations or tumors, neurosurgery is the first choice when surgical treatment options are available. If surgery is not possible due to physical conditions, or for Prader-Willi syndrome, Down syndrome, and congenital hypoventilation syndrome, CPAP machine-assisted treatment can be selected. Generally, a positive airway pressure machine is used after falling asleep at night and does not need to be used during the day.