Respiratory pauses and apnea during daytime sleep in normal infants during the first year of life: Longitudinal observations

Abstract

Respiratory pauses (3–10 sec in duration), apnea (>10 sec in duration), and periodic respiration observed in thoracic respirograms were measured in 226 polysomnograms obtained on 17 normal infants during the first year of life. All subjects had one or more respiratory pauses in a majority of recordings; 35% had respiratory pauses in all recordings; 75% of respiratory pauses were associated with body movement. There is marked intersubject and even intrasubject variability in respiratory pause rates. The range of mean respiratory pause rates among subjects was 2.0–14.4/h, and for single recordings was 0.0–43.6/h. Their occurrence was directly related to the occurrence of periodic respiration. Rates were higher during REM and indeterminate sleep than during slow wave sleep. There was no significant trend toward increase or decrease in respiratory pause rate during the first year post term. Apnea occurred in only one of the 226 recordings (0.4%). Periodic respiration occurred in 8 of 17 subjects (47%), and in 25 of 226 recordings (11%). Its occurrence was unrelated to sleep stage. The following conclusions are considered valid on the basis of the data presented and reports in the literature: (1) Rates of respiratory interruption are higher before than after 40 weeks conceptional age. (2) There is considerable intersubject variability in rates of respiratory interruptions. (3) Respiratory pauses are common during sleep in normal human infants. (4) Respiratory pauses occur more frequently with movements than in their absence. (5) Respiratory pause rates are higher during REM sleep than during slow wave sleep. (6) Apneas of greater than 10–15 sec duration do occur in normal infants, but are rare. From the clinical viewpoint, respiratory pauses (<15 sec) of the central type, regardless of abundance, and periodic respiration cannot by themselves be used as evidence that a baby is at risk of anything. The occurrence of apneas (>15 sec duration), especially if any are of the obstructive or mixed types (and perhaps respiratory pauses of the obstructive and mixed types), and/or if associated with bradycardia or decrease in oxygen saturation, indicate sleep apnea syndrome and suggest risk of sudden infant death.