Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sudden infant death syndrome (SIDS) is diagnosed by the absence of lethal autopsy findings, or in a resuscitatable, "near miss" form with cyanosis, apnea, and bradycardia. The event is unexpected, although a minor respiratory infection is common, and occurs during sleep, between 1 and 6 months of age. There is growing evidence that the victims have had previous hypoxic episodes. Although suffocation is no longer considered a tenable explanation, other forms of airway obstruction are still postulated by many; the evidence, however, favors hypoxia as the common feature. A lethal arrhythmia had been proposed by several groups, based on inappropriate reflex activity, "pathology" of the conduction system, and the long QT syndrome, but the evidence is against arrhythmia as the primary event in most cases of SIDS. Based on the reversible "near miss," apnea is likely as the primary event in SIDS. Several reflexes have the ability to produce apnea, in addition to the relatively common sleep apnea; the crucial aspect, rather, appears to be thefailure of the immature infant to resume respiration. The possibility exists that the infant, who did not have to breather for 9 months of fetal life, literally is not alarmed and aroused by the persistance of apnea. In human and animal studies, respiratory infections and sleep deprivation have been proved to increase the likelihood and duration of sleep apnea. If primary apnea continues for long (45 seconds or more), a dangerous positive feedback develops into hypoxic apnea. Hhis will persist until circulatory failure occurs, or until gasping occurs. The gasp is a highly effective mechanism at birth, but will occur too late for autoresuscitation after the anerobic capacity of fetal life dimineshes; we believe this capacity lasts for approximately 1 month, accounting for the hiatus of crib death, sparing the first month. The "near-miss" infant, after resuscitation, should be monitored at home, if practical, until 6 months of age. A simple cardiac monitor for bradycardia has definite advantage over an apnea monitor alone.
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PMID:Sudden infant death syndrome (crib death). 1 76

When deaths during the first year of life are sudden, unexpected, and unexplained by any clinical or routine postmortem finding, they are placed in the category of sudden infant death syndrome (SIDS). The syndrome may have many causes, but there are probably only a few final pathways to death. Much recent evidence supports sleep apnea as the most common of these final pathways. Several SIDS victims have had reccurent episodes of sleep apnea prior to death. Such episodes are associated with chronic underventilation of the lungs in other disorders, and more than half of SIDS victims have postmortem markers of antecedent chronic underventilation and hypoxemia. The hypoventilation-apnea hypothesis is also attractive because it fits most of the unique epidemiologic features of SIDS.
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PMID:The sudden infant death syndrome: a review of recent advances. 32 36

The carotid bodies of four infants who died of sudden infant death syndrome (SIDS) were compared, using electron microscopic techniques, with the carotid bodies of various control subjects. In the SIDS patients, there was a marked reduction or absence of the dense cytoplasmic granules of the carotid chemorecptor cells, as well as a reduction in cell number and size. These ultrastructural abnormalities may be pathophysiologically related to SIDS. A defect in this respiratory control organ could block normal stimulation of respiration during the periods of hypoxia that occur during episodes of sleep apnea in infancy. Further studies by electron microscopy are required to confirm degranulation of the carotid body as a pathognomonic sign of SIDS. Screening of high-risk infants should be directed at studying the carotid body and its mediated responses to hypoxia.
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PMID:Ultrastructural abnormalities of the carotid body in sudden infant death syndrome. 44 Jul 89

This study examines the relationships between neonatal sleep respiratory instability and infant development. A group of 122 full-term healthy infants was observed during a nap within the first and fourth weeks of life. During each nap, a continuous polygraphic recording was obtained of respiratory activity and extraocular movements. The relative frequency and average duration of apneic pauses (greater than or equal to 2 sec) in each testing session for an infant were employed to calculate a measure of respiratory instability (PSA4) previously found to be related to the occurrence of prolonged sleep apnea. 28 of the infants in this study were maintained at home on apnea monitors. The Bayley Scales of Infant Development were administered to each infant at approximately 9 months of age. Comparisons of infants with high versus low PSA4 values and of monitored versus unmonitored infants were not strongly distorted by imbalances in birth weight, sex, race, birth order, method of feeding, Sudden Infant Death Syndrome (SIDS) sibship, parental education, age at developmental assessment, and developmental tester. Those with increased respiratory instability (PSA4 greater than or equal to -0.04) within the first week of life averaged significantly lower in mental and psychomotor development. Utilization of home apnea monitors was not significantly associated with developmental scores.
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PMID:Neonatal respiratory instability and infant development. 48 89

The purpose of this study was to evaluate the effectiveness of home management of life-threatening apnea in infants with near-miss sudden infant death syndrome (SIDS). A total of 84 infants were monitored with apnea monitors for an average of seven months (range 1 to 27). A group of 27 infants had episodes of apnea requiring resuscitation during home monitoring, all of whom were successfully resuscitated by their parents on at least one occasion using bag and mask resuscitation, and 17 infants required more than one resuscitation. Subsequent resuscitation was unsuccessful with four infants. Infants who experienced more than ten episodes of prolonged sleep apnea (apnea longer than 20 seconds) during home monitoring had a significantly increased risk of requiring resuscitation than other infants being studied. With the use of home monitoring of these infants and parents trained in cardiopulmonary resuscitation, the survival rate was 93.4%.
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PMID:Care of infants with near-miss sudden infant death syndrome. 66 74

Infants who died of SIDS in Onondaga County (New York) were classified into a Nasopharyngitis Group (N = 59) or a No Nasopharyngitis Group (N = 57) on the basis of symptoms, within one week prior to death, referable to the upper respiratory tract. Examination of the postnatal age of death revealed that infants in the Nasopharyngitis Group tended to be older than those in the No Nasopharyngitis Group. These results are consistent with a prediction derived from the hypothesis that prolonged sleep apnea is part of a pathophysiologic process resulting in SIDS.
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PMID:Nasopharyngitis and the sudden infant death syndrome. 90 17

Recent awareness of the magnitude of sudden unexplained deaths in apparently healthy infants has lead to an increased interest in those circumstances that are associated with or can elicit prolonged and serious apneic episodes. In the present studies, attention was directed toward the study of physiologic activity during sleep and feeding. Apneic episodes of varying durations occur during sleep which, in some instances, can be of sufficient length to warrant resuscitative intervention. A number of infants also reveal transient upper airway obstruction following brief periods of sleep apnea. This functional airway obstruction produces sudden and severe bradycardia. Similarly, infant feeding can induce dangerously prolonged periods of apnea and, in some infants, transient airway obstruction. Few detailed studies have been performed to identify the anatomical level or characteristics of the obstruction. Available evidence suggests that this can take the form either of muscle hypotonicity or hypertonicity. Two infants observed by means of direct laryngoscopy revealed transient failure of vocal cord abduction. These results have provided for the development of two theoretical models that can result in the sudden infant death syndrome; furthermore, continuous recordings of respiratory and cardiac activity during feeding and sleep can be extremely valuable in elucidating the mechanisms responsible for the sudden development of apneic and cyanotic episodes in infants.
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PMID:Apnea and airway obstruction during feeding and sleep. 95 47

The effect of nasopharyngitis on the simultaneous occurrence of prolonged sleep apnea (greater than or equal to 20 seconds in duration) was studied in 26 infants managed at home on an apnea monitor. During the observation period, these infants had a total of 69 illnesses which appeared to represent an upper respiratory tract inflammatory process. In general, the daily frequency of prolonged apneic episodes was significantly greater during nasopharyngitis when compared to comparable time intervals immediately prior to and following the illness. In addition, there was a decrease in the frequency of apneic episodes with increasing postnatal age until the episodes finally ceased to occur during the illness-related intervals. Apneic episodes ceased to occur at an earlier age for the before- and after-illness intervals than for the time interval during which there were clinical symptoms. Thus, it would appear that infants go through an age-related phase wherein prolonged apnea occurs during nasopharyngitis but not when free of illness. The implications of these results for the management of infants having prolonged sleep apnea are discussed. In view of the hypothesis that prolonged sleep apnea is part of the physiological process resulting in the sudden infant death syndrome, these results also provide for the prediction that infants who suddenly die in association with nasopharyngitis would do so, in general, at a later age than those who succumb when free of an upper respiratory tract inflammatory process.
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PMID:Nasopharyngitis and prolonged sleep Apnea. 119 64

Periodic breathing (PB) is a pattern of breathing that is frequently recognized in infants being studied for possible sleep apnea. Infants presenting to a sleep laboratory over a 3 1/2-year period who had evidence on their initial study of prolonged (greater than 15% of total sleep time) PB were prospectively studied in an effort to determine the significance of this pattern of breathing. Of the 331 infants studied, 40 demonstrated prolonged PB. Sixteen of these infants, who were of 37 weeks' gestation or greater at birth and did not receive pharmacologic therapy, were studied on at least two occasions (group 1). Of the remaining 24 infants, 11 were treated with methylxanthines by their attending physician (group 2), and 13 did not return for sequential studies (group 3). All infants who were of less than 37 weeks' gestation at birth were separately evaluated (group 4). For group 1, who were studied at a mean age of 15 postnatal weeks, there was a mean of 36.4% periodicity which decreased on the second study to 18.0%. By the fourth study, this had decreased to 9.2%. In group 2, there was a mean of 41.3% periodicity during the first study which decreased to 6.4% on the second study. Infants of group 3 had a mean of 31.4% PB on their initial study and the premature infants, group 4, had 30.1% PB. All infants showed a decrease in PB with sequential studies and no infant was known to have died of sudden infant death syndrome or any other disorder in the first year of life.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prolonged periodic breathing: significance in sleep studies. 174 Dec 21

Near miss events or apparent life threatening events (ALTE) are considered preliminary stages of sudden infant death syndrome (SIDS). The current definition of near miss SIDS postulates that such an event happens unexpectedly and that no life threatening cause of disease can be detected. However in 32 of 34 observations of ALTE pathological changes actually could be identified by through investigations: 11 central nervous diseases, 10 respiratory tract disturbances, 5 metabolic abnormalities, 5 disturbances of the digestive tract and 1 cardiac disease. There were 22 morphologically manifested causes as opposed to 10 functional failures mainly respiratory control and oesophageal disturbances. Irrespective of the main diagnosis sleep apnea syndrome (SAS) could be detected in 17 of 28 infants combined with bradycardia in 5 cases, and oesophageal disturbances in 16 of 17 infants. Four babies later died, two of them suffered from carnitine deficiency and one from organic acidopathy. It is our conclusion that numerous, even banal causes of disease are able to trigger ALTE if there is a coincidence with phases of increased instability of vital regulatory mechanisms of autonomous centres in infants.
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PMID:Factors involved in the pathogenesis of unexpected near miss events of infants (ALTE). 208 4


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