Sleep Apnea in Premature Babies & Preemies

Apnea of prematurity (AOP) – the clinical term for sleep apnea in premature babies – is a medical condition in which babies born earlier than the typical gestational period experience episodes of stopped breathing.

According to Pediatrics, the official journal of the American Academy of Pediatrics, apnea of prematurity is a sudden stop in breathing “that lasts for at least 20 seconds or is accompanied by bradycardia or … cyanosis … in an infant younger than 37 weeks’ gestational age.”¹ (Bradycardia means a slow heart rate; cyanosis is a blue or purple tone to the skin caused by lack of oxygen).

Apnea of prematurity: What we know

According to the website for Children’s Healthcare of Atlanta, sleep apnea in premature babies is common. “Premature infants, particularly those born more than seven weeks early (before 32 weeks of pregnancy), often have apnea,” the website states.

And the Apnea-of-Prematurity Group, a fellowship of physicians vested in research about sleep apnea in premature babies, have written in Pediatrics that apnea of prematurity “is the most common and frequently recurring problem in very low birth weight infants,” found in just under half of premature infants and “almost universal” in infants who weigh less than 1,000 grams at birth.²

Apneas “may happen only once a day or many times a day,” the Children’s Healthcare of Atlanta overview adds. “The more immature the baby is, the more frequent the apnea spells.”

The Pediatrics article echoes the idea that apnea of prematurity often resolves as the baby gets older. “It usually ceases by 37 weeks’ postmenstrual age but may persist for several weeks beyond term, especially in infants born before 28 weeks’ gestation.” The article adds that some “extreme episodes” can last as long as 43 weeks’ age (dating not from the birth, but from the beginning of conception).

Apnea of prematurity: What we don’t know

However, although researchers agree on the above facts, that doesn’t necessarily mean that everything about apnea of prematurity is clear and well understood.

According to the Apnea-of-Prematurity Group’s statement referenced above, “there is no consensus about the duration of apnea that should be considered pathologic.” There’s also “no agreement” about what “constitutes an important apnea event.” And even though apnea events respond to drugs and physical interventions, it isn’t yet known whether these interventions “have any long-term effects.”

“Clinicians often use off-label drugs that have been approved for gastroesophageal reflux disease, which is common in premature infants, with the belief that such treatments also have an impact on AOP, although this link has never been demonstrated,” the group adds.

However, these experts admit that, despite these uncertainties about treating apnea of prematurity, “providing no treatment when an infant stops breathing in the NICU is not an option.”

They add: “The immediate and irresistible urge to respond to apnea is based partly on the uncertainty about exactly what causes the apneic episode and whether the unknown causative factor might also harm the brain or other systems and produce a long-term effect on neurodevelopment.”

So, even given the relative common nature of apnea of prematurity and its tendency to resolve itself with age, sleep apnea in premature babies remains a source of concern for many pediatric physicians who are unsure about long-term effects of treatments.