Apnoea

Question 1

Define apnoea

Answer 1

Cessation of respiratory airflow for 20 seconds or longer

Question 2

What are the 3 main categories of apnoea?

Answer 2

• Central
• Obstructive
• Mixed

Question 3

What happens in central apnoea?

Answer 3

Inadequate medullary response leading to no or poor muscle co-ordination for breathing

Question 4

What can cause central apnoea?

Answer 4

• Cessation of output from the central respiratory centres

- Inability of efferent peripheral nerves or respiratory muscles to process or receive signals from the brain

Question 5

What is obstructive apnoea?

Answer 5

When there is an obstruction of the airways and therefore poor to no air exchange

Question 6

How is the inspiratory effort affected in obstructive apnoea?

Answer 6

It is usually vigorous but has no effect against the obstruction

Question 7

Which type of apnoea is most common in children?

Answer 7

Obstructive

Question 8

What is mixed apnoea?

Answer 8

Where there is an episode with combinations of central and obstructive apnoea

Question 9

What are the common causes of apnoea?

Answer 9

• Apnoea of prematurity
• Infections
• Cardiovascular
• Pain
• CNS
• Respiratory
• GI
• Metabolic
• Drugs
• Head and neck positioning

Question 10

When does apnoea of prematurity occur?

Answer 10

2-7 days of life

Question 11

What are the infective causes of apnoea?

Answer 11

• Sepsis
• Necrotising enterocolitis
• Meningitis

Question 12

What are the cardiovascular causes of apnoea?

Answer 12

• Anaemia
• Hypo/hypertension
• PDA
• Cardiac failure
• Hypovolaemia

Question 13

What are the pain causes of apnoea?

Answer 13

• Acute

- Chronic

Question 14

What are the CNS causes of apnoea?

Answer 14

• Intraventricular haemorrhage
• Seizures
• Hypoxic injury
• Neuromuscular disorders
• BRainstem infarction or anomalies
• Congenital malformations

Question 15

What are the respiratory causes of apnoea?

Answer 15

• Pneumonia
• Intrinsic or extrinsic mass or lesions causing airway obstruction
• Upper airway collapse
• Atelectasis
• Phrenic nerve palsy
• RDS
• Pneumothorax
• Hypoxia
• Malformations of chest
• Pulmonary haemorrhage
• Aspiration

Question 16

What are the GI causes of apnoea?

Answer 16

• Oral feeding
• Bowel movement
• Oesophagitis
• Intestinal perforation
• GORD
• Abdominal distension

Question 17

What are the metabolic causes of apnoea?

Answer 17

• Hypoglycaemia
• Hypocalcaemia
• Hyperammonaemia

Question 18

What drugs can cause apnoea?

Answer 18

• Maternal drugs e.g. narcotics
• Opiates
• Sedatives or GA

Question 19

What is the main risk factor for central apnoea in children?

Answer 19

Prematurity

Question 20

What are the risk factors for obstructive apnoea?

Answer 20

• Overweight
• Boys
• Other conditions

Question 21

What other conditions can increase risk of obstructive apnoea?

Answer 21

• Mucopolysaccharoidosis
• Trisomy 21
• Craniofacial abnormalities

Question 22

How do patients with central apnoea present?

Answer 22

No respiratory effort

Question 23

What investigations can be undertaken in apnoea?

Answer 23

• Pulse oximetry
• Cardiorespiratory monitoring
• Apnoea monitor for chest wall movement

Question 24

What must be done if the apnoea is not phyisiological?

Answer 24

Must investigate to identify underlying cause

Question 25

What are the differentials for apnoea?

Answer 25

- Periodic breathing | - Subtle seizures

Question 26

What is periodic breathing?

Answer 26

Three or more periods with no respiratory effort lasting 3 seconds or more in a 20 second period

Question 27

Is periodic breathing a problem?

Answer 27

No, it is a normal neonatal breathing pattern

Question 28

What does periodic breathing not involve?

Answer 28

Change to colour or heart rate

Question 29

How is acute apnoea managed?

Answer 29

- Ensure head and neck in the right position - Tactile stimulation - Clear the airway - CPAP or mechanical ventilation

Question 30

What is tactile stimulation?

Answer 30

Gentle rubbing of the soles of the feet or the chest wall

Question 31

How may the airway be cleared?

Answer 31

Suction of the mouth and nostrils

Question 32

What are the potential complications of apnoea?

Answer 32

Permanent brain damage and death