Central sleep apnoea in children

Central sleep apnoea can occur in children but is far less common than obstructive sleep apnoea. Consider the possibility of central sleep apnoea in children with:

• a history of pauses in breathing but without obstructive symptoms (eg snoring, mouth breathing)
• a history of symptoms associated with poor sleep quality (eg excessive daytime sleepiness, difficulty concentrating, mood changes, morning headaches).

Central sleep apnoea may be related to:

• infancy or prematurity—prolonged apnoeas or periodic breathing during sleep associated with oxygen desaturation or sleep disturbance, usually caused by immaturity of the brainstem
• conditions affecting the nervous system—neurological abnormalities, craniofacial abnormalities, neuromuscular conditions or neuromuscular injury
• conditions affecting chemoreception—congenital central hypoventilation syndrome, obesity hypoventilation syndrome, Prader-Willi syndrome.

Central sleep apnoea can only be diagnosed with a sleep study (polysomnogram¹). Refer the child to a paediatric respiratory or sleep physician. Screen all children at risk for central sleep apnoea (eg children with Down syndrome or achondroplasia).

Treatment of children with central sleep apnoea is usually by ventilatory support (eg supplemental oxygen or bilevel positive airway pressure [BPAP]) prescribed by a paediatric respiratory or sleep physician. Apnoea of prematurity or infancy may improve as the child gets older and the respiratory centre matures.