Periodic Breathing

Basics

A respiratory pattern consisting of regular oscillations in breathing amplitude
Typically, a respiratory pattern in which ≥3 apneas lasting ≥3 seconds occur, separated by <20 seconds of respiration

ALERT
Don’t confuse periodic breathing with obstructive and/or central apnea.

Usually absent in the first 48 hours of life
More frequent during rapid eye movement (REM or active) sleep versus non-REM (quiet) sleep
Less common in prone versus supine position
In full-term infants
- Amount of periodic breathing usually <4% of total sleep time
- Amount gradually decreases through the 1st year of life.
- By 1 year of age, the mean amount of periodic breathing is <1% of total sleep time.
In premature infants
- Amount of periodic breathing is higher than in full-term infants.
- Amount correlates inversely with gestational age.

No common pathologic finding
Abnormalities, when they exist, are related to the underlying disorder causing the periodic breathing.

Periodic breathing can be seen in healthy infants, children, and adults.
Abnormalities, in any component of the breathing control system, may result in an increased amount of periodic breathing.
Possible etiologies
- A delay in detecting changes in blood gas values by the chemoreceptors
- Increased chemoreceptor gain

Periodic breathing in infants is associated with the following:
- Apnea of prematurity or infancy
- Familial history of sudden infant death syndrome (SIDS)
- Anemia of prematurity
- Hypoxemia
- Hypochloremic alkalosis
Periodic breathing with adults is associated with the following:
- Cardiac abnormalities (especially congestive heart failure [CHF])
- Neurologic dysfunction (meningitis, encephalitis, brainstem dysfunction)
- Exposure to high altitudes

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