Periodic Breathing

Periodic Breathing is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

  • 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.

Epidemiology

  • Usually absent in the 1st 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.

Pathophysiology

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

Etiology

  • 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

Commonly Associated Conditions

  • 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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