This document defines and describes different types of apnea, including central apnea which is due to cessation of brain stem motor stimuli, obstructive apnea which involves absence of airflow with chest wall motion, and mixed apnea which is the most common type. It lists various causes of apnea such as hypoxia, sepsis, metabolic disorders, CNS disorders, and issues like hypotension. The diagnosis of apnea requires investigating these potential underlying causes. Treatments mentioned include apnea monitors, stimulation, bag-mask ventilation, CPAP, theophylline, and caffeine citrate. Apnea of prematurity is also discussed as relating to immaturity of respiratory centers and chemoreceptors in premature babies.

1. APNEA:
• Definition:
• Cessation of breathing for more than
20 seconds, or for any duration if
associated with bradycardia or
cyanosis.
• Periodic breathing :
series of respiratory pauses of
15 seconds occuring at least
3 times/minute, there is no
bradycardia or cyanosis.

2. TYPES OF APNEA:
• Central : due to cessation of motor
stimuli from the brain stem.
Chest wall motions are absent.
• Obstructive : absence of airflow with
aggressive chest wall motion.
• Mixed : is the commonest type.

3. CAUSES OF APNEA:
• Hypoxia.
• Sepsis.
• Metabolic disorders.
• CNS disorders.
• Circulatory e.g. hypotension, heart failure,
anemia, polycythemia.
• Hyperthermia, Hypothermia.
• Excessive pharyngeal suctioning.
• Over dose of anticonvulsants e.g.
Diazepam, Phenobarbiton.
• Apnea of prematurity.
So the diagnosis of apnea requires
investigations of the above causes by
appropriate tests.

4. TREATMENT :
• 1. Apnea monitors.
• 2. Repeated stimulation.
• 3. Intermittent bag&mask.
• 4. C.P.A.P. is useful in
obstructive and mixed apnea
but not useful in central apnea.

5. • 5. Theophylline(5-7mg/kg loading,
then 1-2mg/kg/6-12hr.oral or i.v.) is useful
in all types of apnea.
It sensitizes the respiratory center to
hypercapnia & it stimulates the diaphragm,
but it decreases cerebral blood flow.
• 6. Caffaine citrate, Doxapram.

6. APNEA OF PREMATURITY:
• Immaturity of respiratory centers or
chemoreceptors in premature babies
may cause irregular stimulation of
breathing.
• CENTRAL RECEPTORS respond to
hypercapnia and acidosis.
• CHEMORECEPTORS (carotid and
aortic bodies) respond to hypoxia.