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Disordered Control of Breathing in Infants and Children

Introduction

Breathing must be tightly regulated so that the amount of oxygen inhaled and carbon dioxide exhaled matches precisely the metabolic needs of the body. Acute malfunction of breathing control mechanisms, even for a few seconds, may lead rapidly to serious physiologic derangements, with death as the final outcome if the system fails to recover. Chronic malfunction of breathing control mechanisms may lead to chronically abnormal blood gases (eg, hypoxemia), with such consequent complications as developmental delay or cor pulmonale. Because the upper airway is shared for breathing, eating, drinking, and talking, control of breathing also encompasses coordination of these actions in such a way that all are carried out effectively. The upper airway also must be actively held open during sleep or it will collapse during the inspiratory phase of breathing. Tone and activity of the muscles that maintain upper airway patency are controlled, in part, by the respiratory control systems. Malfunction of upper airway control mechanisms may play a role in obstructive sleep apnea. Thus, respiratory control not only refers to the control of gas exchange, but encompasses breathing pattern, apnea, respiratory protective reflexes, and upper airway control—specifically, maintenance of upper airway patency.

This review will cover infant apnea and home cardiorespiratory monitoring, apparent life-threatening events (ALTEs) and home monitoring, obstructive sleep apnea syndrome (OSAS) in children, central hypoventilation syndromes, and hyperventilation syndromes.

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