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The diagnosis of a breath-holding spell is made clinically. A good history including the sequence of events, lack of incontinence and no postictal phase, help to make an accurate diagnosis. Some families are advised to make a video recording of the events to aid diagnosis. An electrocardiogram (ECG) may rule out cardiac arrhythmia as a cause. [1]
[1] [5] Approximately 85 percent of infants born with a weight less than 2.2 pounds (1 kg) experience infantile apnea within the first month after birth. [4] This risk decreases to 25 percent for infants weighing less than 5.5 pounds (2.5 kg). [4] Studies have found that almost 2% of the pediatric population experience obstructive sleep apnea. [1]
Over 50% of infants who are born preterm are estimated to be affected by apnea of prematurity. [2] Infants who are born weighing less than 1000g have close to a 100% risk of being affected by apnea of prematurity. Most premature infants are affected by 'central' apnea due to the developmental stage of their respiratory tract. [2]
Causes may include heart failure, kidney failure, narcotic poisoning, intracranial pressure, and hypoperfusion of the brain (particularly of the respiratory center). The pathophysiology of Cheyne–Stokes breathing can be summarized as apnea leading to increased CO 2 which causes excessive compensatory hyperventilation, in turn causing decreased CO 2 which causes apnea, restarting the cycle.
Tolerance can in addition be trained. The ancient technique of free-diving requires breath-holding, and world-class free-divers can hold their breath underwater up to depths of 214 metres (702 ft) and for more than four minutes. [4] Apneists, in this context, are people who can hold their breath for a long time.
Transient tachypnea of the newborn occurs in approximately 1 in 100 preterm infants and 3.6–5.7 per 1000 term infants. It is most common in infants born by caesarian section without a trial of labor after 35 weeks of gestation. Male infants and infants with an umbilical cord prolapse or perinatal asphyxia are at higher risk.
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The conditions of hypoxia and hypercapnia, whether caused by apnea or not, trigger additional effects on the body.The immediate effects of central sleep apnea on the body depend on how long the failure to breathe endures, how short is the interval between failures to breathe, and the presence or absence of independent conditions whose effects amplify those of an apneic episode.