Sleep Apnea, Prematurity & Craniofacial Conditions

August 9, 2011

I was listening to a sleep medicine continuing educational audio course and the speaker happened to mention that being born premature increases your risk of sleep apnea by 3 times normal. Coincidentally, an article in the New York Times reported on the March of Dimes’ efforts of cut down on rising rates of electively delivering babies before 39 weeks. They report that as many as 36% of elective deliveries are now occurring before 39 weeks. In a recent poll of women who recently gave birth, the majority chose 34 to 36 weeks as the earliest point in pregnancy to deliver. 

The safest gestational age is 39 to 40 weeks, and with each week that babies are delivered earlier, the higher the risk of complications such as respiratory distress, jaundice, infections, low blood sugar, or extra days spent in the hospital.

For example, infants born at 36 to 38 weeks had 2.5 times higher rates of complications compared with infants born at 39 to 40 weeks. The death rate at 37 weeks is 2-3 times that at 40 weeks. Infants’ brains at 35 weeks are only 2/3 the weight of those born at 39 to 40 weeks.

Another under-appreciated process that’s rarely mentioned is that infants’ faces and jaws are not fully formed when born premature. At the other extreme of this spectrum are babies born with Downs syndrome (DS) or cerebral palsy (CP). We know that these two conditions, as well as various other craniofacial conditions have much higher rates of obstructive sleep apnea.

In a study published in the European Journal of Orthopedics, researchers showed that the presence of DS or CP, bottle-feeding, and non-nutritive sucking habits (thumb sucking), and recent respiratory infections significantly increases the chances of various levels of malocclusion (open bite deformities and crossbites).

This goes to show that any degree of jaw underdevelopment, as well as early feeding habits can significantly increase your chances of developing obstructive sleep apnea later on in life. 



Is Sleep Apnea Higher in Pre-Term Babies?

August 5, 2011

There’s no definitive study showing that being born prematurely increases your chances of developing obstructive sleep apnea, but there are a number of papers and studies that suggest that it is possible. A recent Time Magazine article highlighted a 32% increased rate of asthma, vision problems, and hand-eye coordination in babies born between 24 to 34 weeks. They concluded that by age 17, these children had poorer health, growth and neurological issues, as compared to those born full-term.

One concept that the article mentions is the “fetal origins hypothesis,” which suggest that the stress of being born prematurely (with increased levels of cortisol) can affect various aspects of development. Interestingly, there are also numerous papers describing significantly increased rate of dental crowding, malocclusion, and craniofacial changes in pre-term infants.

What all this means is that the facial skeleton, and especially the jaws, don’t develop fully, leading to crowding of the nasal and oral cavities. Add to this the good possibility that most preemies are more likely to be bottle-fed (which can promote malocclusion). Since soft tissues like the tongue and nasal septum will grow to their normal size, the airway gets crowded, leading to an inability to breathe properly during the day and especially at night. Not sleeping well at night has been shown to significantly increase your stress hormone levels.

Knowing that these kids will be more susceptible to sleep-breathing problems, it’s important to address these issues early on to prevent the various medical complications that can occur later in life.

If you have a child that delivered prematurely, what kind of medical issues did your child have, if any?


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