What type of apnea is characterized by pauses in breathing lasting 10-15 seconds, occurring a few times per hour, in a newborn, with options including Mixed apnea, Obstructive apnea, or Central apnea?

Newborn Apnea Classification

Based on the clinical presentation of 10-15 second apneic pauses occurring a few times per hour in a newborn without additional context about respiratory effort, this most likely represents central apnea, which is the most common type in newborns and typically presents with brief, self-resolving episodes.

Understanding Apnea Types in Newborns

The classification of apnea depends entirely on the presence or absence of respiratory effort during the breathing pause:

Central Apnea

• Characterized by complete absence of respiratory effort during the apneic episode—no chest wall movement, no abdominal movement, and no airflow 1, 2
• Most common type in newborns, accounting for approximately 69% of all apneic episodes in preterm infants 3
• Central apneas are particularly prevalent in active sleep and are considered a feature of immaturity of the central nervous system 4
• Brief central apneas (<15 seconds) are commonly observed even in healthy full-term newborns and typically do not cause significant bradycardia or desaturation 4

Obstructive Apnea

• Demonstrates continued respiratory effort despite absent airflow—you see paradoxical chest and abdominal movements (thoracoabdominal paradox) as the infant tries to breathe against a closed airway 5, 1, 2
• Often associated with snoring or airflow limitation on nasal pressure monitoring 5
• Less frequent than central apneas in newborns, accounting for only 11% of purely obstructive episodes 3
• More commonly associated with anatomic upper airway abnormalities 2

Mixed Apnea

• Begins with a central component (no respiratory effort) followed by obstructive breathing efforts (paradoxical chest/abdominal movements against a closed airway) 1
• Accounts for approximately 20% of apneic episodes in preterm infants 3
• The proportion of mixed apneas increases with longer duration episodes—rising from 20% in 10-14 second episodes to 60% in episodes >20 seconds 3

Clinical Context for This Case

Given the presentation of 10-15 second pauses occurring only a few times per hour without mention of:

• Continued respiratory effort during the pause (which would indicate obstructive)
• Initial absence followed by obstructive efforts (which would indicate mixed)
• Associated cyanosis, significant desaturation, or bradycardia

This clinical picture is most consistent with central apnea 4, 3. Short central apneas of this duration are extremely common in newborns and are typically benign, representing normal developmental immaturity of respiratory control 4.

Key Diagnostic Distinctions

To definitively classify the apnea type, you must assess:

• Chest impedance monitoring: Minimal or absent fluctuations suggest central apnea 6
• Thoracoabdominal movement: Absence indicates central; paradoxical movement indicates obstructive or mixed 5, 1
• Nasal pressure waveform: Flattening suggests obstruction; absence of flow with no flattening suggests central 5

Important Clinical Pitfalls

• Do not assume all brief apneas are pathological—short central apneas (<15 seconds) without significant desaturation or bradycardia are normal in newborns 4
• Duration matters for classification: As apneas become longer (>20 seconds), the likelihood of mixed apnea increases significantly 3
• Obstructive apneas >20 seconds are associated with worse neurological outcomes including higher rates of intraventricular hemorrhage and abnormal development, so proper classification is critical 3
• Polysomnography is required for definitive diagnosis if clinical significance is uncertain, as it allows measurement of respiratory effort, oxygen saturation, and CO2 monitoring 5, 1