In a newborn with brief apneic pauses lasting 10–15 seconds occurring a few times per hour, which type of apnea—mixed, obstructive, or central—is most likely?

Central Apnea

In a newborn with brief apneic pauses lasting 10–15 seconds occurring a few times per hour, the most likely diagnosis is central apnea, as these represent normal developmental immaturity of respiratory control when not accompanied by significant desaturation or bradycardia. 1, 2

Distinguishing the Three Types of Apnea

The key to classification lies in assessing respiratory effort during the apneic episode:

• Central apnea shows complete absence of respiratory effort with no thoracoabdominal excursions—the chest and abdomen do not move at all during the pause 3, 1
• Obstructive apnea demonstrates continued or paradoxical respiratory effort despite absent airflow—you see the chest and abdomen moving in opposite directions (thoracoabdominal paradox) throughout the entire event 3, 1
• Mixed apnea begins with absent respiratory effort (central component) followed by obstructive breathing efforts with paradoxical chest/abdominal movements against a closed airway 1

Why This Case Points to Central Apnea

Several clinical features strongly suggest central apnea in this scenario:

• Brief duration (10-15 seconds) falls within the normal range for newborns—respiratory pauses <15 seconds are common and occur in the majority of normal infants during sleep 4
• Low frequency (a few times per hour) aligns with normal respiratory pause rates, which range from 2.0-14.4 per hour in healthy infants, with individual recordings showing 0-43.6 per hour 4
• Absence of concerning features such as bradycardia, desaturation, or prolonged duration suggests benign developmental physiology rather than pathologic apnea 2, 4
• Central apneas of 10-15 seconds without significant desaturation or bradycardia are considered normal developmental phenomena in infants, particularly those 2-8 months old 2, 5

Clinical Context: Normal vs. Pathologic

Understanding what constitutes pathologic apnea is critical:

• Pathologic apnea is defined as pauses >20 seconds, or >10 seconds when accompanied by bradycardia (heart rate <50-60 bpm for ≥10 seconds) or oxygen desaturation (<80% for ≥10 seconds) 2, 6
• Normal respiratory pauses of <15 seconds occur in all normal infants and cannot be used as evidence of risk 4
• The presence of obstructive or mixed apnea types (rather than central) would be more concerning, especially if associated with desaturation or bradycardia 4

When to Escalate Concern

Polysomnography would be indicated if any of the following higher-risk features develop:

• Recurrent breathing pauses that increase in frequency or duration 2
• Central apnea >30 seconds in duration 2
• Oxygen saturation <80% for ≥10 seconds accompanying the pauses 2
• Heart rate <50-60 bpm for ≥10 seconds during events 2
• Witnessed cyanosis, color change, or signs of cardiorespiratory compromise 2

Common Pitfalls to Avoid

• Do not assume all apnea requires intervention—brief central apneas are part of normal infant physiology and over-testing lower-risk infants leads to false-positive results and unnecessary anxiety 2
• Do not rely on clinical assessment alone if higher-risk features are present—objective polysomnography is essential for definitive diagnosis, as clinical assessment correctly identifies sleep apnea in only ~55% of suspected cases 2
• Do not use home monitoring devices instead of laboratory polysomnography if testing is indicated, as these cannot detect CO₂ retention or central apnea reliably 2
• Recognize that obstructive apnea would show continued respiratory effort with thoracoabdominal paradox, not the absence of effort seen in central apnea 1, 7