1. Apparent life-threatening event (ALTE). An episode that is frightening to observer and is characterized by a combination of apnea, color change, marked change in muscle tone, choking, and gagging. In many cases, observer believes the episode was life threatening and in some instances believes infant or child has died. Because any relationship between ALTE and sudden infant death syndrome (SIDS) is unproven, the term "near-miss SIDS" or "aborted SIDS" should be avoided.
2. Central apnea. Absence of airflow at nose or mouth and no respiratory efforts.
3. Obstructive apnea. Absence of airflow at nose or mouth despite continued respiratory efforts.
4. Obstructive sleep apnea syndrome (OSAS). A disorder of sleep consisting of prolonged partial upper airway obstruction, or episodic obstructive apnea, or both, that affects gas exchange during sleep as well as sleep architecture and quality. Adenotonsillar hypertrophy is the most common cause in children. Children who are obese and those with craniofacial syndromes (eg, midfacial hypoplasia, microg-nathia) or disorders associated with abnormal muscle tone are at risk.
C. What is patient's clinical status? Initial evaluation and management includes rapid assessment of airway, breathing, and circulation (ABCs).
D. What is patient's sleep pattern? OSAS, which occurs only during sleep, is associated with snoring, pauses in or labored breathing, abnormal movements or head positioning, and excessive sweating during sleep.
E. Who was with patient when ALTE occurred? May raise suspicion of abuse or Munchausen syndrome by proxy.
F. What are characteristics of patient's sleep position and environment? Supine sleep position and presence of gas-trapping objects in cribs (eg, stuffed animals, pillows) place young infants at risk of SIDS. Tobacco, alcohol, or other substance exposures increase the risk of SIDS and child abuse.
G. Are other problems associated with event? Fever and symptoms of upper respiratory infection suggest an underlying infectious process. Abnormal eye or body movements suggest seizures. Associated feeding problems may suggest dysphagia, gastroesophageal reflux, or cardiac abnormalities.
H. Is there a family history of ALTEs or SIDS? SIDS can run in families, but may suggest child abuse and certain metabolic conditions.
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