3.4 Sleep and Rest Pattern part 4

Question 2

Circadian rhythm disorders

What is delayed sleep phase

Answer 2

when the sleep cycle begins at a late hour and is followed by a late awakening

kid not tired til late and sleeps in

Question 3

What are related factors for delayed sleep phase esp in school aged kids

2

Answer 3

excessive naps
waking up late

Question 4

What is the best management for delayed sleep phase

Answer 4

keep nighttime routine same but awaken child in morning earlier every day by 15 min intervals

Question 5

Circadian rhythm disorders

What is advanced sleep phase

Answer 5

when kid gets tired too early and wakes too early

sleep cycle begins too early with correlated early rising.

Question 6

What is the best management of advanced sleep phase

Answer 6

delay meals, naps, bedtime until desired time

early waking will self resovle when you do this

Question 7

Circardian rhythm disorders

What is inappropriate or unpredicatable sleep schedules

Answer 7

when people have poorly organized sleep-wake cycles

Question 8

What is the best management of inappropriate or unpredicatable sleep schedules in kids

Answer 8

maintain routines of eating, activities, sleeping

The older child may need to learn to play quietly in
bed until others awaken or until an alarm begins to play. At night,
the child may need to learn to read or listen to music in bed when
bedtime comes.

Question 9

What are dyssomnias

Answer 9

a general term for a group of sleep disorders that impact the quality and quantity of sleep

Question 10

Chronic health conditions and dyssomnias

What is nocturnal enuresis

Answer 10

night time incontinence

Question 11

What is primary vs secondary enuresis

Answer 11

primary- occurs in kids who have never attained dryness at night

secondary- kids who have been potty trained before

Question 12

Why is sleep disordered berathing associated with enuresis

2

Answer 12

due to altered arousal response and sleep fragmentation

enuresis commonly resolves after treatment of sleep disordered breathing (tonsils and adenoids out, cpap etc)

Question 13

Chronic Health Conditions and Dyssomnias

What is restless leg syndrome

Answer 13

a sensory and motor disorder characterized by irritating sensations
in the legs accompanied by an irresistible urge to move the legs, which typically helps

Question 14

What is periodic limb movement disorder

Answer 14

PLMs are repetitive jerks, typically in the
legs, that are found by sleep study to occur every 5 to 90 seconds.

Question 15

Do RLS and PLM disoders always occur together

Answer 15

typically yes but PLM can occur without RLS

Question 16

What will children often complain of that indicates RLS

2

Answer 16

• leg pain
• itchy/crawly sensation in legs

Question 17

What do sleep disturbances associated with RLS often look like in kids

Answer 17

awakening after 1 to 3 hours of sleep followed by screaming, crying, kicking, and slapping the legs or by verbally expressing that the legs hurt

Question 18

What lab result can be implicated in RLS

Answer 18

serum iron

Question 19

What can help children with RLS

Answer 19

iron supplement even if levels are normal on BW

Question 20

What is bruxism

Answer 20

clench or grind teeth

can occur during sleep

Question 21

What is associated with sleep time bruxism

Answer 21

stress

Sleep bruxism is rarely associated with temporal lobe seizure activity in children.

Question 22

When is head banging or body rocking to fall asleep typically seen inkids

Answer 22

before 2 years old

Classed as rhythmic movement disorders

Question 23

What is the treatment of head banging or body rocking to fall asleep

Answer 23

nothing- self limiting, transient

Question 24

What types of seizures typically occur during sleep

Answer 24

frontal lobe

Question 25

FYI

Nocturnal frontal lobe epilepsy (NFLE) -
events can be more complex than typical seizures with vocalizations, complex automatisms, and ambulation.

Routine EEG and MRI are often normal

Events can mimic parasomnias.

Patient often wakes up fully after the event, has recollection of the event,
and typically has academic decline,

parasomnias where the patient has amnesia and sleeps through the
event.

Question 26

What are signs of sleep disordered breathing in kids

Answer 26

snoring, gasping, apneas, increased
work of breathing with paradoxic respirations, neck hyperextension, night sweating, tachycardia, restless sleep, and disrupted sleep.

also persistent parasomnias

Question 27

What are risk factors for sleep disordered breathing

5

Answer 27

• enlarged tonsils/adenoids
• obesity
• craniofacial abnormalities
• GERD
• allergic rhinitis

Question 28

What is the first line treatment for OSA in kids

Answer 28

Adenotonsillectomy

Question 29

How do nasal steroids and montelukast work as non surgical tx of mild OSA in kids

Answer 29

reduce size lymphoid issue

Question 30

What is central sleep apnea

Answer 30

refers to absences of airflow that are
related to failure of the ventilator control system to stimulate a breath

Question 31

Do kids with central sleep apnea snore or gasp

Answer 31

no

Question 32

Is central sleep apnea common in kids

Answer 32

yes common intermittently especially following a sigh

often outgrow with age

When CSA occurs frequently or results in oxygen
desaturations, it is considered pathologic.

Question 33

what is narcolepsy

Answer 33

is a disorder characterized by excessive daytime sleepiness, fragmented nocturnal sleep, and signs of REM intrusion, the most specific of which is cataplexy.

Narcolepsy is an imbalance
among wakefulness, REM, and SWS states that can range from
mild to severe.

Question 34

What is cataplexy

Answer 34

is a brief sudden loss of skeletal muscle
tone, which is typically brought on by laughter but can also be stimulated by other strong emotions.

Not all people with narcolepsy have cataplexy.

Neck, facial, and knee weakness are common cataplexy symptoms.

Question 35

What helps differentiate cataplexy from seizures

Answer 35

cataplexy- individual stays concious
seizue- lose conciousness

Question 36

What is often the first symptom of narclepsy

Answer 36

excessive sleepiness

may present years before
the cataplexy

Question 37

What are hypnogogic hallucinations

Answer 37

vivid dreamlike visual, tactile, or auditory hallucinations that occur as the patient is falling asleep.

seen in narcolepsy

Children may complain of feeling
someone whispering in their ear or breathing on their neck. Rarely
can the patient decipher the whispering. Sleep

Question 38

What causes narcolepsy with cataplexy

Answer 38

deficiency of hypothalamic hypocretin (aka orexin)

medication is core management