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Systems: Resp. WK > 37. Sleep Medicine in Children > Flashcards

37. Sleep Medicine in Children Flashcards

1
Q

What is the respiratory pattern for infants before 36 weeks?

A
  • periodic/ apneic before 36 weeks
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2
Q

At how many weeks do infants have an increased regular respiratory movement?

A

36 weeks

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3
Q

What is REM sleep?

A

Rapid eye movement sleep: involves faster breathing, pulse, dreaming and bodily movement

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4
Q

What is NREM sleep?

A

Non-rapid eye movement sleep: sleep is relatively still, no dreaming, slower breathing, pulse and pressure

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5
Q

What percentage of infant sleeping time is spent in REM and NREM?

A

50% REM

50% NREM

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6
Q

How much do newborns on average sleep?

A

16-18 hours

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7
Q

How long are the cycles between which infants sleep-wake?

A

Sleep-wake states alternate in 3-4 hour cycles and then start to adapt to light/dark/ social cues as infant ages

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8
Q

Which sleeping phase puts infants at higher risk of a respiratory condition?

A

REM phase

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9
Q

When does REM phase occur?

A
  • usually predominates in the later half of sleeping
  • REM cycles last 90-120 minutes throughout the night
  • account for 20-25% of total sleeping time in adults
  • time length of each REM cycle as night progresses
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10
Q

Is periodic breathing normal?

A

Only normal in INFANTS, not in adults

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11
Q

What is periodic breathing?

A
  • normal variation in breathing in infants
  • occurs when infant pauses in breathing for no more than 10 seconds followed by a series of rapid and shallow breaths
  • breathing then returns to normal without any intervention or stimulation
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12
Q

Describe sleeping pattern for 6 month old infants.

A
  • 14-15 hours asleep
  • 2 longer sleep periods at night
  • 1-2 daytime naps
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13
Q

Describe sleeping pattern for 2 year old child.

A
  • 12 hour sleep

- 1 daytime nap

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14
Q

What happens to the amount of REM sleep a person gets as age increases from 1-85 years?

A

REM sleep decreases

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15
Q

What happens to the amount of NREM sleep a person gets as age increases from 1-85 years?

A

Increases slightly until puberty and and begins to gradually decrease from age 14 onwards (approximately)

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16
Q

What is the sleep like for prepubertal children?

A

highly efficient sleep

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17
Q

What is the sleep like for adolescents?

A
  • increased awakenings

- need more sleep but obtain less sleep

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18
Q

What are the different assessments done for monitoring sleep disorders in children?

A
  1. polysomnography
  2. direct behavioural observation
  3. time-lapse video
  4. movement sensors in cot mattress
  5. oxygen/CO2 monitoring
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19
Q

What does polysomnography measure and record? (5)

A
  • brain waves
  • breathing rate
  • heart rate
  • oxygen level in blood
  • eye and leg movements
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20
Q

What is the most common assessment method for sleeping disorders?

A

direct behavioural observation (more common since other methods like time-lapse video are more difficult to analyse)

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21
Q

When do napping and enuresis (involuntary urination by children especially at night)

A

abnormal after 3-5 years

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22
Q

Is it abnormal for a 1 year old to sleep 8 hours at night and doesn’t nap?

A

yes, it’s abnormal

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23
Q

Is sleep walking normal in toddlers?

A

Yes, it’s normal

24
Q

Is it normal for an unmedicated adult to be unrousable from sleep?

A

Yes, it’s abnormal

25
Q

When is REM onset normal?

A

in first 3 months

26
Q

Which sleep phenomena often arise in middle childhood which are normal for that age range? (3)

A
  1. sleep walking
  2. hypnic jerk
  3. sleep terrors (“look of fear”)
27
Q

What are 2 categories of infant behavioural aspects that cause sleeplessness?

A
  1. “self-soothers”

2. “signalers” which cause more problems as they will be very active and want to do things

28
Q

How long does infant sleep arousal last for especially in children aged 1+?

A

1-5 minutes each night

29
Q

What are 3 causes for child sleeplessness?

A
  1. mainly behavioural problems
  2. medication
  3. neurological disorders
30
Q

What hormone can be impaired in neurological disorders?

A

Melatonin; hormone produced by pineal gland which regulates sleep and wakefulness

31
Q

What is excessive sleepiness caused by? (3)

A
  1. insuifficient sleep
  2. OSAS; obstructive sleep apnoea syndrome
  3. Narcolepsy
32
Q

What occurs in child narcolepsy?

A
  • cataplexy; sudden weakness in muscles and instant sleep collapse (muscle tone lost)
  • orexin deficiency; neuropeptide which regulates arousal and wakefulness
33
Q

Define primary snoring.

A
  • Snoring without apnoea, frequent arousals from sleep or inability of lungs to breathe in sufficient oxygen (not associated with serious problems)
34
Q

What are some clinical features of primary snoring? (4)

A
  1. hypoventilation
  2. hypoxia
  3. hypercarbia/ hypercapnia (CO2 retention)
  4. daytime symptoms
35
Q

How prevalent is primary snoring?

A

~10%

36
Q

What can primary snoring be caused by?

A
  • enlarged lymphoid tissue
  • obesity (fat gathered around the throat)
  • sleeping on a particular side
  • throat weakness
37
Q

What can primary snoring theoretically progress onto?

A

progress to OSAS; obstructive sleep apnoea syndrome

38
Q

What surgery can be considered in extreme snoring?

A

adenotonsillectomy; surgical removal of tonsils and adenoids (pharyngeal tonsil found above tonsils in the nasal region)

39
Q

How prevalent is obstructive sleep apnoea syndrome in children?

A

~2%

40
Q

What is the OSAS (obstructive sleep apnoea syndrome) prevalence between males and females in children?

A

Same prevalence, 50% male and 50% female

41
Q

What are some morbidities/complications which arise from obstructive sleep apnoea syndrome? (4)

A
  1. failure to thrive
  2. neurocognitive defects/ ADHD
  3. systemic hypertension
  4. cor pulmonale
42
Q

By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare daytime sleepiness.

A

adult: main symptom
child: minority

43
Q

By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare obesity.

A

adult: majority
child: minority

44
Q

By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare mouth breathing.

A

adult: no mouth breathing
child: common

45
Q

By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare gender.

A

adult: M:F= 2:1
child: M:F= 1:1

46
Q

By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare enlarged tonsils.

A

adults: uncommon
child: common

47
Q

By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare obstructive pattern.

A

adult: apnoea
child: hypoventilate

48
Q

What is the treatment for child OSAS; obstructive sleep apnoea syndrome? (4)

A
  1. adenotonsillectomy
  2. CPAP; continous positive airway pressure
  3. weight loss
  4. avoid environmental tobacco smoke (which damages lymphoid tissue)
49
Q

What are common respiratory disorders in children which affect sleeping? (3)

A
  1. chronic neonatal lung disease (child equivalent of COPD)
  2. cystic fibrosis
  3. asthma (worse at night)
50
Q

What are features of chronic neonatal lung disease in sleeping disorders? (2)

A
  1. hypoxaemia in REM sleep (similar to COPD)

2. cardiac complications

51
Q

What are features of cystic fibrosis in sleeping disorders? (2)

A
  1. FEV1 30-60% associated with decrease in SaO2 (~8%)

2. less REM/ more awakenings

52
Q

What are common neurological disorders in children which affect sleeping? (4)

A
  1. cerebral palsy
  2. Down syndrome
  3. Prader- WIlli syndrome
  4. Neuromuscular disease (Duchenne’s muscular dystrophy)
53
Q

What effect does cerebral palsy have on sleep? (2)

A
  • fragmented sleep/delayed onset

- melatonin used to treat

54
Q

What effect doe Down Syndrome have on sleep?

A
  • causes OSAS; obstructive sleep apnoea syndrome
  • due to people with Down’ syndrome having smaller facial and upper airway features like pharynx which can lead to sleep problems and complications
55
Q

What effect does Prader-Willi syndrome have on sleep?

A

causes excessive daytime sleepiness

56
Q

In Duchene’s muscular dystrophy, what is death caused by?

A

respiratory failure; nocturnal desaturation associated with FVC <1L

57
Q

How can patients with Duchene’s muscular dystrophy have an increased quality of life/survival?

A

Non-invasive ventilation (BiPAP) which has two different applied levels of positive pressure

Systems: Resp. WK (40 decks)

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