37. Sleep Medicine in Children Flashcards
What is the respiratory pattern for infants before 36 weeks?
- periodic/ apneic before 36 weeks
At how many weeks do infants have an increased regular respiratory movement?
36 weeks
What is REM sleep?
Rapid eye movement sleep: involves faster breathing, pulse, dreaming and bodily movement
What is NREM sleep?
Non-rapid eye movement sleep: sleep is relatively still, no dreaming, slower breathing, pulse and pressure
What percentage of infant sleeping time is spent in REM and NREM?
50% REM
50% NREM
How much do newborns on average sleep?
16-18 hours
How long are the cycles between which infants sleep-wake?
Sleep-wake states alternate in 3-4 hour cycles and then start to adapt to light/dark/ social cues as infant ages
Which sleeping phase puts infants at higher risk of a respiratory condition?
REM phase
When does REM phase occur?
- 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
Is periodic breathing normal?
Only normal in INFANTS, not in adults
What is periodic breathing?
- 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
Describe sleeping pattern for 6 month old infants.
- 14-15 hours asleep
- 2 longer sleep periods at night
- 1-2 daytime naps
Describe sleeping pattern for 2 year old child.
- 12 hour sleep
- 1 daytime nap
What happens to the amount of REM sleep a person gets as age increases from 1-85 years?
REM sleep decreases
What happens to the amount of NREM sleep a person gets as age increases from 1-85 years?
Increases slightly until puberty and and begins to gradually decrease from age 14 onwards (approximately)
What is the sleep like for prepubertal children?
highly efficient sleep
What is the sleep like for adolescents?
- increased awakenings
- need more sleep but obtain less sleep
What are the different assessments done for monitoring sleep disorders in children?
- polysomnography
- direct behavioural observation
- time-lapse video
- movement sensors in cot mattress
- oxygen/CO2 monitoring
What does polysomnography measure and record? (5)
- brain waves
- breathing rate
- heart rate
- oxygen level in blood
- eye and leg movements
What is the most common assessment method for sleeping disorders?
direct behavioural observation (more common since other methods like time-lapse video are more difficult to analyse)
When do napping and enuresis (involuntary urination by children especially at night)
abnormal after 3-5 years
Is it abnormal for a 1 year old to sleep 8 hours at night and doesn’t nap?
yes, it’s abnormal
Is sleep walking normal in toddlers?
Yes, it’s normal
Is it normal for an unmedicated adult to be unrousable from sleep?
Yes, it’s abnormal
When is REM onset normal?
in first 3 months
Which sleep phenomena often arise in middle childhood which are normal for that age range? (3)
- sleep walking
- hypnic jerk
- sleep terrors (“look of fear”)
What are 2 categories of infant behavioural aspects that cause sleeplessness?
- “self-soothers”
2. “signalers” which cause more problems as they will be very active and want to do things
How long does infant sleep arousal last for especially in children aged 1+?
1-5 minutes each night
What are 3 causes for child sleeplessness?
- mainly behavioural problems
- medication
- neurological disorders
What hormone can be impaired in neurological disorders?
Melatonin; hormone produced by pineal gland which regulates sleep and wakefulness
What is excessive sleepiness caused by? (3)
- insuifficient sleep
- OSAS; obstructive sleep apnoea syndrome
- Narcolepsy
What occurs in child narcolepsy?
- cataplexy; sudden weakness in muscles and instant sleep collapse (muscle tone lost)
- orexin deficiency; neuropeptide which regulates arousal and wakefulness
Define primary snoring.
- Snoring without apnoea, frequent arousals from sleep or inability of lungs to breathe in sufficient oxygen (not associated with serious problems)
What are some clinical features of primary snoring? (4)
- hypoventilation
- hypoxia
- hypercarbia/ hypercapnia (CO2 retention)
- daytime symptoms
How prevalent is primary snoring?
~10%
What can primary snoring be caused by?
- enlarged lymphoid tissue
- obesity (fat gathered around the throat)
- sleeping on a particular side
- throat weakness
What can primary snoring theoretically progress onto?
progress to OSAS; obstructive sleep apnoea syndrome
What surgery can be considered in extreme snoring?
adenotonsillectomy; surgical removal of tonsils and adenoids (pharyngeal tonsil found above tonsils in the nasal region)
How prevalent is obstructive sleep apnoea syndrome in children?
~2%
What is the OSAS (obstructive sleep apnoea syndrome) prevalence between males and females in children?
Same prevalence, 50% male and 50% female
What are some morbidities/complications which arise from obstructive sleep apnoea syndrome? (4)
- failure to thrive
- neurocognitive defects/ ADHD
- systemic hypertension
- cor pulmonale
By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare daytime sleepiness.
adult: main symptom
child: minority
By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare obesity.
adult: majority
child: minority
By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare mouth breathing.
adult: no mouth breathing
child: common
By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare gender.
adult: M:F= 2:1
child: M:F= 1:1
By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare enlarged tonsils.
adults: uncommon
child: common
By comparing adult vs childhood OSAS; obstructive sleep apnoea syndrome, compare obstructive pattern.
adult: apnoea
child: hypoventilate
What is the treatment for child OSAS; obstructive sleep apnoea syndrome? (4)
- adenotonsillectomy
- CPAP; continous positive airway pressure
- weight loss
- avoid environmental tobacco smoke (which damages lymphoid tissue)
What are common respiratory disorders in children which affect sleeping? (3)
- chronic neonatal lung disease (child equivalent of COPD)
- cystic fibrosis
- asthma (worse at night)
What are features of chronic neonatal lung disease in sleeping disorders? (2)
- hypoxaemia in REM sleep (similar to COPD)
2. cardiac complications
What are features of cystic fibrosis in sleeping disorders? (2)
- FEV1 30-60% associated with decrease in SaO2 (~8%)
2. less REM/ more awakenings
What are common neurological disorders in children which affect sleeping? (4)
- cerebral palsy
- Down syndrome
- Prader- WIlli syndrome
- Neuromuscular disease (Duchenne’s muscular dystrophy)
What effect does cerebral palsy have on sleep? (2)
- fragmented sleep/delayed onset
- melatonin used to treat
What effect doe Down Syndrome have on sleep?
- 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
What effect does Prader-Willi syndrome have on sleep?
causes excessive daytime sleepiness
In Duchene’s muscular dystrophy, what is death caused by?
respiratory failure; nocturnal desaturation associated with FVC <1L
How can patients with Duchene’s muscular dystrophy have an increased quality of life/survival?
Non-invasive ventilation (BiPAP) which has two different applied levels of positive pressure
