Ch 17 Flashcards
What percent of children experience sleep problems?
25-40 %
BEARS a screening algorithm for
Bedtime problems Excessive daytime sleepiness Awake during night Regularity if sleep Snoring
Most commonly used test for evaluating sleep
Polyaomnography
Assessment of daytime sleepiness and diagnosis of narcolepsy
Multiple sleep latency test(MSLT)
Snoring is the most common symptom of child obstructive sleep APNEA in preschool children occurring at
3-12%
Gold standard for diagnosis of OSA
Polysomnography quantifies the severity and at risk children.
Second line treatment for OSA
Positive airway pressure, indicated in children with obesity.
Upper airway resistance syndrome(UARS)
Daytime sleepiness, tiredness, awakenings during sleep, no apnea or hypopnea
UARS symptoms
Intermittently high negative airway pressures
Upper airway collapse during sleep
Negative Intrathoracic pressures
CSA central sleep apnea
40% of healthy children central apnea’s are common
Cheyenne stokes
Diminished or absent intermittent during sleep
CSA occurrence
Periodic breathing incidence 7% babies born 34-35 weeks.
54% born 30-31 weeks gestation
Almost all infants born less than 29 weeks
CSA description
In children apnea lasts 20 seconds or longer, awakening or around 3% desaturation
Transition from wake to sleep in supine position
Central apnea index greater than 1 considered abnormal.
CCHS Congenital central hypoventilation syndrome
Odines curse
Rare genetic
Severe alveolar hypoventilation
Mutated PHOX2B GENE
hypoventilation worse during NREM than REM
CCHS congenital central hypoventilation syndrome
1 in 200,000 live births France
1 in 148,000 Japan
50% chance of passing to children
Some infants don’t breath at all during first few months of life
In CCHS What PaCO2 should be maintained at
30-35 and SpO2 T 94%
Can use diaphragm pacing that provides daytime ventilatory support permitting tracheal decannulatuon
Electrodes are placed on phrenic nerves
Can be used 6-8 weeks after implant and takes 2-3 months to establish full pacing
