Ch 19 Sleep disordered breathing/snoring/OA/ALTE/SIDS Flashcards
________ is any abnormal respiratory pattern during sleep, which may include noisy breathing, mouth breathing, and/or pauses in breathing
Sleep-disordered breathing
A child presents with symptoms of loud or habitual snoring (three or more nights per week), witnessed apnea, labored breathing, mouth breathing, or frequent nighttime arousals. What may this indicate?
Obstructive sleep apnea
2 - 7 year olds typically present with what specific finding associated with airway obstruction?
tonsillar hypertrophy
obesity may also be a risk for airway obstruction
Obstructive sleep apnea in children may have what medical conditions or are on what types of medications that cause this
Craniofacial abnormalities
Neuromuscular disease
on medications like Hypnotics, sedatives, anticonvulsants
What is the gold standard for diagnosis of obstructive sleep apnea?
Polysomnography
“sleep study”
____________ is the cessation of breathing and classified as either obstructive or central
sleep apnea
Describe obstructive sleep apnea
airflow stops despite persistence of respiratory effort
Describe central sleep apnea
lack of effort to breathe
What children are at greater concern for central apnea?
infants/children - especially high elevation
What are nighttime symptoms of obstructive sleep apnea?
habitual snoring
gasping or pausing
labored breathing
night terrors, sleep walking, enuresis, morning headaches
What are daytime symptoms of obstructive sleep apnea?
un-refreshed sleep attention deficit hyperactivity emotional lability temperamental behavior poor weight gain daytime fatiuge** (adults)
A child with 4+ tonsils has nightly snoring, but no gasping, apnea, or pauses and quality of life is not effected. What should the NP consider?
What if the child experiences QOL issues?
arrange for sleep study
Refer for ENT evaluation (a 3+ with QOL issues also receives this recommendation)
A child with 3+ tonsils and nightly snoring, but no gasping, apnea, or pauses. What should the NP consider?
observation
A healthy child that snores with recurrent tonsillitis should be
referred for adenotonsillectomy
A healthy child that snores with normal tonsils 1-2+ without quality of life issues should be assessed for what?
any nasal obstruction
treat if so and reevaluated snoring or if not assess the adenoids (enlargement = ENT eval)
_______ _____ are pauses in breathing without concomitant effort and may occur in a pattern of alternating apnea and tachypnea (periodic breathing).
Central apnea - infants and children, especially high elevation
What is the intervention for central apnea?
none!
may use supplemental oxygen if necessary
What is an apparent life-threatening event (ALTE)?
An acute, unexpected change in an infant’s breathing, appearance, or behavior that is frightening to the observer.
What are characteristic findings of ALTEs?
Apnea Change of color Marked change in muscle tone Choking Gagging
What will a thoracentesis reveal post ALTE in an infant?
blood in the pleural space
What body systems are associated as a problem with ALTEs?
Gastrointestinal (50%) Neurologic Respiratory Cardiovascular Metabolic/endocrine
The NP must obtain what from the parents with a patient with suspected ALTE?
Careful History! (duration, measures taken to resuscitate, infant’s recovery)
Physical Exam
What is the MOST important part of the examination that can explain cause of death for suspected SIDS/SUIDS?
Postmortem autopsy
Causes of death included under SUID include:
infection ingestion metabolic diseases cardiac arrhythmias trauma accidental suffocation and strangulation (from unsafe sleep surfaces)
Risk factors of SUID includes?
What is not a risk factor?
ethic/racial minority socioeconomically disadvantaged (prone positioning, bed sharing) males premature birth, low birth weight recent infection young maternal age high paternal parity maternal tobacco or drug use crowded living conditions RECENT IMMUNIZATIONS IS NOT A FACTOR!
The FNP suspects SUID. What is the MOST consistent finding he/she should be looking for?
Intrathoracic petechiae and mild inflammation / congestion of the respiratory tract
(brainstem gliosis, extramedullary hematopoiesis or increase in peri-adrenal brown fat suggests infant had intermittent or chronic hypoxia before death)
