Ch 19 Sleep disordered breathing/snoring/OA/ALTE/SIDS

Question 1

________ is any abnormal respiratory pattern during sleep, which may include noisy breathing, mouth breathing, and/or pauses in breathing

Answer 1

Sleep-disordered breathing

Question 2

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?

Answer 2

Obstructive sleep apnea

Question 3

2 - 7 year olds typically present with what specific finding associated with airway obstruction?

Answer 3

tonsillar hypertrophy

obesity may also be a risk for airway obstruction

Question 4

Obstructive sleep apnea in children may have what medical conditions or are on what types of medications that cause this

Answer 4

Craniofacial abnormalities
Neuromuscular disease
on medications like Hypnotics, sedatives, anticonvulsants

Question 5

What is the gold standard for diagnosis of obstructive sleep apnea?

Answer 5

Polysomnography

“sleep study”

Question 6

____________ is the cessation of breathing and classified as either obstructive or central

Answer 6

sleep apnea

Question 7

Describe obstructive sleep apnea

Answer 7

airflow stops despite persistence of respiratory effort

Question 8

Describe central sleep apnea

Answer 8

lack of effort to breathe

Question 9

What children are at greater concern for central apnea?

Answer 9

infants/children - especially high elevation

Question 10

What are nighttime symptoms of obstructive sleep apnea?

Answer 10

habitual snoring
gasping or pausing
labored breathing
night terrors, sleep walking, enuresis, morning headaches

Question 11

What are daytime symptoms of obstructive sleep apnea?

Answer 11

un-refreshed sleep
attention deficit
hyperactivity
emotional lability
temperamental behavior
poor weight gain
daytime fatiuge** (adults)

Question 12

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?

Answer 12

arrange for sleep study

Refer for ENT evaluation (a 3+ with QOL issues also receives this recommendation)

Question 13

A child with 3+ tonsils and nightly snoring, but no gasping, apnea, or pauses. What should the NP consider?

Answer 13

observation

Question 14

A healthy child that snores with recurrent tonsillitis should be

Answer 14

referred for adenotonsillectomy

Question 15

A healthy child that snores with normal tonsils 1-2+ without quality of life issues should be assessed for what?

Answer 15

any nasal obstruction

treat if so and reevaluated snoring or if not assess the adenoids (enlargement = ENT eval)

Question 16

_______ _____ are pauses in breathing without concomitant effort and may occur in a pattern of alternating apnea and tachypnea (periodic breathing).

Answer 16

Central apnea - infants and children, especially high elevation

Question 17

What is the intervention for central apnea?

Answer 17

none!

may use supplemental oxygen if necessary

Question 18

What is an apparent life-threatening event (ALTE)?

Answer 18

An acute, unexpected change in an infant’s breathing, appearance, or behavior that is frightening to the observer.

Question 19

What are characteristic findings of ALTEs?

Answer 19

Apnea
Change of color
Marked change in muscle tone
Choking
Gagging

Question 20

What will a thoracentesis reveal post ALTE in an infant?

Answer 20

blood in the pleural space

Question 21

What body systems are associated as a problem with ALTEs?

Answer 21

Gastrointestinal (50%)
Neurologic
Respiratory
Cardiovascular
Metabolic/endocrine

Question 22

The NP must obtain what from the parents with a patient with suspected ALTE?

Answer 22

Careful History! (duration, measures taken to resuscitate, infant’s recovery)
Physical Exam

Question 23

What is the MOST important part of the examination that can explain cause of death for suspected SIDS/SUIDS?

Answer 23

Postmortem autopsy

Question 24

Causes of death included under SUID include:

Answer 24

infection
ingestion
metabolic diseases
cardiac arrhythmias
trauma
accidental suffocation and strangulation (from unsafe sleep surfaces)

Question 25

Risk factors of SUID includes?

What is not a risk factor?

Answer 25

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!

Question 26

The FNP suspects SUID. What is the MOST consistent finding he/she should be looking for?

Answer 26

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)