Paediatric Sleep Disorders

Question 1

OSA in children: aetiology/causes

Answer 1

• Adenotonsillar hypertrophy
• Obesity (increased neck thickness)
• Craniofacial abnormalities (e.g. micrognathia; tongue pushed backwards)
• Neuromuscular disorders (cerebral palsy, down syndrome)

Question 2

OSA in children: diagnosis

Answer 2

• Hx (snoring, observed apneas, daytime somnolence, secondary bedwetting/enuresis)
• Physical exam (enlarged tonsils?, nasal obstruction?, craniofacial abnormalities [e.g. midface hypoplasia; eugene alford], faltering growth, obesity)
• Polysomnography (gives apnea-hypopnea number per hour [apnoea-hypopnoea index; AHI])
• Overnight oximetry

Question 3

OSA and primary snoring in children: natural history

Answer 3

• Cardiovascular remodelling (sympa activation)
• Blood pressure elevation
• Poorere school performance
• Increased likelihood behavioural issues
• Increased depression risk

Question 4

OSA in children: management

Answer 4

• Tonsillectomy and adenoidectomy (gold standard)
• Intranasal steroids for milder cases
• CPAP for post-surgical residual OSA

Question 5

What are the four stages of sleep? In which stage does pathology most commonly occur?

Answer 5

• Stage 1: light sleep, easy to wake
• Stage 2: k complexes, sleep spindles on EEG
• Stage 3/4: deeper, very hard to rouse
• REM: no muscle tone, rapid eye movement, irregular resp/heart rate

REM is where most pathology occurs

Question 6

What is the pattern of proportions of REM/NREM of total sleep in childhood vs adulthood? Link this to pathology

Answer 6

• Throughout life, less REM and more NREM (kids dream more)
• Since most pathology occurs in REM, this also means kids have more time during which things can go wrong

Question 7

What’s the core differentiating feature between OSA and primary snoring in children?

Answer 7

• Primary snoring is not associated with oxygen desaturation or arousal from sleep (Sophie & Cleo)
• Sleep apnoea is associated with oxygen desaturation and arousal from sleep (Tony Andonas)

Question 8

Complications of OSA in children

Answer 8

• Cor pulmonale
• Failure to thrive
• Developmental delay/behavioral issues (also seen in PS)

Question 9

Describe mallampati scoring system (used in anos)

Answer 9

• Measure of size of airway
• Scored from 1-4; lower number, more visible structures = larger and easier airway to manage/less likely OSA

Question 10

What are some metrics we track during polysomnography?

Answer 10

• EEG (check for arousal from sleep)
• EOG (check for REM sleep)
• EMG (check for muscle tone at the chin)
• Airflow (nose vs mouth ?where is the obstruction)
• ECG
• Heart rate
• Pulse oximetry