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Pediatric Sleep > Pediatric Sleep > Flashcards

Pediatric Sleep Flashcards

1
Q

What characterizes T sleep in an infant

A

T has features of NREM sleep such as closed eyes, regular respiration, and absence of rapid eye movements.
It also contains features of REM sleep with low baseline chin EMG, transient muscle activity, and low-voltage mixed frequency EEG
At least three NREM and two REM or Vice versa

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2
Q

What characterizes wake in an infant

A

Eyes open open intermittently or scanning movements

vocalization or feeding

sustained chin EMG tone with burst of muscle activity plus irregular respirations

low-voltage irregular or mixed voltage EEG

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3
Q

What characterizes Infant NREM

A 
Eyes closed No Eye movements
Chin tone in chin EMG
Regular respiration
Trace alternant high-voltage slow or sleep spindles
Few body movements
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4
Q

Describe Infant REM

A

Low chin EMG

Eyes closed at least one movement

Irregular respiration

Sucking, twitches, or brief head movements

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5
Q

what are Pediatric rules for obstructive apnea

A

Greater than 90% drop in thermal sensor for minimum of two breaths duration

presence of respiratory effort during the event

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6
Q

Pediatric central apnea

A

Greater than 90% drop in on nasal thermal sensor absence of respiratory effort during event last 20 seconds or shorter minimum of two breaths duration but is associated with either arousal, greater than or equal to 3% desaturation

Four instance less than one year decrease in heart rate to West and 50 bpm for at least five seconds or 60 bpm for 15 seconds

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7
Q

What are the criteria for pediatric hypopnea

A

30% drop in nasal pressure transducer signal

3% desaturation arousal minimum of two breaths duration

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8
Q

What are the criteria far Obstructive hypopnea In pediatrics

A

Snoring increased flattening of nasal transducer chest abdomen paradox

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9
Q

What are the criteria for Central hypopnea in pediatrics

A

Meets none of criteria for obstructive hypopnea

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10
Q

Pediatric hypoventilation

A

PCO2>50mm Hg for 25% of total sleep time or >55 for 10 min or elevation in PCO2 > 50 for 10min

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11
Q

What gives end tidal CO2 Triangular wave peaks

A

Nasal obstruction, mouth breathing, supplemental oxygen, and moisture in the tubing

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12
Q

What is Hypnagogic Hypersynchrony

A

Rhythmic, diffuse, bilateral, high amplitude rhythm with a frequency of 3 to 4.5 Hz

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13
Q

What Frequency is the posterior dominant rhythm at various ages

A

At three months 3.5 Hz
at six months six hertz
at 36 months 8 hertz
nine years nine hertz, adult 8 to 13 hertz

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14
Q

What is the timing of Trace discontinue vs trace alternant

A

36 weeks vs 46 weeks

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15
Q

When can all stages of sleep be seen in infant sleep

A

EEG waveforms that allow non-REM sleep to be divided into stages N1 N2, and N3 identifiable by 5 to 6 months of life.

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16
Q

Describe what sleep stage produces periodic breathing in infants

A

Periodic breathing occurs in REM sleep in infants because certain factors that predispose infants to respiratory instability

low functional residual capacity

neuronal instability, sleep stage, and low apnea threshold.

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17
Q

Define pediatric central apnea

A

According to pediatric respiratory scoring rules, a central apnea is scored when there’s a drop in the flow signal by 90% of baseline on the thermal sensor and the event lasts greater than 20 seconds or duration of two breaths and is associated with either an arousal or arterial desaturation greater than 3% or in infants less than a year a decrease in heart rate to less than 50 bpm for at least five seconds or 60 bpm for at least 15 seconds

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18
Q

How do you Prevent crib death

A

Lay the infant in a supine position

Use a firm mattress cover it with a film sheet

Placed it in a bassinet in the parents bedroom

Breast-feed

Offer a pacifier at bedtime and nap times

Stay up-to-date with immunization

Supervised the week tummy time

Don’t smoke

Don’t use commercially available devices they claim to prevent SIDS

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19
Q

When does pulse oximetry Become inaccurate

A

Below 80% however, motion low perfusion abnormal hemoglobin dark skin pigmentation synthetic nails and nail polish can make it more inaccurate

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20
Q

When do infant sleep spindles occur

A

Sleep spindles occur by age 3 months.

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21
Q

When do infant k complexes emerge

A

K complexes and slow waves by six months.

22
Q

When do infant slow waves emerge

A

slow waves emerge by six months.

Slow wave activity in children is frequently high amplitude 100 to 400 Microvolts.

23
Q

What is risk of SIDS

A 
SIDS occurs at 40 per 100,000 live births. 
It occurs in the winter months. 
It occurs at high altitude’s. 
80% occurs during night time sleep. 
It occurs in four months of age. 
It is more common in males. 
Pacifier use reduces SIDS
24
Q

What is the best marker of drowsiness in an infant 0 to 2 months of age

A

Sustained closure of the eyes is the best marker of drowsiness and in the infant 0 to 2 months of age

25
Q

What is the best marker of the wake in infants 0 to 2 months of age

A

Eyes open is the best marker for wake in an infant

26
Q

When does stage T occur

A

in the transition from wake to REM

27
Q

What are infant sleep problems

A

SIDS

Self-limiting sleep wake problems.

28
Q

What are toddler sleep problems 1 to 2 years old

A

Night wakings

Difficulty settling

Rhythmic movements

Obstructive sleep apnea

29
Q

What are preschool 3 to 5 year problems

A

Night wakings

Bedtime resistance

Sleep terrors

Rhythmic movements

Bedtime fears

Nightmares

Obstructive sleep apnea

30
Q

What are school-age sleep problems

A

Insufficient sleep

Bedtime resistance

Night wakings

Confusional arousals

Sleepwalking

Obstructive sleep apnea

Enuresis

Bruxism

Narcolepsy

Insomnia and anxiety

31
Q

What is the effectiveness of adenotonsillectomy in sleep apnea

A

80% effective but watchful waiting may be an option and CPAP is second in line.

32
Q

What are the findings of CHAT

A

No significant difference in measured executive function

Global behaviors improved

Quality of life improved

Obstructive sleep apnea symptoms including snoring and sleeping this improve.

Normalization of the PSG in a larger proportion of cases

33
Q

What are risk factors for pediatric obstructive sleep apnea

A

Asthma

nasal allergies

sickle cell

African-American

Prematurity

Prior tonsillectomy

Positive family History

Environmental

34
Q

What is the severity rating for sleep apnea in children

A

2 to 5 is mild; 5 to 10 is Moderate; over 10 is severe

35
Q

What childhood conditions are Comorbid for obstructive sleep apnea

A

Downs

Prader Willi

Achrondoplasia

Morbid obesity

Pierre Robyn

Cerebral palsy

Sickle cell disease

Spina bifida

Chiari 1

Hunter’s

Craniosynostosis

36
Q

Pierre Robin Anomaly

A

Micrognathia, glossoptosis
UAO
 cleft palate
May have other cardiac,
pulmonary or GI abnormalities
High risk for OSA and feeding difficulties
Can be part of many genetic syndromes
Requires craniofacial, dental , other ENT procedures
Distraction osteogenesis has replaced tracheostomy in infancy

37
Q

What type of respiratory problems occur with Spina Bifida, Chiari II malformation, VP shunt, and spinal cord defect

A
  • Respiratory control abnormalities
  • Apnea, bradypnea, hypoventilation
  • Absent O2, CO2 responses
  • OSA 2º vocal cord paresis
  • Breath-holding spells
  • Restrictive lung disease
38
Q

What sleep problems occur with Achondroplasia and Other Forms of Dwarfism

A
  • SDB risk factors for both OSA (32%) and central apnea (60%)
  • Midface hypoplasia, short cranial base,
  • Brainstem compression @ foramen magnum (35%)
  • Pulmonary restriction (90%); nocturnal hypoxemia (44%)
39
Q

Central Sleep Apnea (CSA) in Childhood

A
  • CSA in early infancy: part of immaturity of respiratory control
  • desaturations with altered mechanics, immature reflexes
  • Short (< 20 sec) central pauses post sigh, post mvt, transition to sleep or in REM are common in children (usually < 5/hr)
  • Outside of infancy (or altitude), CSA  hypoventilation is unusual requires further evaluation!
  • a/w other disorders: neurodevelopment, metabolic, genetic
  • If otherwise normal, r/o hindbrain malformation, eg Chiari I, tumor
40
Q

What are the characteristics of Congenital Central Hypoventilation Syndrome

A
  • Rare genetic disorder of autonomic dysregulation and control of breathing
  • Profound hypoventilation; NREM > REM > ± Wake; ↓ CO2 response, ↓O2 response
  • Normal respiratory rate, ↓ tidal volume rather than central apnea
  • Hirschsprung’s ~20%, neural crest tumors ~6%, other ANS dysfunction
  • PHOX2B, disease-defining gene, must test patient, parent
  • Autosomal dominant, heterozygote, 90% de novo
  • 90% from polyalanine repeat expansion, 10% other
  • PHOX2B genotype informs CCHS phenotype; more repeats = more severe
  • If PHOX2B is negative, look for another disease
  • Treatment: invasive, non-invasive ventilation and diaphragmatic pacing
41
Q

What is ROHHAD (in ICSD-3): Late Onset Central hypoventilation

A

• Rapid onset obesity with hypothalamic dysfunction, hypoventilation,
and autonomic dysregulation
• Endocrine dysfunction: ↓thyroid, ROHHAD (in ICSD-3): Late Onset Central Hypoventilation
• Rapid onset obesity with hypothalamic dysfunction, hypoventilation,and autonomic dysregulation
• Endocrine dysfunction: ↓thyroid, ↓GH, DI, precocious puberty
• Autonomic: temp instability, pupillary abnormalities, GI dysmotility
• Association with tumors of neural origin
• Rapid weight gain with hyperphagia between 3 to 10 y
• High incidence of respiratory arrest: 50-60% require ventilation
• PHOX2B mutations not seen GH, DI, precocious puberty

42
Q

What is Rett Syndrome

A

MECP2 gene on X chromosome; 1/10 K females
• Developmental regression 6 – 18 months with stereotypic movements, dystonia, seizures, aspiration, scoliosis; high incidence of sudden death
• Breathing
• Wake: hyperventilation alternating with prolonged apnea;
• Sleep: central apneas, insomnia, circadian disturbance

43
Q

What is normal breathing in healthy full-term infants.

A

Full-term infants: centrals < 20 sec, but OA rare
• Healthy term infants 43% had central apnea >20 s; 2% had >30 s
• Regular breathing in NREM sleep; irregular breathing in REM sleep
• Thoraco-abdominal asynchrony in REM up to age 2-3 y
• Desaturation with normal pauses, especially if lung disease

44
Q

What kind of issues occur in preterm Infants

A

• Apnea of prematurity: 100% if <1000 gm; rare after 36 wk
• Last longer with greater immaturity; management caffeine
• Associated with periodic breathing
• Apnea can “reappear” if triggered by illness or metabolic disturbance
• Prolonged apnea and bradycardia in preterm infants typically disappears by
43-44 week post-conceptional age

45
Q

Defined.Periodic Breathing In children

A

• 3 or more episodes of central apnea last ≥ 3 sec separated by no more than 20 sec of
normal breathing; cycle length 16 sec
• Commonly seen in preterm infants, rare in childhood
• % of sleep time: up to 5% (term) and 10% (preterm < 40 wk PCA)
• 1 preterm > term; related to lower lung volumes; faster desaturation rates
• Can improve with supplemental O2 in infants with desaturation
• Often caused by ventilatory instability where apneic CO2 threshold ~ 1 torr below eupneic CO2
• In older infants and children, can be a sign of CNS pathology

46
Q

Describe Sudden Infant Death Syndrome (SIDS)

A

• Sudden death of a child < 1 y, unexplained after post
mortem and death scene investigation
• Prevalence (2013) is 39.7/100,000
– Peak age 4 mo; winter, altitude, 80% nighttime sleep
• Modifiable risk factors: position, maternal smoking,
bed sharing, soft sleeping surfaces, overheating
• Protective factors: supine, breastfeeding, room
sharing, pacifier use
– Apnea monitors do not reduce risk

47
Q

Define Sleep Hypoventilation In childhood

A

≥ 25% total sleep time ≥ 50 mmHg by

EtCO2 or tcCO2

48
Q

What are the usual Genetic Disorders with Awake Hyperventilation with Apnea

A 
• Rett’s
• Joubert’s
• Angelman’s
• Pitt-Hopkins
• Mitochondrial disorder
– Dilated cardiomyopathy with ataxia
49
Q

Described Joubert’s and Breath Holding

A

• Rare (1/80,000), heterogeneous, AR disorder
– Agenesis of the cerebellar vermis and failure of decussation of the superior cerebellar peduncles and pyramidal tracts
– Ataxia, hypotonia, nystagmus, and MR
– “molar tooth sign” on MRI
• Breathing disturbances: tachypnea followed by prolong central apnea in wake and sleep or other types of periodic breathing
also at risk for OSA

50
Q

How is Infant periodic breathing defined

A

The scoring manual defines periodic breathing as three more episodes of central apnea lasting for at least three seconds each and separated by 20 seconds or less of normal breathing. Periodic breathing in the absence of high altitude is abnormal if it is 5% of total sleep time in full term or 10% in preterm

Pediatric Sleep (1 decks)

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