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MDCN 370: Course 3 > Pediatric Sleep Problems > Flashcards

Pediatric Sleep Problems Flashcards

1
Q

BEARS problems

A

bedtime problems

excessive day time sleepiness

awakenings at night

regularity/duration of sleep

snoring

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2
Q

3 types of respiratory sleep disorders

A
  1. hypoventilation
  2. OSA
  3. CSA
    - can have more than one
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3
Q

6 year old boy
– History of snoring, restless sleep
– Concerns regarding attention and focus in school
Tonsillar hypertrophy on examination

type of respiratory sleep disorder?

A

obstructive sleep apnea

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4
Q

Obstructive Sleep Apnea (OSA)

A

• Recurrent events of partial or complete upper
airway obstruction during sleep

• Disruption of normal gas exchange (hypoxia,
hypercapnia)

• Sleep fragmentation

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5
Q

anatomic factors that cause OSA

A
  • Adenotonsillar hypertrophy
  • Pharyngeal tissue
  • Mandible size/position
  • Airway size
  • Fatty infiltration
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6
Q

functional factors of OSA

A

• Reduced tone of pharyngeal
dilator muscles

• Ventilatory control
variability

• Upper airway reflexes and
arousal response blunted

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7
Q

pathway to OSA from snoring

A
  1. snoring
  2. upper airway resistance syndrome
  3. OSA
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8
Q
A
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9
Q

biggest risk factor in typical child for oSA

A

adenotonsillar hypertrophy

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10
Q

how does pierre robin sequence, premature infant, or obese child get predisposed to OSA

A

these syndromes affec airway structure

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11
Q

how do children with cerebral palsy have a higher risk factor for OSA

A

it affects airway tone

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12
Q

how do kids with downs sydnrome get predisposed with ISA

A

combo of adenotonsillar hypertrophy, they have more airway compressibilities and they have alterations in air way structure

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13
Q

consequences of OSA

A
  1. systemic inflammatory condition
  2. cardiovascular – systemic, pulmonary hypertension
  3. metabolic – lipid abnormalities, insulin resistance
  4. somatic growth impairment
  5. neurobehaviroual (hyperactivity, impulsivity, depression)
  6. cognitive impairments
  7. decreased quality of life
  8. increased health care utilization
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14
Q

clinical presentation of nocturnal OSA

A
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15
Q

day time presentation of OSA

A
  • Difficulty waking
  • Morning headaches
  • Nasal obstruction •

Mouth breathing •

Daytime fatigue

  • Daytime sleepiness
  • Hyperactivity
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16
Q

things to do on PE for OSA

A
  1. oropharyngeal/nasal assessment and malampatti score
  2. facial structure assessment
  3. height/weight
  4. vitals, screening cardiorespiratory exam
17
Q

T?F: Clinical history and physical exam are poor predictors
of OSA

A

true.

• Home sleep apnea testing is often not feasible, is not
validated, and is not recommended in children

• Gold standard test for diagnosis is the overnight
polysomnogram (PSG)

• So why didn’t we refer this patient for PSG?

18
Q

factors that are measured by PSG

A
  1. sleep quality
  2. respiratory pattenr
  3. gas exchange
  4. limb movements
19
Q

gold standard test for OSA

A

• Gold standard test for diagnosis is the overnight
polysomnogram (PSG)

20
Q

what does each lead represent

A
21
Q

• Obstructive apnea = “trying to breathe and can’t”
– Absent airflow despite continued respiratory effort
– Lasts ___ breaths or longer

___ = “poor quality breathing causing and/or arousal on EEG troubles”
– Decrease in airflow by >___% of baseline
– Lasts two breaths or longer
– Associated with a 3% drop in oxygen saturation

A

• Obstructive apnea = “trying to breathe and can’t”
– Absent airflow despite continued respiratory effort
– Lasts 2 breaths or longer

hypopnea = “poor quality breathing causing and/or arousal on EEG troubles”
– Decrease in airflow by >30% of baseline
– Lasts two breaths or longer
– Associated with a 3% drop in oxygen saturation

22
Q

normal and severe OSA

A
23
Q

we have huge accessibility problems for PSG in children. Who needs a PSG? Who must have one?

A
  • children who are high risk for adenotonsillectomy: less than 2-3 years old, syndromic children
  • diagnostic dilemma (small/absent tonsils issue)
  • recommended screening (achondroplasia, trisomy 21)
  • children with classic OSA presentation– just refer to ENT
24
Q

___ remains first line treatment
for obese children with OSA

A

Adenotonsillectomy remains first line treatment
for obese children with OSA

  • encourage weight stabilization/weight loss
25
Q

central apnea

A

Central apnea = “not trying to breathe, either for a long time, or long enough to cause troubles”

26
Q

• Central apneas are common in healthy infants
and children, especially during ___ sleep

– Central apnea index (CAI) derived from PSG data

– 0 – 6 events/hr in healthy children > 1 year old

– More frequent in infants under a year of age

• Clinical cutoffs for significance vary from 1 – 5

A

• Central apneas are common in healthy infants
and children, especially during REM sleep

27
Q

praimary vs secondary CS

A
28
Q

management of CSA

A

NIPPV, IPPV

29
Q

note; kids with CSA don’t have nocturnal symptoms– no snoring, but they’re so still and not breathing. because of sleep distrurbances, they have daytime symptoms (irritability)

A
30
Q

What counts as hypoventilation?
Elevation of carbon dioxide greater than ___ mmHg for 25% of the night

  • • Can be an isolated issue, or in combination with
    obstructive or central sleep apnea

• An additional group at high risk is children with
decreased muscle tone (eg __
disorders)

A

What counts as hypoventilation?
Elevation of carbon dioxide greater than 50 mmHg for 25% of the night

  • • Can be an isolated issue, or in combination with
    obstructive or central sleep apnea

• An additional group at high risk is children with
decreased muscle tone (eg NEUROMUSCULAR
disorders)

31
Q

management of hypoventilaton

A
32
Q

T/F – Snoring is a good predictor for sleep disordered
breathing in children with Trisomy 21

A

false.•

Sleep disordered breathing is very common in
children with Trisomy 21
– Snoring is NOT a good predictor for sleep disordered
breathing in children with Trisomy 21

33
Q

in trisomy21, ___ ____ is the most common abnormality on PSG

A 
obstructive hypoventilation (a mix of OSA and
hypoventilation)
34
Q

in trisomy 21, ___ curative in ~50%, so follow-
up is required

A

Adenotonsillectomy curative in ~50%, so follow-
up is required

MDCN 370: Course 3 (90 decks)

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