sleep

Question 1

when do naps stop

Answer 1

5yo

Question 2

when do parasomnias peak and why?

Answer 2

parasomnias occur in SWS (stage 3+4 NREM)
SWS peaks in early childhood

Question 3

what age group has most REM

Answer 3

infants - 50% sleep is REM

Question 4

night terrors
- what
- when
- age

Answer 4

• sudden screaming/terror 1-3h after sleep onset (stage 3/4)
• 18mo to 7yo

Question 5

stage 3/4 NREM happens first or second half of night

Answer 5

first half

Question 6

three examples of partial arousal parasomnias

Answer 6

sleep walking/talking
confusional arousal
night terrors

Question 7

restless legs happen in what stage of sleep

Answer 7

stage 2 NREM sleep

Question 8

age of peak OSA prevalence and why

Answer 8

2-6yo - adenotonsillar hypertrophy

Question 9

how many children have OSA vs snore

Answer 9

20% snore, only 3% OSA

Question 10

positive oximetry for apnoeas

Answer 10

= > 3 clusters of SpO2 desaturations, with at least 3 desaturations <90%
can’t tell between central apnoeas and OSA on oximeter

Question 11

cx of OSA

Answer 11

1. neurocognitive
2. FTT
3. cardiac - systemic and pulmonary HTN

Question 12

normal RDI/AHI for PSG

Answer 12

<1
>10 severe

Question 13

advantage and disadvantage of longer average time on oximeter

Answer 13

reduces artefact, but reduced ability to detect rapid changes in saturations like in apnoeas

Question 14

PSG criteria for OSA

Answer 14

i. One or more obstructive apnoeas, mixed apnoeas, or hypopneas, per hour of sleep
ii. A pattern of obstructive hypoventilation, defined as >25% of total sleep time with hypercapnia (PaCO2 > 50 mmHg) in association with
1. Snoring
2. Flattening of the nasal pressure waveform
3. Paradoxical thoracoabdominal motion

Question 15

achondroplasia develop OSA - why?

Answer 15

cervical medullar stenosis - degree of foramen magnum involvement corresponds with extent of respiratory dysfunction

Question 16

important DDx of parasomnias

Answer 16

Nocturnal frontal lobe epilepsy (NFLE) - brief, repetitive stereotypical movements +/- vocalisations throughout the night that may be associated with awareness

Question 17

screaming is classic for which parasomnia

Answer 17

night terror

Question 18

compare nocturnal seizures vs parasomnia

Answer 18

parasomnia - first half of night, nocturnal seizure - random
parasomnia - 5-30min, nocturnal seizure - 1-5min
parasomnia - normal daytime behaviour

Question 19

confusional arousal vs night terror

Answer 19

confusional arousal usually <5yo
- wake gradually
- sit up with whimpering/crying/moaning, no sweating/flushing/sterotypic motor behaviour

night terror 4-8yo
- wake up suddenly screaming
- autonomic arousal

Question 20

4 key clinical features of narcolepsy

Answer 20

1. Profound daytime sleepiness (and night time)
2. Cataplexy = sudden and temporary loss of muscle tone
3. Hypnogogic/hypnopompic (immediately before falling asleep/after waking) hallucinations
4. Sleep paralysis