Sleep apnoea and neuromuscular respiratory failure in children

Question 1

What are respiratory patterns in newborns?

Answer 1

• 16-18 hours asleep
• Sleep-wake states alternate in 3-4 hour cycles
• Then start to adapt to light-dark/social cues.

Question 2

What are respiratory patterns in infants: 6 months and 2nd year?

Answer 2

6 months

• 14-15 hr asleep
• 2 longer sleep periods at night
• 1-2 daytime naps

2nd year

• 12 hr asleep
• 1 daytime nap

Question 3

Assessment methods of sleep in children?

Answer 3

• Polysomnography
• Oxygen/CO2 monitoring
• Direct behavioural observation
• Time-lapse video
• Movement sensors in cot mattress

Question 4

Normal v Abnormal patterns of sleep

Answer 4

• Napping and enuresis become relatively abnormal after 3-5y.
• 1y old “abnormal” if sleeps 8h at night and does not nap.
• Sleep walking normal in toddlers.
• Abnormal if unmedicated adult is unrousable from sleep.
• REM onset normal in first 3 months

Question 5

Other normal phenomena in sleep

Answer 5

• Sleep walking: middle childhood.
• Sleep terrors, “look of fear”
• Hypnic jerks

Question 6

Features of sleeplessness

Answer 6

• Mainly behavioural problems: infants 1+ arousal for 1-5 mins each night, self-soothers, signalers.
• Medication
• Neurological disorders e.g. melatonin

Question 7

What cause cause excessive sleepiness?

Answer 7

• Insufficient sleep
• OSAS
• Narcolepsy: often not diagnosed in childhood, cataplexy, orexin deficiency.

Question 8

What is primary snoring?

Answer 8

Snoring without apnea, hypoventilation, hypoxia, hypercarbia, daytime symptoms.

Prevalence - 10%
May progress to adenotonsillectomy.

Question 9

Features of OSAS

Answer 9

• Commonest pre-school child (adenoids)
• Prevalence, 2%.
• Morbidity: failure to thrive, neurocognitive defects/adhd, systemic hypertension, cor pulmonale.

Question 10

What is common in childhood OSAS?

Answer 10

• Mouth breathing
• Enlarged tonsils
• Hyperventilation as an obstructive pattern

Question 11

Treatment for childhood ASOS

Answer 11

• Adenotonsillectomy
• (CPAP)
• Weight loss
• Avoid environmental tobacco smoke

Question 12

Respiratory disorders in children linked to sleep

Answer 12

• Chronic neonatal lung disease: hypoxaemia in REM sleep (similar COPD), cardiac complications
• Cystic fibrosis: FEV1 30-60% associated with decreased SaO2, less REM/more awakenings
• Asthma

Question 13

Neurological disorders linked to sleep problems

Answer 13

• Cerebral palsy: fragmented sleep/delayed onset , melatonin
• Down syndrome: OSAS
• Prader-Willi syndrome: excessive daytime sleepiness
• Neuromuscular disease (Duchenne’s MD)

Question 14

Features of Neuromuscular disease (Duchenne’s MD)

Answer 14

• Death due to respiratory failure
• Nocturnal desaturation associated with FVC <1 litre
• Increasing quality of life/survival with BiPAP