Sleep Medicine in Children Flashcards
What are the respiratory patterns of foetuses?
- Periodic/apneic before 36 weeks
- Increased regular resp after 36 weeks
What are the sleep patterns of new-borns?
- 16-18hrs asleep
- Sleep- wake states alternate in 3-4 hr cycles
- Then start to adapt to light/dark/social cues
What are the sleep patterns of 6 month olds?
- 14-15hr asleep
- 2 longer sleep periods at night
- 1-2 daytime naps
What are the sleep patterns of 2 year olds?
- 12 hr asleep
- 1 daytime nap
How can the sleep of prepubertal children be described?
-Highly efficient
How can the sleep of adolescents be described?
- Increased awakenings
- Need more/obtain less
How is sleep assessed in children?
- Polysomnography
- Direct behavioural observation
- Time-lapse video
- Movement sensors in cot mattress
- Oxygen/CO2 monitoring
What are normal sleep presentation?
- Sleep walking is normal in toddlers
- REM onset normal in first 3 months
What are abnormal sleep presentations?
- Napping and enuresis become relatively abnormal after 3-5 yrs
- 1 yr old abnormal if sleeps 8hr at night and does not nap
- Abnormal if unmedicated adult is unarousable from sleep
Give examples of normal phenomena (3)
- Sleep walking
- Sleep terrors
- Hypnic jerks
What can cause sleeplessness?
-Mainly behavioural problems
-Medication
Neurological disorders
What can cause excessive sleepiness?
- Insufficient sleep
- OSAS
- Narcolepsy
Define primary snoring.
-Snoring without apnoea, hypoventilation, hypoxia, hypercarbia, daytime symptoms
What is the prevalence of primary snoring?
~10%
What can primary snoring progress to?
OSAS
What may cure some cases of primary snoring?
Adenotonsillectomy
What is the prevalence of OSAS?
~2%
What is the morbidity of OSAS?
- Failure to thrive
- Neurocognitive defects/ADHD
- Systemic hypertension
- Cor pulmonale
What is the treatment?
- Adenotonsillectomy
- CPAP
- Weight loss
- Avoid environmental tobacco smoke
What respiratory disorders can children have that affect sleep?
- Chronic neonatal lung disease
- Cystic fibrosis
- Asthma
How can chronic neonatal lung disease affect sleep ?
- Hypoxaemia in REM sleep
- Cardiac complications
How can cystic fibrosis affect sleep?
- FEV1 30-60% associated with decreased SaO2
- Less REM/more awakenings
What neurological disorders can children have that affect sleep?
- Cerebral palsy
- Down syndrome
- Prader-Willi Syndrome
How can cerebral palsy affect sleep?
- Fragmented sleep/delayed onset
- Melatonin
How can Down Syndrome affect sleep?
OSAS
How can Prader-Willi Syndrome affect sleep?
-Excessive daytime sleepiness
How do neuromuscular disorders such as Duchenne’s MD affect sleep?
- Death due to respiratory failure
- Nocturnal desaturation associated with FVC <1litre
- Increasing quality of life/survival with BiPap
