Sleep Medicine in Children

Question 1

What are the respiratory patterns of foetuses?

Answer 1

• Periodic/apneic before 36 weeks

- Increased regular resp after 36 weeks

Question 2

What are the sleep patterns of new-borns?

Answer 2

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

Question 3

What are the sleep patterns of 6 month olds?

Answer 3

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

Question 4

What are the sleep patterns of 2 year olds?

Answer 4

• 12 hr asleep

- 1 daytime nap

Question 5

How can the sleep of prepubertal children be described?

Answer 5

-Highly efficient

Question 6

How can the sleep of adolescents be described?

Answer 6

• Increased awakenings

- Need more/obtain less

Question 7

How is sleep assessed in children?

Answer 7

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

Question 8

What are normal sleep presentation?

Answer 8

• Sleep walking is normal in toddlers

- REM onset normal in first 3 months

Question 9

What are abnormal sleep presentations?

Answer 9

• 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

Question 10

Give examples of normal phenomena (3)

Answer 10

• Sleep walking
• Sleep terrors
• Hypnic jerks

Question 11

What can cause sleeplessness?

Answer 11

-Mainly behavioural problems
-Medication
Neurological disorders

Question 12

What can cause excessive sleepiness?

Answer 12

• Insufficient sleep
• OSAS
• Narcolepsy

Question 13

Define primary snoring.

Answer 13

-Snoring without apnoea, hypoventilation, hypoxia, hypercarbia, daytime symptoms

Question 14

What is the prevalence of primary snoring?

Answer 14

~10%

Question 15

What can primary snoring progress to?

Answer 15

OSAS

Question 16

What may cure some cases of primary snoring?

Answer 16

Adenotonsillectomy

Question 17

What is the prevalence of OSAS?

Answer 17

~2%

Question 18

What is the morbidity of OSAS?

Answer 18

• Failure to thrive
• Neurocognitive defects/ADHD
• Systemic hypertension
• Cor pulmonale

Question 19

What is the treatment?

Answer 19

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

Question 20

What respiratory disorders can children have that affect sleep?

Answer 20

• Chronic neonatal lung disease
• Cystic fibrosis
• Asthma

Question 21

How can chronic neonatal lung disease affect sleep ?

Answer 21

• Hypoxaemia in REM sleep

- Cardiac complications

Question 22

How can cystic fibrosis affect sleep?

Answer 22

• FEV1 30-60% associated with decreased SaO2

- Less REM/more awakenings

Question 23

What neurological disorders can children have that affect sleep?

Answer 23

• Cerebral palsy
• Down syndrome
• Prader-Willi Syndrome

Question 24

How can cerebral palsy affect sleep?

Answer 24

• Fragmented sleep/delayed onset

- Melatonin

Question 25

How can Down Syndrome affect sleep?

Answer 25

OSAS

Question 26

How can Prader-Willi Syndrome affect sleep?

Answer 26

-Excessive daytime sleepiness

Question 27

How do neuromuscular disorders such as Duchenne’s MD affect sleep?

Answer 27

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