Week 5- Sleep disorders in children Flashcards
Why is sleep important?
it is an acitve process invovled in learning and memory, growth and repair, and immune fucntion
adults spend 1/3 of their life asleep and kids 1/2
Physiological effects of sleep
- lowered BP by 10-20mmHg
- lowered HR
- lowered CO
- lowered sympathetic activity
- increased parasympathetic activity
- decreased muscle tone( including airway muscles)
Dysomnia
trouble falling asleep or staying asleep
conditions like…
- sleep disordered brething
- insomnia
- circadian rhythm sleep-wake disorder
- narcolepsy and hypersomnolence
- restless legs syndrome
parasomnias
abnormal activities during sleep
things like…
- sleepwalking
- sleep terrors
- rhythmic movement disorder
- bruxism
- sleep paralysis
major cause of sleep-disordered breathing in children?
adenotonsillar hypertrophy
enlarged tonsils and adenoids decrease muscle tone and cause occlusion in the airways.
this causes either (more common) partial obstruction or complete obstruction
Features that may increase OSA likelihood in children
- snoring or noisy breahting suring sleep present for 3 or more nights a week
- increased effort of breathing whilse asleep
- choking/gasping/snoring noises observed by parents following apnea
- frequent daytime mouth breathing
- pectus excavatum
- “funnel chest”
- rare but seen with more severe OSA
How do we diagnose OSA?
The gold standard is polysomnography( sleep study)
What occurs in OSA?
physical symptoms include loud snoring and increased work of breathing
Important risk factors for osa
predisposing factors of down syndrome for OSA?
- macroglossia
- large tongue leads to increased occlusion
- midfacial hypoplasia
- mid face grows slower
- overweight
- there is an association of OSA with increased weight
- poor muscle tone
OSA in down syndrome kids vs non syndromic
OSA prevalence is up to 75% in syndromic gorup
syndromic group demonstrates worse gas exchange and also they seem to have more CVD complications because of the CVD stress occurring in OSA
Prader-Willi and SDB
SDB thought to be caused by mix of hypotonia and craniofacial dysmorphism
OSA has been diagnosed in 44% of PWS kids who were referred for sleep before starting GH therapy
Growth hormone treatment in PWS
PWS kids have decreased grwoth hormone so it was being supplemented to improve growth and body compostion
it was found that resp disorders have been implicated as a cause of death in this group with sudden death being seen during sleep. Hypothesized that growth hormone lead to increased lymphoid tissue which potentially caused a fatal event
Aus guidelines now
OSA in adults vs children
How do we measure severity of SDB?
Severity is measured according to the OAHI(obstructive apnoea hypopnoea index)
prevalence of OSA and primary snoring in a paediatric population
prevalence: Osa=1-5%, primary snoring=8-27%
when is peak incidence of SDB
between 3-6yrs as this is when the tonsils and adenoids are the largest
does obesity increase the risk of OSA in kids
yes it does, OSA affects up to 50% of overweight and obese children
The challenges in measuring burden of disease and diagnosis
- clinical hisotry alone is a poor diagnsoitic took as it has low accuracy (very variable) in predicting OSA in kids
- the gold standard sleep studies are expensive and there si only limited avail. it is also not well tolerated in many children
- many kids who have strong history of enlarged tonsils with no other comorbidities often get assessed by ENT so we are missing alot of kids in SDB meausrement who go straight to ENT
screening tools for OSA
Paedetiric sleep questionaires and pulse overnight oximetry
Consequences of SDB
can cause behav problems, neurocog deficits, CV consequences( hypoxia/arousals–>increased BP and increased symp activation
In adults OSA has been assocuated with..
hypertension, increased risk of MI and 4x risk of stroke, arrhythmias, renal disease
increased BP in children is also associated with increased BP in adults
Behvaioural issues and SDB
Increased frequency of hyperactivity and externalizing behaviours( aggression, oppositionality, irritability)
Neurocog consequences and SDB
differences in IQ seen with SDB
CV complication seen in SDB
SDB and blood pressure
How do we treat SDB in adults?
weight loss, CPAP
How do we treat SDB in children
what happens to children with SDB?
Adenotonsillectomy in treatment efficacy
Does treatment reverse SDB reverse CV sequelae
