Pediatric Sleep Disorders

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sleep disorder classifications:
dyssomnias
parasomnias
secondary
proposed

Back 1

disturbed sleep or wakefulness
undesirable events or movements
to medical or psychiatric disorders
insufficient evidence to classify

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3 types of dyssomnia `

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extrinsic
intrinsic
circadian rhythm

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extrinsic dyssomnia

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causes of disorder due to causes outside of body ex) alcohol dependant, mountain sickness etc

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circadian rhythm dyssomnias

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Misalignment between physiological timing and
environmental cues or social norm and demands
ex) jet lag,

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insomnia complaints (2)

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difficult initiating sleep (result=bedtime resistance)
maintaing sleep (result=inability to sleep independently)

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insomnia impairs daytime resulting in inattention, mood affected, memory/conc problems, impaired ___

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performance

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patter of Behavioral Insomnia of Childhood consistent with either:
1)
or
2)

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Sleep-onset association type
Limit-setting type

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Sleep-onset association type-

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Child associates sleep onset with circumstances that are problematic/demanding of the caregiver
unable to fall asleep without these associations

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to treat sleep onset ass. you tell parents it (3)

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normal (awakenings at night normal)
ass. not abnormal, they are learned
new ass. can be taught

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to manage behavioral sleep disorders use (5)
which most effective?

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-extinction: cry it out
graduated extinction: timed "checks"
scheduled awakenings
systematic desensitization for fears
preventative education for parents
-*extinction

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limit setting type

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-refuse to go to bed at good time/after awakening
-inappropriate/insufficient limit setting shown by caregiver

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treatment for limit setting (4)

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-educate importance
-teach guidelines
-specific/individualized techniques
-positive reinforcement

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Circadian Sleep Disorders- ICSD-2*:
Delayed Sleep Phase Disorder
-SW delayed by __or more hours conflicts with ADL
-symptoms

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2
hard to initiate, impaired alertness during waking

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Circadian Sleep Disorders- ICSD-2*:
Advanced Sleep Phase Disorder
-body clock set too____
-symptoms
-sleep quality/during are___if uninterrupted

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early
insomnia, excessive sleepiness
normal

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Circadian Sleep Disorders- ICSD-2*:
Free-Running Circadian Rhythm
-SW variable due to
-symptoms
-SW pattern becomes

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-circadian pacemaker unable to get/is insensitive to info about light dark cycle
-insomnia, excessive sleepiness
-later each day, period longer than 24hr

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Nonpharmacologic Therapy to entrain circadian rhythm(2)

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light therapy
behavioral methods

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light therapy
give morning light for____
give evening light for___

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delayed sleep phase
advanced sleep phase

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behaviroal methods (3)

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establish regular wake up time
chronotherapy (extreme cases)
structured/successive delay of bedtime (2-3hours)

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can also use light therapy for people with

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adhd

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intrinisic dyssomnias

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causes within body
ex) restless leg syndrome, narcolepsy, sleep breathing disorder

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type of sleep disordered breathing based on

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amount of upper airway obstruction

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4 types of sleep disordered breathing:
primary snoring
upper airway resistance syndrome (UARS)
obstructive hypoventiliation
obstructive sleep apnea

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-noisy breathing
-noisy breathing+disturbed sleep
-NOISY BREATHING ± DISTURBED SLEEP +increase CO2 and/or decrease SaO2
-" "+absence of airflow

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order of increasing airway obstruction for sleep disordered breathing

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ps>uars>OH>OSA
*double check this may be wrong

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OSA epidemiology:
snoring in children
-____% habitual snorers
-____% intermittent snorers
-___% of preschool children have
-peaks from age___to___
-M:F ratio is

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7-10
20
1-3
2-5
approx equal

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for OSA if took cross section of oropharynx youd see (3)

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nasal obstruction
tonsilar hypertrophy
large tongue

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OSA shows ___symtoms

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diurnal

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PSG used to determine if have OSA
it differentiates OSA from_____
helps define
and evaluate

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primary snoring
severity
success of treatment

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(3) main Consequences of Pediatric OSA

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-effect growth
-neurocognitive morbidity
-cardiovascular consequences

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Neurocognitive Morbidity result in (4)

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depression
hyperactive/inattention/aggression
daytime sleepiness
impaired school performance

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OSA's cardiovascluar consequences involve (2)

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pulmonary hypertension
systemic hypertension

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below are surgical treatments for
Adenotonsillectomy
Uvulopalatopharyngoplasty
Craniofacial surgery
Tracheostomy

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pediatric osa

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below are medical treatments for
Continuous positive airway pressure(CPAP mask)
Weight loss if obese
Intranasal steroids

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pediatric osa

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childhood parasomnias occur during (3)

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entry into sleep
in sleep
during arousal from sleep

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3 types of parasomnia

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disorders of arousal from NREMS
parasomnia associated with REMS
other

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common words of confusional arousal

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no, no!

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sleep terrors:
peak age____
most will later____
begin abruptly from

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5-7
sleepwalk
NREMS

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clinical characteristics of sleepwalking
-____wandering (2)
-___behaviors
-most have few___effects

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-quiet&agitated
-inappropriate/variable complexity
-daytime

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disorders of arousal have ___basis

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family
60% of children have positive family
history
10-fold increased prevalence in first degree
relatives of an affected individual

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when evaluating disorders of arousal
video psg needed if (3)
PSG needed if

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-spells stereotypes/atypical features, potential injury
-if OSA suspected

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treat disorders of arousal with (4)

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time
emphasize sleep hygiene
secure bedroom to prevent injury
medication in severe cases

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get (3) with Parasomnias Associated with REM
Sleep

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nightmares
sleep paralysis
rem sleep behaviour disorder

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___%experiance nightmares
peak ages of children reporting

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75
6-10yrs (after this they decrease)

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nightmares:
usually occur during

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last half night

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anxiety/stress
personality
PTSD
all possible

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factors for nightmares

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for PTSD most common problem is

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trauma related nightmares (80% of PTSD have)

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can treat nightmares with(3)

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explanation/reassurance
sleep hygiene
behavioral therapies

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nightmare occur during__sleep
most common____
___return to sleep
__comforted
___recall
__autonomic activity
___upon awakening

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rem
parasomnia
delayed
easily
detailed
mild
alert

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sleep terrors:
-___sleep
-___prevalence
-___half of night
-___return of sleep
-__comforting
-____recall
-___autonomic activity
-___upon awakening

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NREM
2-6.5%
1st
rapid
resists
intense
confusion