Pediatric Sleep Medicine

Question 1

What is behavioral insomnia of childhood, sleep onset association type?

Answer 1

• The child needs special conditions to fall asleep
• Requires conditions that are problematic or demanding
• Needs the parents intervention to fall back asleep

Question 2

What is behavioral insomnia of childhood, sleep onset association type and limit setting type?

Answer 2

• Child stalls or delays at bedtime
• Child falls asleep in a setting other than his own bed

Question 3

At what age are healthy babies able to fall and stay asleep for 11 to 12 hours without a feeding?

Answer 3

6 months

Question 4

At what age can you address sleep onset association insomnia?

Answer 4

6 months

Question 5

What is a technique called bedtime fading?

Answer 5

In a patient that takes longer to fall asleep than the desired bedtime, you put them to bed at that bedtime and then gradually move the bedtime earlier and earlier until the desired bedtime is reached.

Question 6

In CCHS, in what stage of sleep will hypoventilation most commonly be seen?

Answer 6

NREM sleep (not REM)

Question 7

What is primary central sleep apnea of infancy?

Answer 7

• Occurs in infants > 37 weeks conceptional age (primary central sleep apnea of prematurity is < 37 weeks)
• An observed apnea or cyanosis or oxygen desaturation detected by monitoring
• Prolonged (> 20 seconds) central apneas or periodic breathing for greater than or equal to 5% of the total sleep time

Question 8

What is the treatment for primary central sleep apnea of infancy/prematurity?

Answer 8

Theophylline or O2

Question 9

What is the treatment for periodic breathing if it occurs on a background of hypoxemia?

Answer 9

O2, theophylline and caffeine

Question 10

If the pediatric patient does not have any apneas/hypopneas, what are the alternate criteria for making a diagnosis of sleep apnea?

Answer 10

• > 25% TST
• PaCO2 > 50 mm Hg and
  
  • The child snores or
  • Paradoxical thoracoabdominal movements or
  • Flattened inspiratory nasal pressure waveform

Question 11

What are the minimum PLM index to diagnose PLMD in peds

Answer 11

5 for peds

15 for adults

Question 12

What is settling?

Answer 12

It’s the process in kids where daytime napping decreases and nighttime sleep increases

Question 13

CCHS is a genetic disorder involving what gene and what abnormality of that gene?

Answer 13

Trinucleotide repeats within the PHOX2B gene