February 26, 2016 - Pediatric Sleep Problems

Question 1

REM Sleep

Answer 1

Very important in terms of breathing because your muscles become essentially paralyzed. When this happens, your diaphragm takes on the bulk of the work.

Because of this, REM sleep can accentuate any respiratory problems. The child may be appearing to sleep fine, but when they enter REM sleep it is very clear that it is not.

Duration of REM sleep increases during the night.

Question 2

Why Does OSA Occur in Children?

Answer 2

Anatomic factors (adenotonsillar hypertrophy, pharyngeal tissue, mandible size/position, airway size, fatty infiltration)

Functional factors (reduced tone of muscles, ventilatory control variability)

Question 3

OSA Prevalence in Children

Answer 3

2-3%

Question 4

Risk Factors for OSA

Answer 4

Adenotonsillar hypertrophy

Airway structure (decreased chin)

Airway tone (musculature)

Trisomy 21 (decreased tone and structure)

Question 5

Consequences of OSA in Kids

Answer 5

Systemic inflammatory condition

Cardiovascular problems

Metabolic problems

Somatic growth impairment

Neurobehavioural issues

Cognitive impairments

Decreased QOL

Question 6

Clinical Presentation of OSA

Answer 6

At night - Snoring, mouth breathing, noising breathing, paradoxical breathing, laboured breathing, witnessed apneas, cyanosis, neck hyperextension, restlessness, diaphoresis.

During the day - difficulty waking, morning headaches, nasal obstruction, mouth breathing, daytime fatigue, daytime sleepiness, hyperactivity.

Question 7

Gold Standard for OSA Diagnosis

Answer 7

Overnight polysomnogram (PSG)

Question 8

What Counts as OSA?

Answer 8

Absent airflow lasting two breaths or longer with continued respiratory effort.

Question 9

Apnea-Hypopnea Index (AHI) for Children

Answer 9

Normal <1.5 events / hour

Mild 1.5-5 events / hour

Moderate 5-10 events / hour

Severe >10 events / hour

Question 10

Who Needs a PSG?

Answer 10

High-risk child to undergo adenotonsillectomy (less than 2-3 years old, medically complex, or pulmonary hypertension)

Diagnositic dilemma (small/absent tonsil tissue)

Recommended screening (achondroplasia, trisomy 21)

Question 11

Who Gets Referred Where?

Answer 11

Suspicion for OSA high - pediatric ENT

Suspicion for OSA moderate - pediatrician

If unsure - sleep clinic

Question 12

Adenotonsillectomy Effectiveness

Answer 12

~90%

Question 13

Obesity and OSA

Answer 13

Children who are obese can suffer from OSA as well.

First line treatment is still an adenotonsillectomy, however the cure rate is lower at about 50% rather than 90% for non-obese children.