Sleeping Disorders in Children

Question 1

Respiratory pattern in infants

Answer 1

Periodic/apnoeic before 36 weeks

REM onset rapid and spend more time in it

Question 2

New born respiratory pattern (3)

Answer 2

16-18h asleep
Sleep-wake states alternate in 3-4h cycles
Slowly start to adapt to light-dark/social cues

Question 3

6 months

Answer 3

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

Question 4

2nd year

Answer 4

12 hours asleep

1 day time nap

Question 5

Prepurbetal children

Answer 5

High efficient sleep

Question 6

Adolescence

Answer 6

Increased awakening

Need more/Obtain less

Question 7

Assessment (5)

Answer 7

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

Question 8

Abnormal (3)

Answer 8

Napping and enuresis after 3-5 years
Sleeping for 8 hours with no nap- 1 years old
Unmedicated adult is unrousable from sleep

Question 9

Normal (4)

Answer 9

Sleep walking in toddlers
REM onset in first 3 months
Sleep terrors
Hypnic Jerks

Question 10

Causes of Sleeplessness (3)

Answer 10

Mainly behavioral problems
Medication
Neurological disorders- Melatonin

Question 11

Cause of excessive sleepiness (5)

Answer 11

Insufficient sleep
OSAS
Narcolepsy
-Often not diagnosed in childhood
-Cataplexy
-Orexin deficiency

Question 12

Primary Snoring

Answer 12

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

Question 13

OSAS prevalence andreason why

Answer 13

Commonest in pre-school child

Adenoids are larger in children

Question 14

Morbidity of OSAS

Answer 14

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

Question 15

Differences between OSAS in Adults and Children

Answer 15

Day time sleepiness is main symptom in adults
Obesity is in the majority of adult cases
Mouth breathing is common in children
Enlarged tonsils are common in children
The obstructive pattern in adults is Apnoea whereas in children it is hypoventilation

Question 16

Treatment

Answer 16

Adenotonsillectomy
CPAP
Weight loss
Avoid environmental tobacco smoke

Question 17

Respiratory Disorders (3)

Answer 17

Chronic neonatal disease
Cystic Fibrosis
Asthma

Question 18

Neurological Disorders

Answer 18

Cerebral Palsy
Downs syndrome
Prader-Willi syndrome
Duchenne’s MD

Question 19

Cerebral Palsy

Answer 19

Fragmented sleep/delayed onset

Melatonin deficiency

Question 20

Downs syndrome

Answer 20

OSAS

Question 21

Prader-Willi Syndrome

Answer 21

Excessive daytime sleepiness

Question 22

Duchenne’s MD

Answer 22

Nocturnal desaturation due to low FVC

Therapy: BiPAP