Post on 12-Jan-2016
DISORDERED SLEEPIN
INFANTS AND CHILDREN
Stephen H. Sheldon, D.O., F.A.A.P.Professor of Pediatrics
Northwestern University Feinberg School of Medicine
Director, Sleep Medicine Center,Ann and Robert H. Lurie Children’s Hospital of
Chicago
Disordered Sleep
BEHAVIORAL
Disordered Sleep
BEHAVIORAL
PSYCHOLOGICAL
Disordered Sleep
BEHAVIORAL
PSYCHOLOGICAL
BIOLOGICAL
NOSOLOGY
SIMILAR TO ADULTS
NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep Fragmentation
NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
Movement Disorders/Parasomnias
NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
Movement Disorders/ParasomniasPain Syndromes
NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
Movement Disorders/ParasomniasPain SyndromesEnvironmental
Nosology (cont.)
Psychiatric
Nosology (cont.)
PsychiatricDrugs/Alcohol
Nosology (cont.)
PsychiatricDrugs/Alcohol
CNS Disease/Disorders
Nosology (cont.)
PsychiatricDrugs/Alcohol
CNS Disease/DisordersCircadian Rhythm Abnormalities
Children are Different Different Diagnostic Categories
Different Diagnostic Criteria
Different Symptomatology – Often Paradoxical
Different Nosology?
The Sleepless Child
Disorders of Initiating sleep
Disorders of Initiating and Maintaining Sleep
Disorders of Maintaining Sleep
The Most Important Historical Question
The Most Important Historical Question
Does the Child Sleep Well …
The Most Important Historical Question
Does the Child Sleep Well …
SOMEWHERE?
YES
BEHAVIORAL/CONDITIONED
NO
BIOLOGICAL
Initiating Sleep
AGE DEPENDENTNeonatal / Early Infancy
Normal Ultradian Rhythm45 - 60 minute cycles
3 - 4 hour feedingsTotal sleep time about 16 - 17 hours
Colic/Pain/teething/medical disorders
Sleepless Child: 9 - 12 Months
Parental Behaviors at child’s bedtime
&Parental response to normal
nocturnal wakings=
DISORDER OF INITIATING & MAINTAINING SLEEP
Sleepless Child: Toddler
Behavioral / Conditioned
Occasionally Biological
Sleepless Child: Adolescent
NORMAL PHYSIOLOGY
CIRCADIAN FACTORS
ANXIETY
MOTIVATED
Sleepless Child
DISORDERS OF SLEEP MAINTENANCE
ENVIRONMENTAL
BIOLOGICAL
Sleepless Child: Maintenance
DIFFERENTIAL DIAGNOSISPain Syndromes
AllergyApneaPLMD
NightmaresSeizures
Circadian Rhythm Abnormalities
Gastroesophageal Reflux/Disorder
Reflux into the esophagus– Level ??
Reflux into the pharynx Aspiration into the lungs
GER
DIAGNOSIS
– pH Probe study– Swallow Studies– Age dependent approach
GER
GER does not = G.E.R.D.
GER & OSA
Which comes first?
– Association– Vocal cord excoriation, swelling,
edema– Aspiration pneumonia– Changes in airway physiology
GER diagnosis
Diagnosis not made in sleep lab
Methods– pH Study
– Polysomnography– Probe + PSG– Endoscopy
GER
Treatment
H2 Blockers(ranitidine)
Parasympathomimetics(cisapride)