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Pediatric Sleep 101

Daniel Erichsen, MD, FAAP 10/25/2011. Pediatric Sleep 101. PS 101. Pediatric Sleep Clinic The function(s) of sleep Consequences of sleep loss Obstructive sleep apnea Division of Peds Sleep What’s going on?. Clinic. Thursday AM session Patients 2 – 26 y Sleep-disordered breathing

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Pediatric Sleep 101

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  1. Daniel Erichsen, MD, FAAP 10/25/2011 Pediatric Sleep 101

  2. PS 101 • Pediatric Sleep Clinic • The function(s) of sleep • Consequences of sleep loss • Obstructive sleep apnea • Division of Peds Sleep • What’s going on?

  3. Clinic • Thursday AM session • Patients • 2 – 26 y • Sleep-disordered breathing • Insomnia • Hypersomnia • Restless legs • Parasomnias

  4. Clinic

  5. Clinic

  6. Clinic

  7. Clinic

  8. Clinic

  9. Clinic

  10. Clinic + Facesheet Plz

  11. Clinic • Pediatric Sleep Clinic • The function(s) of sleep • Consequences of sleep loss • OSA • Insufficient sleep

  12. Bronx

  13. Eksjö, Småland

  14. Sävsjö, Småland

  15. Jonas Bronck • Born • Sävsjö 1600 • 1620s • Captain Dutch West India Company • New Netherlands

  16. June 1639 • Jonas Bronck • Navigates up East River in De Brant Van Troyen (The fire of Troy) • Purchases land north of Harlem River • South of 150th st

  17. Bronx • South of 150th • Jonas Bronk’s land

  18. Bronx • South of 150th • Jonas Bronck’s land • -> Bronck’s land

  19. Bronx • South of 150th • Jonas Bronck’s land • -> Bronck’s land • -> Broncksland

  20. Bronx • South of 150th • Jonas Bronck’s land • -> Bronck’s land • -> Broncksland • -> Bronx

  21. Back to Sleep • 1/3 of your life

  22. Human behavior • Eating • Energy supply • Talking • Communication • Sex • Reproduction • Sleep • ???

  23. Disadvantageous state • Sleep • No food gathering • No reproduction • Easy pray

  24. Sleep • Why do we sleep? • How important is sleep?

  25. Evolutionary perspective • Important functions conserved • How conserved is sleep? • How important is sleep?

  26. Mammals

  27. Northern fur seal • Lungs • Max 7 minutes submerged • Lives in water • Emerges 4-6 weeks/year

  28. Implanted brain electrodes • Land • Synchronized slow EEG activity entire brain and eyes closed night. • Asynchronized fast EEG activity entire brain and eyes open day.

  29. Implanted brain electrodes • Sea • Right hemisphere synchronized slow activity with left eye closed. • Left hemisphere asynchronized fast activity with right eye open.

  30. Sleep is universal • All species studied have sleep or sleep equivalent • Fish • Insects • Bacteria

  31. Sleep deprivation

  32. Sleep deprivation • Complete sleep deprivation • Hyperphagia • Hyperthermia • Autonomic dysregulation • Loss of fur • Death

  33. Wagner - 2006

  34. Wagner - 2006 • 90 practice tasks-> 8 hr break -> 300 testing tasks • Group 1 – Awake 11 am -> 7 pm • Group 2 – Awake 11 pm -> 7 am • Group 3 – Sleep 11 pm -> 7 am • Outcome • % subjects gained “insight”

  35. Wagner - 2006 • None gained “insight” after first 90 tasks

  36. Wagner - 2006 • % gained “insight” after 300 test tasks

  37. Functions of sleep • Consolidation of declarative memory

  38. Gais- 2002

  39. Gais- 2002 • 1 hr learning session -> 12 hr break -> 1 hr testing session • Group 1 – Slept 3 hrs • Group 2 – Slept 8 hrs • Group 3 – Awake daytime • Group 4 – Awake nighttime

  40. Gais- 2002 • Outcome • Improvement in speed of correct answer • Decrease in milliseconds

  41. Gais- 2002 • Results

  42. Functions of sleep • Consolidation of procedural memory

  43. Normal sleep architecture

  44. Memory consolidation

  45. Memory consolidation • Slow wave, “deep”, sleep • Consolidation of declarative memory • REM sleep • Consolidation of procedural memory

  46. Functions of sleep • Memory consolidation

  47. Margoliash - 2005 • Single neuron recording • Zebra Finch

  48. Margoliash - 2005 • Record singing

  49. Margoliash - 2005 • New song

  50. Functions of sleep • Memory consolidation may occur 2nd to reactivation of neural pathways in sleep

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