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Health Relationships

Obstructive Sleep Disorders in Breathing in Childhood- Behavioral and Developmental Problems Michael S. Blaiss, MD Clinical Professor of Pediatrics and Medicine University of Tennessee Health Science Center Memphis, Tennessee. Health Relationships. Sleep. HEALTH. Exercise. Nutrition.

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Health Relationships

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  1. Obstructive SleepDisorders in Breathing in Childhood-Behavioral and Developmental ProblemsMichael S. Blaiss, MDClinical Professor of Pediatrics and MedicineUniversity of Tennessee Health Science CenterMemphis, Tennessee

  2. Health Relationships Sleep HEALTH Exercise Nutrition

  3. Common Sleep Disorders • Insomnia: wants to sleep but cannot • Sleep Deprivation: does not want to sleep but can; problem of sleep quantity • Sleep apnea: sleepy during day, snores at night because of obstruction in throat and/or nose; problem of sleep quality • Obstructive sleep disorders can have a major effect on the child’s behavior and development

  4. Sleep Disturbances in Children • Parents of 5 to 12-year-olds reported the following sleep problems: • Bedtime resistance (27%) • Problems waking up (17%) • Fatigue (17%) • Sleep-onset delays (11%) • Night waking (6.5%)

  5. Sleep Disturbances in ChildrenObstructive Sleep Apnea • Pauses in breathing during sleep • Momentary wakening/arousals may not allow entrance into deep NREM stages and may reduce REM • Symptoms • Loud snoring, restless sleep, daytime sleepiness

  6. Sleep Apnea is Common • Children (age 2 - 8) • Middle aged adults • Older adults ( > 65) • 2-3% • 5-7% • >15% AJRCCM 2002 165:1217-39

  7. Sleep Apnea in Children: Risk Factors • Family history • Obesity: 80 % of sleep apnea patients • Allergic rhinitis • Large tonsils / adenoids • Male gender

  8. Childhood Sleep Apnea Nightmares and night terrors Morning headaches Unusual "arched" sleeping positions. Developmental delays Learning difficulties Personality changes Hyperactivity and symptoms of ADHD • A "pulling in" of the chest when breathing • High rates of upper respiratory infections • Confusion when awakened • Frequent bedwetting • Excessive sweating while asleep • Failure to grow at normal rates

  9. Methods • One hundred thirty-six children aged 7–12 were studied. • Routine overnight polysomnography (PSG) classified children into 4 groups: Primary snoring (PS) (n = 59), mild OSAS (n = 24), moderate/severe OSAS (n = 18), and controls (n = 35). • Behavioral function and behavioral aspects of attention and executive function were assessed • the Behavior Rating Inventory of Executive Function (BRIEF) • the Child Behavior Checklist (CBCL)

  10. BRIEF is a parent-rated, 86-item questionnaire which assesses children’s attentional and executive skills

  11. The Child Behavior Check List (CBCL) is an empirically derived parent-rated questionnaire consisting of 118 problem items assessing psychopathology and social competence

  12. Attention Deficit Hyperactivity Disorder AD(H)D: criteria Core symptoms of: Impulsivity (or Hyperactivity) Inattention Impairing home, school, social and self-concept (at least 2 settings) Some symptoms by age 7 years Chronic condition (at least 6 months) The most commonly-diagnosed behavioral disorder in children Estimates of prevalence 3-11%

  13. Differential Diagnosis Vision and hearing problems Developmental or learning problems; language deficits Absence seizures Acute change in living situation, grief, family conflict, recent trauma Substance abuse; side effect of medications Stress Breathing impairment, e.g., sleep apnea; sleep problems

  14. Methods • Assessed sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old • 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected sleep disordered breathing • 27 for unrelated surgical care • One year later, we repeated all assessments in 100 of these children.

  15. SDB in Children • Results • AT group • Higher scores for hyperactivity, inattention, Multiple Sleep Latency Test (MSLT), and ADHD at baseline and improved to control rate 1 yr after surgery • Even with children with “primary snoring” (in the absence of frequent apneic events, arousals, or gas-exchange abnormalities) may still be at risk for significant neurobehavioral consequences. Chervin et al. Sleep disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 117(4) 2006 e769-e778.

  16. SLEEP 2009;32(3):343-350.

  17. Study Design Overnight sleep recordings were conducted in 15 children diagnosed with ADHD (DSM-IV) without comorbid psychiatric problems and in 23 healthy controls aged 7 to 11 years. Children were on no medication, in good health and did not consume products containing caffeine ≥ 7 days prior to the polysomnography (PSG) study. PSG evaluation was performed at each child’s home; children slept in their regular beds and went to bed at their habitual bedtimes.

  18. Conclusions • Sleep disorder breathing was associated with behavioral problems, including hyperactivity, reduced attention, somatic complaints, and developmental disorders • In all children with learning, behavioral, or ADHD problems, assessment of SDB is paramount

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