Pediatric Sleep Disorders: Things that go Bump in the Night

1. Pediatric Sleep Disorders: Things that go Bump in the Night Kristen H. Archbold, RN, PhD

3. Pediatric Sleep Disorders • Common sleep disorders of childhood • Sleep disorders of infancy: • SIDS • ALTEs • Central apnea of infancy

4. Pediatric Sleep Disorders • Overview of pediatric sleep • Obstructive Sleep Apnea • Other sleep disorders: • Restless leg syndrome (RLS) • Periodic limb movement disorder (PLMD) • Parasomnias • Disorders of Sleep Onset and Maintenance

5. Sleep: Overview • Electroencephalographic (EEG) frequencies • Non-Rapid Eye Movement Sleep (NREM) • Stage 1 • Stage 2 • Stages 3 & 4 (Slow wave sleep) • Rapid Eye Movement Sleep (REM)

9. Pediatric Sleep: Function • Restoration Theory • Evolutionary/Adaptation Theory • Energy Conservation Theory • Learning Theory • UN-Learning Theory • Children are different from adults, depending on age and developmental level

10. Pediatric Sleep: Norms • Varies according to age: • Between ages 2 and 5, children spend equal amounts of time asleep and awake • Throughout childhood sleep accounts for 40% of an average day • At birth, REM sleep is 50% of total sleep time, by adulthood, drops to 25% • SWS declines from 45% in late childhood to 3% in older aged adults

11. Pediatric sleep lab: • Developed in the 1960’s • Accredited by the American Academy of Sleep Medicine • First pediatric sleep lab: 1987 • American Academy of Pediatrics position statement on obstructive sleep apnea in 2002

12. Pediatric Sleep Disorders • Obstructive Sleep Apnea Syndrome (OSAS) • “disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation and sleep patterns” American Thoracic Society, 1996, Am J Respir Crit Care Med, 153:866-878

13. Pediatric Sleep Disorders http://www.egms.de/egms/servlet/Figure?id=cto000028&figure=f9&vol=2006-5

14. OSAS: Consequences • Medical • Enuresis • Failure to thrive, stunted growth • CV cor pulmonale at severe end • Behavioral • Inattention • Distractibility • Scholastic and cognitive difficulties

15. Other Pediatric Dyssomnias • Disturbances in the amount, timing or quality of sleep • Restless Legs Syndrome • Periodic Limb Movements & Disorder • Insomnias • Circadian Rhythm Disorders • Narcolepsy

16. Restless Legs Syndrome (RLS) • Prevalence estimated at 2% in U.S. • Hereditary evidence • Severe leg pain is main symptom, often dismissed as ‘growing pains’. • Disturbs sleep, subsequent consequences • Inattention • Scholastic and cognitive difficulties

17. Periodic Limb Movements & Disorder • PLMD present in up to 60% of people with RLS • People with PLMD don’t have RLS in most cases • Jerks or kicks of limbs (legs and arms) every 20-30 seconds • Disrupts sleep, results in sleep deprivation

18. INSOMNIA • Difficulties initiating or maintaining sleep • Children do experience insomnia • Mainly treated with behavioral interventions • Limit setting • Media removed from bedroom, use bedroom only for sleeping • Avoid caffeine • Consistent bedtime routine and positive reinforcement from parents/caregivers

19. Circadian Rhythm Disorders • Main onset in adolescence • Delay of sleep phase, later to bed later to rise. • Evidence that there may be a biological basis for this behavior • Treatment is primarily behavioral

20. Narcolepsy • Present in 0.5 percent of the population • Genetic component • Lack of gene which produces orexin/hypocretin. Neurons are there, just don’t produce the neurotransmitter on their own • Treatment with modafanil

21. Pediatric Parasomnias • Disturbances in arousal and sleep stage transitions that interfere with the sleep process • Bruxism • Sleep terrors • Sleep walking

22. Conclusions • Children do experience sleep disorders • No one-size-fits-all treatment approach • Snoring is not a good thing, inquire!!!