1 / 61

Treatment of Pediatric OSA

Treatment of Pediatric OSA. Dr Meir Kryger. Introduction: Why this is important . State of alertness affects a child's ability to Concentrate Focus Learn Succeed Sleepiness can ruin a child’s life Disorders causing sleepiness such as OSA can be treated. Objectives.

newton
Download Presentation

Treatment of Pediatric OSA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Treatment of Pediatric OSA Dr Meir Kryger

  2. Introduction: Why this is important • State of alertness affects a child's ability to • Concentrate • Focus • Learn • Succeed • Sleepiness can ruin a child’s life • Disorders causing sleepiness such as OSA can be treated

  3. Objectives • Recognize the faces of sleepiness • Understand the causes of sleepiness • What to do with a sleepy child suspected of OSA

  4. Overview • Sleep breathing disorders in children are common • They can cause children to fail • The symptoms can be easily recognized • The disorders can be treated • Once treated performance can be normal

  5. Important principles in dealing with pediatric sleep problems • Children almost never bring a sleep problem to anyone’s attention • The medical encounter is started by a parent or a teacher • What is the problem? • Whose problem is it?

  6. How do children with apnea present? • Behavioral symptoms • Manifestations of sleepiness • Observations of their sleep • What does the parent see?

  7. The faces of the sleepy child • Falling asleep • Difficulty concentrating • Memory lapses • Loss of energy • Lack of initiative • Emotional lability • Hyperactivity

  8. The differential diagnosis of sleepiness • Reduced quantity of sleep • Deprivation, abnormal body clock • Reduced quality of sleep • Sleep disruption • Primary Sleep Disorder • Sleep apnea • Narcolepsy

  9. Almost all students are sleep deprived!

  10. Diary of a night owl Sunday Saturday Friday Thursday Wednesday Tuesday Monday 0 2 4 6 8 10 12 14 16 18 20 22 24 Time

  11. What the parent observes • Noisy breather • Snoring, snorting • Gasping • Stopping breathing • Restless • Moves a lot • Sweats

  12. The HPI will cover • Behavioral symptoms • Manifestations of sleepiness • Observations of their sleep • What does the parent see? • Medications • Other illnesses

  13. What illnesses? • Congenital • Skeletal structures • Control of breathing • Acquired

  14. Patient Normal Central canal Spinal cord Spinal Cord Congenital: Syringomyelia

  15. Congenital: KlippelFeil

  16. Congenital: Down syndrome

  17. Congenital: Mucopolysaccharidosis

  18. Infiltration of airway

  19. Congenital: mysteries

  20. Acquired: enlarged tonsils

  21. Acquired: enlarged tonsils

  22. Acquired: enlarged tonsils

  23. Acquired: (from parent) Small lower jaw

  24. Acquired: obesity in toddler

  25. Acquired: obesity in teen

  26. Confirming the diagnosis

  27. Confirming the diagnosis • What you end up doing depends on • Beliefs of parents • Beliefs of referring clinician • Beliefs of insurance companies • Whether long term treatment will be needed • Most of the times you’ll end up doing PSG

  28. Nitty gritty of PSG in children • Show child bedroom before they come in • Have them bring in whatever they use to fall asleep (blankets, teddy bears) • Parent/guardian in room • One tech per patient– need experienced tech • Don’t do split in child

  29. Pediatric PSG Synchronized video End tidal PCO2

  30. Pediatric PSG

  31. Pediatric PSG: may be classic

  32. Pediatric PSG: may be classic with surprises

  33. Pediatric PSG: with more surprises

  34. Pediatric PSG: yet more surprises

  35. What is observed: may be subtle

  36. What is observed sped up

  37. Restless sleep and apnea

  38. Mask fitting in child may be difficult

  39. 3 case studies • Presentation • What is the problem? Whose problem is it? • Assessment • What data is needed to find cause of problem? • Analysis • How is data used to find cause of problem? • Solution • What was done

  40. Case 1: Falling asleep in class • Presentation • 12 year old female student who dropped out of school 3 months before because of “depression”; on antidepressants • Fell asleep repeatedly in class for about a year • Referred for diagnosis of sleep disorder • Assessment • Analysis • Solution

  41. Case 1: Falling asleep in class • Presentation • Assessment • Explore typical sleep wake pattern • Explore daytime performance • Explore symptoms of sleep disorders • Explore development of problem • Analysis • Solution

  42. Case 1: Falling asleep in class • Presentation • Assessment • Explore typical sleep wake pattern • Falls asleep whenever in low stimulus situation • Never feels refreshed • Analysis • Solution

  43. Case 1: Falling asleep in class • Presentation • Assessment • Explore daytime performance • School performance has been poor for 2 years • Frequently absent • Daydreams or falls asleep in class • Analysis • Solution

  44. Case 1: Falling asleep in class • Presentation • Assessment • Explore symptoms of common sleep disorders • Loud snoring and stops breathing • Overweight • Large tonsils; large overbite (small jaw) • No dream related symptoms • Analysis • Solution

  45. Case 1: Falling asleep in class • Presentation • Assessment • Analysis • Classic sleep apnea • Confirmed by sleep test • Solution

  46. Case 1: Falling asleep in class • Presentation • Assessment • Analysis • Solution • Referral to surgeon for possible tonsillectomy • May require orthodontic evaluation • Weight loss program

  47. Case 1: Falling asleep in class Take home messages • Sleep apnea occurs in children • History of snoring • Often have big tonsils, obesity or overbite • Check bite during health exam • Usually cured with treatment • Remember the orthodontic window

  48. Case 2: Hyperactive child • Presentation • 5 year old boy who was expelled from kindergarten because of “hyperactivity”; small for age • “Crashes” during the midafternoons • Referred for diagnosis of sleep disorder • Assessment • Analysis • Solution

  49. Case 2: Hyperactive child • Presentation • Assessment • Explore typical sleep wake pattern • Explore daytime performance • Explore symptoms of sleep disorders • Snoring and restless sleep • Explore development of problem • Analysis • Solution

More Related