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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.
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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 • Recognize the faces of sleepiness • Understand the causes of sleepiness • What to do with a sleepy child suspected of OSA
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
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?
How do children with apnea present? • Behavioral symptoms • Manifestations of sleepiness • Observations of their sleep • What does the parent see?
The faces of the sleepy child • Falling asleep • Difficulty concentrating • Memory lapses • Loss of energy • Lack of initiative • Emotional lability • Hyperactivity
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
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
What the parent observes • Noisy breather • Snoring, snorting • Gasping • Stopping breathing • Restless • Moves a lot • Sweats
The HPI will cover • Behavioral symptoms • Manifestations of sleepiness • Observations of their sleep • What does the parent see? • Medications • Other illnesses
What illnesses? • Congenital • Skeletal structures • Control of breathing • Acquired
Patient Normal Central canal Spinal cord Spinal Cord Congenital: Syringomyelia
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
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
Pediatric PSG Synchronized video End tidal PCO2
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
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
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
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
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
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
Case 1: Falling asleep in class • Presentation • Assessment • Analysis • Classic sleep apnea • Confirmed by sleep test • Solution
Case 1: Falling asleep in class • Presentation • Assessment • Analysis • Solution • Referral to surgeon for possible tonsillectomy • May require orthodontic evaluation • Weight loss program
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
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
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