Pediatric Sleep 101

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