disordered sleep in infants and children stephen h. sheldon, d.o., f.a.a.p. professor of pediatrics...
TRANSCRIPT
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DISORDERED SLEEPIN
INFANTS AND CHILDREN
Stephen H. Sheldon, D.O., F.A.A.P.Professor of Pediatrics
Northwestern University Feinberg School of Medicine
Director, Sleep Medicine Center,Ann and Robert H. Lurie Children’s Hospital of
Chicago
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Disordered Sleep
BEHAVIORAL
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Disordered Sleep
BEHAVIORAL
PSYCHOLOGICAL
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Disordered Sleep
BEHAVIORAL
PSYCHOLOGICAL
BIOLOGICAL
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NOSOLOGY
SIMILAR TO ADULTS
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NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
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NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep Fragmentation
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NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
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NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
Movement Disorders/Parasomnias
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NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
Movement Disorders/ParasomniasPain Syndromes
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NOSOLOGY
SIMILAR TO ADULTSBehavioral/Psychophysiological
Sleep FragmentationSleep Disordered Breathing
Movement Disorders/ParasomniasPain SyndromesEnvironmental
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Nosology (cont.)
Psychiatric
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Nosology (cont.)
PsychiatricDrugs/Alcohol
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Nosology (cont.)
PsychiatricDrugs/Alcohol
CNS Disease/Disorders
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Nosology (cont.)
PsychiatricDrugs/Alcohol
CNS Disease/DisordersCircadian Rhythm Abnormalities
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Children are Different Different Diagnostic Categories
Different Diagnostic Criteria
Different Symptomatology – Often Paradoxical
Different Nosology?
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The Sleepless Child
Disorders of Initiating sleep
Disorders of Initiating and Maintaining Sleep
Disorders of Maintaining Sleep
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The Most Important Historical Question
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The Most Important Historical Question
Does the Child Sleep Well …
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The Most Important Historical Question
Does the Child Sleep Well …
SOMEWHERE?
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YES
BEHAVIORAL/CONDITIONED
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NO
BIOLOGICAL
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Initiating Sleep
AGE DEPENDENTNeonatal / Early Infancy
Normal Ultradian Rhythm45 - 60 minute cycles
3 - 4 hour feedingsTotal sleep time about 16 - 17 hours
Colic/Pain/teething/medical disorders
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Sleepless Child: 9 - 12 Months
Parental Behaviors at child’s bedtime
&Parental response to normal
nocturnal wakings=
DISORDER OF INITIATING & MAINTAINING SLEEP
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Sleepless Child: Toddler
Behavioral / Conditioned
Occasionally Biological
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Sleepless Child: Adolescent
NORMAL PHYSIOLOGY
CIRCADIAN FACTORS
ANXIETY
MOTIVATED
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Sleepless Child
DISORDERS OF SLEEP MAINTENANCE
ENVIRONMENTAL
BIOLOGICAL
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Sleepless Child: Maintenance
DIFFERENTIAL DIAGNOSISPain Syndromes
AllergyApneaPLMD
NightmaresSeizures
Circadian Rhythm Abnormalities
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Gastroesophageal Reflux/Disorder
Reflux into the esophagus– Level ??
Reflux into the pharynx Aspiration into the lungs
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GER
DIAGNOSIS
– pH Probe study– Swallow Studies– Age dependent approach
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GER
GER does not = G.E.R.D.
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GER & OSA
Which comes first?
– Association– Vocal cord excoriation, swelling,
edema– Aspiration pneumonia– Changes in airway physiology
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GER diagnosis
Diagnosis not made in sleep lab
Methods– pH Study
– Polysomnography– Probe + PSG– Endoscopy
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GER
Treatment
H2 Blockers(ranitidine)
Parasympathomimetics(cisapride)