Paediatric sleep disorders
123 important questions on Paediatric sleep disorders
What is the prevalence of sleep disorders in children with neurodevelopmental disorders (NDDs)?
Sleep disorders are notably prevalent in children with NDDs for various reasons. Key points include:
- High rates of insomnia and obstructive sleep apnea
- Comorbidities often obscure sleep issues
- Significant impact on physical, cognitive, and emotional well-being
What are the core symptoms of narcolepsy type 1 (NT1)?
The main characteristics of NT1 include:
- Excessive daytime sleepiness (EDS)
- Frequent lapses into sleep
- Cataplexy
- Sleep paralysis
- Hypnagogic/hypnopompic hallucinations
- Disrupted nocturnal sleep
How should treatment objectives be determined for children with sleep disorders and NDDs?
Treatment objectives must be clearly defined and agreed upon, highlighting:
- Partnership with parents and child
- Consideration of multiple stakeholders
- Monitoring outcomes systematically
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What are sleep-related movement disorders in children and adolescents?
These disorders include:
- Periodic limb movement disorders
- Restless legs syndrome
- Growing pains
- Restless sleep disorder
- Nocturnal leg cramps
- Rhythmic movement disorder
- Bruxism
- Benign sleep myoclonus
- Propriospinal myoclonus
How do the two types of narcolepsy differ?
Narcolepsy types are classified as:
1. Type 1 (NT1):
1. Type 1 (NT1):
- Cataplexy present
- - Low CSF hypocretin-1 (hcrt-1) levels
- No cataplexy
- - Normal CSF hcrt-1 levels
What role do parent-directed behavioral interventions (BSIs) play in treating sleep disorders in NDDs?
BSIs serve as the first-line approach for insomnia, offering benefits like:
- Effective strategies for healthy sleep behaviors
- Long-term benefits without adverse effects
- Flexibility in delivery methods (face-to-face, online, etc.)
What are the main characteristics of non-rapid eye movement parasomnias in children?
These disorders include:
- Frequent benign occurrences
- Disorder of arousals, like sleepwalking, confusional arousals, and sleep terrors
- Typically resolve during adulthood
- Associated with familial occurrence and certain neurodevelopmental issues
What is the significance of recognizing sleep-related movement disorders in children?
It is essential to:
- Diagnose accurately considering age-related features
- Understand polysomnographic and clinical specifics
- Address prevention and treatment strategies
- Provide parental support and guidance
What are the impacts of NT1 on overall functioning?
Impacts on functioning include:
- Metabolic effects (e.g., weight gain)
- Endocrinological effects (e.g., precocious puberty)
- Psychiatric issues (e.g., mood disorders)
- Psychosocial effects (e.g., social stigma)
What challenges exist when measuring sleep in children with NDDs?
Investigating sleep disorders in this group presents various challenges, including:
- Mobility issues and sensory sensitivities
- Limitations of traditional sleep diaries
- Need for careful planning in monitoring
What is the prevalence of insomnia in children and its potential impacts?
Insomnia is prevalent in children, affecting 10% to 30% of the general population and up to 80% in those with behavioral issues. Impact includes:
- Compromised quality of life
- Poor developmental outcomes
- Overweight
- Behavioral disturbances
Which children are more likely to experience disorder of arousals?
Increased prevalence of DOA has been seen in:
- Children with epilepsy
- Those with attention-deficit hyperactivity disorder (ADHD)
- Neurodevelopmental disorders
What are the clinical features of periodic limb movement disorder (PLMD)?
Key features include:
- Leg movements or jerks every 20-40 seconds during sleep
- Symptoms cause subjective sleep disturbance
- Movements may progress to flexion of the leg
- Significant night-to-night variability
Why is narcolepsy often misdiagnosed?
Misdiagnosis occurs due to:
1. Multifaceted symptoms resembling:
3. Long diagnostic delays impacting treatment
1. Multifaceted symptoms resembling:
- Laziness
- - ADHD
- - Neurological disorders
3. Long diagnostic delays impacting treatment
What pharmacological interventions are common for children with NDDs?
Most pharmacological treatments for sleep lack robust evidence, characterized by:
- Use of unlicensed or off-label medications
- Small and poorly controlled studies
- Broad similarities in choices compared to typically developing (TD) children
How should clinicians assess pediatric insomnia?
Assessment should be comprehensive and medical, including:
- Examination of sleep/wake schedules
- Behaviour during sleep
- Daytime effects of sleep issues
- Evaluation of sleep environment and bedtime routines
What are the diagnostic procedures recommended for disorder of arousals in children?
The diagnosis is mainly clinical, but video-polysomnography is suggested for:
- Atypical cases
- Suspected sleep-disordered breathing
- Periodic limb movement disorder
How can periodic limb movements be documented?
Movements should be assessed through:
- Overnight polysomnography (PSG)
- Actigraphy devices for additional data
- Assessment of inter-movement intervals
- Documentation of the periodicity index
What approaches are essential for NT1 diagnosis?
Important diagnostic steps include:
- Clinical assessment of symptoms
- Differential diagnosis:
- Neurological-muscular disorders
- - Epileptic disorders
- - Mood and psychotic disorders
What is the prevalence of sleep disorders in children with neurodevelopmental disorders (NDDs)?
Children with NDDs have a high prevalence of sleep disorders due to various reasons, including:
- Comorbidities
- Diagnostic overshadowing
- Impact on physical, cognitive, and emotional well-being
- Considerable effects on caregivers
What are the main characteristics of chronic insomnia as per the ICSD-3?
Chronic insomnia is defined by:
- Difficulty with sleep initiation, duration, consolidation, or quality
- Occurrence despite adequate opportunity for sleep
- Resulting in daytime impairment
What is the significance of rapid eye movement sleep behavior disorder in children?
RBD is:
- Very rare in childhood
- Usually secondary to other disorders or medications
- Could indicate narcolepsy and hypocretin loss
What conditions should be considered in the differential diagnosis of PLMD?
Differential diagnosis includes:
- Nocturnal epileptic seizures
- Benign sleep myoclonus in infancy
- Sleep starts
- Sleep disorders like RLS and narcolepsy
- Neurological disorders such as ADHD
How should narcolepsy be treated?
Treatment involves a multidisciplinary approach:
- Pharmacological therapies
- Behavioral therapies
Why are sleep disorders often missed in children with NDDs?
Identification of sleep disorders is difficult in this population due to:
- Limited communication skills
- Coexisting health needs
- Overlap of symptoms with other issues
- Challenges faced by families
What types of paediatric insomnia are identified in the ICSD-3?
The ICSD-3 identifies three types:
- Sleep-onset association type: dependency on specific conditions to fall asleep
- Limit-setting type: lack of parental control at bedtime
- Combined type: mixed symptoms of both previous types
Which factors are associated with primary sleep enuresis in children?
Key aspects include:
- Strong familial occurrence
- Decreased nocturnal bladder storage
- Increased night urine production
- Difficulty waking up
What behavioral management strategies are suggested for PLMD?
Recommended strategies include:
- Educating parents and children about the disorder
- Establishing a regular sleep routine
- Encouraging regular exercise
- Avoiding caffeinated substances
What are the possible environmental triggers for NT1?
Environmental factors contributing to NT1 include:
- H1N1 infection and vaccination
- Seasonal incidence fluctuations
- Elevated anti-streptococcal antibodies
What are the first-line interventions for sleep disorders in children with NDDs?
Parent-directed behavioral interventions are effective when implemented correctly, including:
- Teaching healthy sleep behaviors
- Unlearning inappropriate sleep behaviors
- Prioritizing these over medication before treatment
What treatment approaches are recommended for managing insomnia in children?
Recommended treatment strategies include:
- Starting with cognitive-behavioural approaches
- Considering medication at low doses if necessary
- Individualizing treatment based on severity and type of insomnia
- Incorporating sleep hygiene, behavioural strategies, and pharmacological treatment
What are the common forms of NREM parasomnias?
NREM parasomnias primarily include:
- Disorder of arousals (DOA)
- Confusional arousals
- Sleep terrors
- Sleepwalking
- Sleep-related eating disorder (SRED) is mainly adult-related
What are the iron supplementation recommendations for children with PLMD?
Recommendations include:
- Young children: 3 mg/kg/day of elemental iron
- Older children: 325 mg ferrous sulfate + vitamin C
- Monitor ferritin and serum iron levels
What is the genetic association with NT1?
Genetic associations involve:
- DQB1*0602 haplotype
- Immune system-related loci identified in studies
- Elevated CSF hcrt-1 deficiency in most patients
What is the significance of setting realistic treatment targets for sleep disorders?
Defining clear treatment goals is crucial to:
- Ensure proper monitoring
- Avoid unnecessary medication
- Address the child's and family's specific needs
- Improve overall management
What are the common descriptors parents use when discussing insomnia in children?
Parents often report symptoms like:
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Night awakenings
- Resistance to a bedtime schedule
- Inability to sleep without parental intervention
How does genetic predisposition impact the occurrence of sleepwalking in children?
Studies show:
- High familial occurrence (40%) in sleepwalking
- Increased prevalence with stronger parental history
- Genetic ties to specific alleles and inheritance patterns
What characterizes restless legs syndrome (RLS) in children?
RLS features:
- Urge to move legs due to unpleasant sensations
- Symptoms worsen during rest or inactivity
- Relief with movement during activity
- Occurs mainly at night or evening
How does sleep impact children with NDDs?
Sleep significantly affects the following areas in children with NDDs:
- Physical health
- Cognitive functions
- Emotional well-being
- Overall quality of life
What are the key outcomes associated with chronic insomnia in children?
Chronic insomnia can lead to:
- Poor quality of life for children and families
- Developmental issues
- Overweight
- Behavioural disturbances
What precipitating factors can trigger disorders of arousals in children?
Common precipitating factors consist of:
- Sleep deprivation
- Recovery sleep
- Internal/external stimuli
- Other sleep disorders like sleep-disordered breathing (SDB)
What are some examples of sleep-related movement disorders in children and adolescents?
Key examples include:
- Periodic limb movement disorders
- Restless legs syndrome (RLS)
- Growing pains
- Restless sleep disorder
- Nocturnal leg cramps
- Rhythmic movement disorder
- Bruxism
- Benign sleep myoclonus in infancy
- Propriospinal myoclonus at sleep onset
What are the core symptoms of narcolepsy type 1 (NT1)?
Symptoms include:
- Excessive daytime sleepiness
- Cataplexy
- Sleep paralysis
- Hypnagogic/hypnopompic hallucinations
- Disrupted nocturnal sleep
What are common sleep-related disorders in children with NDDs?
Key sleep disorders frequently observed include:
- Insomnia
- Circadian rhythm disorders
- Obstructive sleep apnea (OSA)
- Sleep-related breathing disorders
How should paediatric insomnia be assessed?
A medical approach should be followed, including:
- Examining primary and secondary contributing factors
- Identifying maladaptive sleep behaviours
- Incorporating sleep questions in health assessments
What are the clinical characteristics of sleepwalking in children compared to adults?
Notable differences include:
- Adults often exhibit violent behavior
- Children display fewer self-injuries and less aggression
- Characteristics include confusion and lack of awareness
What are the typical features of periodic limb movement disorder (PLMD)?
PLMD includes:
- Periodic leg movements >5 per hour
- Jerking motions every 20-40 seconds
- Dorsiflexion of the big toe and ankle
- Occurs during sleep
- Causes subjective sleep disturbance
How is narcolepsy distinguished into types?
Distinctions include:
1. Narcolepsy type 1 (NT1):
1. Narcolepsy type 1 (NT1):
- Cataplexy present
- - Low CSF hypocretin-1
- No cataplexy
- - Normal CSF hypocretin-1
What factors can contribute to sleep disorders in children with NDDs?
Factors contributing to sleep disorders are:
- Medical comorbidities (pain, reflux, etc.)
- Environmental factors
- Diagnostic overshadowing
- Communication barriers
What clinical tools are used for diagnosing insomnia in children?
Diagnosis relies primarily on:
- Clinical history
- Polysomnography is usually not indicated
- Actigraphy can give objective sleep estimates
What is the main characteristic of non-rapid eye movement parasomnias in children?
These disorders are often seen as benign phenomena and generally:
- More common in childhood
- Disappear in adulthood
- Include disorders of arousals (DOA)
- Associated with family occurrences
How is periodic limb movement disorder diagnosed?
Diagnosis requires:
- Documented movements through polysomnography
- Frequency of >5 leg movements per hour
- Significant sleep disturbance
- Exclusion of other disorders like RLS or sleep apnea
What is the prevalence of narcolepsy type 1?
Prevalence is approximately:
- 30 per 100,000 people globally
- Varies significantly by region and ethnicity (e.g., 0.23 in Israel to 160 in Japan)
Why is evidence important in medication for sleep disorders in children with NDDs?
Evidence is vital because:
- Many medications used are unlicensed
- Lack of robust studies and controlled trials
- Need for safety in prescribing
- Understanding the benefits and risks
What approval status do sleep medications for paediatric insomnia have?
Currently:
- No approved sleep medications by FDA or EMA for children
- Most are prescribed off-label
- Recent approval for prolonged-release melatonin for neurodevelopmental disabilities
Which childhood disorders are frequently associated with disorder of arousals?
DOAs are more commonly observed in children with:
- Epilepsy
- Attention-deficit hyperactivity disorder (ADHD)
- Neurodevelopmental disorders
What are common comorbidities associated with periodic limb movement disorder?
Common comorbidities include:
- Restless legs syndrome (RLS)
- Obstructive sleep apnea (OSA)
- Narcolepsy
- Attention deficit hyperactivity disorder (ADHD)
- Autism
- Sickle cell disease
What common misdiagnoses occur in children with narcolepsy?
Misdiagnoses can include:
- Laziness
- Attention deficit hyperactivity disorder (ADHD)
- Other neurological disorders due to symptoms like irritability and hypotonia
What is actiography and its significance in measuring sleep?
Actiography monitors sleep-wake patterns and is important because:
- Provides objective data
- Useful in "n of one" trials
- Measures patterns over extended periods
- Can be executed in the child’s natural environment
What are common treatments for paediatric insomnia?
Common treatments include:
- Sleep hygiene
- Behavioural strategies
- Pharmacological treatment
How is the diagnosis of disorder of arousals primarily established in children?
Diagnosis relies on clinical evaluation, focusing on:
- Age of onset
- Frequency of episodes
- Daytime symptoms
- Family history
- Possible comorbidities
What factors may increase the risk of developing periodic limb movement disorder?
Risk factors include:
- Family history of restless legs syndrome
- Genetic variants (e.g., BTBD9, MEIS1)
- History of prematurity
- Age (more common in younger children)
What psychological impact can narcolepsy have on children?
Psychosocial effects include:
- Behavioral disorders
- Mood disorders
- Psychosis
- Need for multidisciplinary management
What are some treatment options used to address sleep disorders in NDDs?
Various interventions include:
- Parent-directed behavioral interventions
- Environmental modifications
- Pharmacological treatments
- Combination approaches tailored to individual needs
What sleep issues are common in infants and toddlers?
Common sleep complaints include:
- Night wakings (25%-50%)
- Bedtime resistance in 10%-15% of toddlers
- Difficulties falling asleep in preschoolers (15%-30%)
When is video-polysomnography recommended for children with disorder of arousals?
Video-polysomnography (PSG) is suggested when:
- Diagnosing atypical or potentially harmful parasomnias
- Differentiating from sleep-related epilepsy
- Suspecting sleep-disordered breathing or periodic limb movement disorder
What are the key polysomnographic findings for diagnosing PLMD?
Key findings are:
- Index movements documented by overnight PSG
- Limb movements >8 microvolts in EMG
- Series of at least four consecutive movements
- Autonomic arousals may occur frequently
What factors are explored in the aetiology of narcolepsy type 1 (NT1)?
Factors include:
- Autoimmune processes
- Genetic predispositions
- Environmental triggers (e.g., infections, vaccinations)
What is the role of polysomnography (PSG) in assessing sleep disorders?
PSG is essential because it:
- Provides a comprehensive evaluation of sleep
- Helps diagnose disorders like OSA
- Is considered the gold standard for diagnostics
- Can be challenging for children with sensory issues
How has the ICSD-3 redefined insomnia categorization?
ICSD-3 consolidates insomnia diagnoses into:
- A single chronic insomnia disorder
- Behavioral insomnia of childhood included
- Previous subtypes considered unreliable
What are common clinical manifestations of sleepwalking in children?
Clinical features of sleepwalking in children include:
- Brief episodes of partial awakening
- Less violent behaviors compared to adults
- Less self-injuries reported
How does iron supplementation benefit children with PLMD?
Benefits of iron include:
- Reduces symptoms of PLMD
- Recommended dosage:
- - Young children: 3 mg/kg/day
- - Older children: 325 mg of ferrous sulfate + vitamin C
What role do human leukocyte antigen (HLA) types play in narcolepsy?
HLA types are associated with:
- Elevated risk for NT1
- DQB1*0602 haplotype found in >98% of patients with cataplexy
What determines the treatment goals for sleep interventions in NDDs?
Treatment goals should be based on factors like:
- Sleep onset and continuity
- Total sleep time (TST)
- Child’s daytime behavior
- Input from caregivers
What is the definition of chronic insomnia according to ICSD-3?
Chronic insomnia is characterized by:
- Persistent difficulty with sleep initiation, duration, or quality
- Results in daytime impairment
- Occurs despite adequate opportunities for sleep
Which disorders frequently overlap with ADHD in children?
Children with ADHD often experience:
- Sleep-onset delays
- Bedtime resistance
- Night awakenings
- Specific sleep disorders like RLS or SDB
What are effective behavioral management strategies for PLMD?
Effective strategies include:
- Educating parents and children about the disorder
- Establishing a regular sleep routine
- Encouraging regular exercise
- Avoiding caffeinated substances
- Reviewing medications
How does the H1N1 pandemic relate to narcolepsy incidence?
Post-H1N1 observations reveal:
- Increased narcolepsy cases, especially in vaccinated individuals
- 4-13 fold risk due to Pandemrix® vaccination
What are parent-directed behavioral interventions (BSIs)?
BSIs aim to:
- Equip parents with strategies
- Foster healthy sleep behaviors
- Address insomnia issues
- Flexibly delivered via multiple mediums
What secondary conditions can lead to narcolepsy?
Conditions may include:
- Brain tumors
- Head injuries
- CNS infections
- Autoimmune diseases
What characterizes the sleep-onset association type of insomnia?
Defined by:
- Need for specific objects or people to fall asleep
- Commonly multiple nocturnal awakenings
- Sleep onset is delayed without these conditions
What do studies indicate about the incidence of parasomnias in children with Autism Spectrum Disorder (ASD)?
Children with ASD often present:
- Increased prevalence of sleep disorders
- Sleep problems reported by 86%
- Issues include insomnia and parasomnias
- Sleep affects social skills and cognitive performance
What distinguishes restless legs syndrome (RLS) from other movement disorders?
RLS is characterized by:
- Urge to move legs due to unpleasant sensations
- Symptoms worsen during rest or inactivity
- Temporary relief through active movement
- Symptoms occur predominantly at night
How do comorbidities affect sleep disorders in children with NDDs?
Comorbidities can complicate sleep disorders by:
- Causing additional pain or discomfort
- Masking sleep issues due to primary health focus
- Influencing child behavior and responses
- Creating challenges for diagnosis
What are typical features of narcolepsy in children?
Features include:
- Severe symptoms
- Behavioral and mood effects
- Metabolic and endocrinological disorders
Describe the limit-setting type of insomnia.
It occurs when:
- Parents lose control during bedtime
- Children refuse to go to bed or stall
- Inadequate parental controls reinforce sleep problems
What is the genetic correlation found in sleepwalking among children?
Familial occurrences in sleepwalking include:
- Higher occurrence in childhood-onset versus adult-onset
- Positive family history in about 40% of cases
- Genetic associations with specific HLA alleles
What are the diagnostic criteria for pediatric RLS according to the IRLS-SG?
Diagnostic criteria include:
- Urge to move legs
- Symptoms worsen during rest
- Relief through voluntary movement
- Sleep disturbances and distress caused by symptoms
What are environmental interventions recommended for children with NDDs?
Environmental interventions aim to improve sleep and include:
- Sleep hygiene practices
- Safe spaces for sleep
- Special modifications tailored to needs
- Evidence-based recommendations when possible
What are the symptoms of sleep disturbance in children?
Children may exhibit:
- Difficulty initiating or maintaining sleep
- Resistance to bedtime
- Daytime fatigue or mood disturbances
What triggers disorder of arousals in children?
Triggers for DOA can include:
- Sleep deprivation
- External/internal stimuli
- Other sleep disorders like SDB and RLS
What are some differential diagnoses for periodic limb movements/PLMD?
Differential diagnoses include:
- Nocturnal epileptic seizures
- Benign sleep myoclonus in infancy
- Fragmentary myoclonus
- Sleep disorders like RLS and narcolepsy
- Neurological disorders such as ADHD
What multi-faceted impacts does narcolepsy type 1 have?
Impacts consist of:
- Metabolic complications
- Endocrinological issues
- Psychiatric disturbances
- Psychosocial challenges
Describe the treatment approach for narcolepsy.
Treatment approaches include:
- Pharmacological: medication for symptoms
- Behavioural: lifestyle changes and therapies
What should parents consider when assessing their child's sleep issues?
Parents need to reflect on:
- Unrealistic sleep expectations
- Risk factors like home situations
- Past medical history and environmental influences
What is the reported prevalence of confusional arousals in preschool-aged children?
Confusional arousals occur in approximately:
- 17% of children aged 3 to 13
- Often brief and unnoticed by parents
What is the prevalence range of periodic limb movement disorder in children?
Prevalence ranges from:
- 10%-20% in pediatric populations
- 0.3% in children referred for polysomnography
- 5% in children with PLMs >5 per hour
What factors contribute to paediatric insomnia?
Contributing factors include:
- Biological and circadian elements
- Neurodevelopmental issues
- Environmental and behavioural factors
What is primary sleep enuresis and its prevalence in childhood?
Primary sleep enuresis is characterized by:
- Strong family history
- Common in children aged 6 to 10
- Linked to decreased bladder storage and excess nighttime urine
What does the presence of CSF hypocretin-1 indicate in narcolepsy?
Low CSF hypocretin-1 levels are indicative of:
- Narcolepsy type 1
- Associated with severe symptoms and cataplexy
What is a common issue found with insomnia in adolescents?
In adolescents, insomnia is often linked to:
- Use of media devices
- Social network involvement
- Consequent sleep disturbances
What factors are associated with the presence of disorder of arousals according to the “3-P model”?
The “3-P model” identifies factors such as:
- Genetic predisposition
- Priming factors (deep sleep conditions)
- Precipitating factors (stimuli or sleep disorders)
What are the common manifestations of non-rapid eye movement parasomnias in children?
Common manifestations include:
- Confusional arousals
- Sleep terrors
- Sleepwalking
- Sleep-related eating disorder (SRED)
- Typically considered benign and occur mostly in childhood.
What is obstructive sleep apnea syndrome (OSAS) characterized by?
The condition is marked by:
- Increased upper airway resistance
- Pharyngeal collapsibility
- Symptoms like snoring and apneas
- Associated with excessive daytime sleepiness and learning problems
What are common symptoms of obstructive sleep-disordered breathing (SDB)?
Symptoms include:
- Snoring
- Witnessed apneas
- Difficulty breathing during sleep
- Arousals from sleep
- Restless sleep
What are the risk factors for obstructive sleep apnea syndrome (OSAS)?
The main risk factors are:
- Adenotonsillar hypertrophy
- Obesity
- Craniofacial abnormalities
- Neuromuscular disorders
- Complex conditions like Down syndrome
How is the severity of sleep-disordered breathing (SDB) assessed?
Objective assessment should be done via:
- Polysomnography (PSG)
- Identifying apnea-hypopnea index (AHI)
- Determining severity based on AHI scores
What are key treatment modalities for OSAS?
Common treatment options include:
- Adenoidectomy with/without tonsillectomy
- Intranasal corticosteroids
- Oral appliances
- Nasal continuous positive airway pressure (CPAP)
How is obstructive sleep apnea syndrome defined according to the 2016 guidelines?
Definitions include:
- AHI ≥2 episodes/hr + SDB symptoms with adenotonsillar hypertrophy
- Presence of SDB symptoms + AHI ≥1 episode/hr
What are potential morbidities associated with OSAS?
OSAS may lead to:
- Daytime sleepiness
- Hyperactivity
- Learning problems
- Elevated blood pressure
- Nocturnal enuresis
- Growth delay
What abnormalities are commonly associated with OSAS in children?
Common abnormalities include:
- Adenotonsillar hypertrophy
- Allergic rhinitis
- Craniofacial abnormalities
- Neuromuscular disorders
- Complex disorders like Down syndrome
What is the role of polysomnography (PSG) in diagnosing OSAS?
PSG helps in:
- Recording physiological signals during sleep
- Identifying apneas and hypopneas
- Distinguishing between SDB types
What is obstructive sleep apnea syndrome (OSAS)?
This syndrome is a severe form of obstructive sleep-disordered breathing (SDB) causing:
- Intermittent upper airway obstruction
- Increased airway resistance
- Pharyngeal collapsibility
- Symptoms include snoring, apneas, & arousals
What are common symptoms related to upper airway obstruction in OSAS?
Symptoms of upper airway obstruction typically include:
- Snoring
- A reported apnea
- Breathing difficulties during sleep
- Frequent nighttime arousals
- Excessive daytime sleepiness
Which factors contribute to morbidity associated with OSAS?
OSAS is linked to several morbidities, including:
- Daytime sleepiness
- Inattention and hyperactivity
- Learning problems
- Elevated blood pressure
- Nocturnal enuresis
- Delayed growth rate
What are common risk factors for obstructive sleep-disordered breathing (SDB)?
Risk factors include:
- Adenotonsillar hypertrophy
- Obesity
- Craniofacial abnormalities
- Neuromuscular disorders
- Genetic conditions (e.g., Down syndrome)
How is the severity of sleep-disordered breathing (SDB) determined?
Severity assessment should ideally use:
- Polysomnography (PSG)
- Apnea-hypopnea index (AHI)
- Reports of symptoms
- Factors predicting SDB persistence
What are treatment options for obstructive sleep apnea syndrome (OSAS)?
Frequently-used treatments include:
- Adenoidectomy
- Tonsillectomy
- Intranasal corticosteroids
- Oral appliances
- Nasal continuous positive airway pressure (CPAP)
What defines obstructive sleep apnea syndrome (OSAS) according to technical definitions?
OSAS is defined by:
- AHI ≥2 episodes/hr or obstructive apnea index ≥1 episode/hr
- Symptoms present with adenotonsillar hypertrophy or obesity
- AHI ≥1 episode/hr with symptoms
What characterizes primary snoring?
Primary snoring is defined by:
- No apneas or hypopneas
- Absence of frequent arousals
- No gas exchange abnormalities on PSG (AHI
What is the prevalence of obstructive sleep apnea syndrome (OSAS) in children?
Prevalence estimates indicate:
- Snoring (3+ nights/week) in 7%-15% of children
- Moderate-to-severe OSAS in ~1%
- Mild OSAS in about 25%
What are common physical examination findings in OSAS?
Physical findings associated with OSAS typically include:
- Adenotonsillar hypertrophy
- Allergic rhinitis
- Craniofacial abnormalities
- Obesity
What are some complex conditions associated with obstructive sleep apnea?
Conditions that may contribute to OSAS include:
- Down syndrome
- Prader-Willi syndrome
- Achondroplasia
- Cerebral palsy
- Various syndromic disorders
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