Pediatric Sleep Disorders: Things that go Bump in the Night Kristen H. Archbold, RN, PhD

Pediatric Sleep Disorders Common sleep disorders of childhood Sleep disorders of infancy: –SIDS –ALTEs –Central apnea of infancy

Pediatric Sleep Disorders Overview of pediatric sleep Obstructive Sleep Apnea Other sleep disorders: –Restless leg syndrome (RLS) –Periodic limb movement disorder (PLMD) Parasomnias Disorders of Sleep Onset and Maintenance

Sleep: Overview Electroencephalographic (EEG) frequencies Non-Rapid Eye Movement Sleep (NREM) –Stage 1 –Stage 2 –Stages 3 & 4 (Slow wave sleep) Rapid Eye Movement Sleep (REM)

Pediatric Sleep: Function Restoration Theory Evolutionary/Adaptation Theory Energy Conservation Theory Learning Theory UN-Learning Theory Children are different from adults, depending on age and developmental level

Pediatric Sleep: Norms Varies according to age: –Between ages 2 and 5, children spend equal amounts of time asleep and awake –Throughout childhood sleep accounts for 40% of an average day –At birth, REM sleep is 50% of total sleep time, by adulthood, drops to 25% –SWS declines from 45% in late childhood to 3% in older aged adults

Pediatric sleep lab: Developed in the 1960’s Accredited by the American Academy of Sleep Medicine First pediatric sleep lab: 1987 American Academy of Pediatrics position statement on obstructive sleep apnea in 2002

Pediatric Sleep Disorders Obstructive Sleep Apnea Syndrome (OSAS) “disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation and sleep patterns” American Thoracic Society, 1996, Am J Respir Crit Care Med, 153:

Pediatric Sleep Disorders

OSAS: Consequences Medical –Enuresis –Failure to thrive, stunted growth –CV cor pulmonale at severe end Behavioral –Inattention –Distractibility –Scholastic and cognitive difficulties

Other Pediatric Dyssomnias Disturbances in the amount, timing or quality of sleep –Restless Legs Syndrome –Periodic Limb Movements & Disorder –Insomnias –Circadian Rhythm Disorders –Narcolepsy

Restless Legs Syndrome (RLS) Prevalence estimated at 2% in U.S. Hereditary evidence Severe leg pain is main symptom, often dismissed as ‘growing pains’. Disturbs sleep, subsequent consequences –Inattention –Scholastic and cognitive difficulties

Periodic Limb Movements & Disorder PLMD present in up to 60% of people with RLS People with PLMD don’t have RLS in most cases Jerks or kicks of limbs (legs and arms) every seconds Disrupts sleep, results in sleep deprivation

INSOMNIA Difficulties initiating or maintaining sleep Children do experience insomnia –Mainly treated with behavioral interventions Limit setting Media removed from bedroom, use bedroom only for sleeping Avoid caffeine Consistent bedtime routine and positive reinforcement from parents/caregivers

Circadian Rhythm Disorders Main onset in adolescence Delay of sleep phase, later to bed later to rise. Evidence that there may be a biological basis for this behavior Treatment is primarily behavioral

Narcolepsy Present in 0.5 percent of the population Genetic component Lack of gene which produces orexin/hypocretin. Neurons are there, just don’t produce the neurotransmitter on their own Treatment with modafanil

Pediatric Parasomnias Disturbances in arousal and sleep stage transitions that interfere with the sleep process –Bruxism –Sleep terrors –Sleep walking

Conclusions Children do experience sleep disorders No one-size-fits-all treatment approach Snoring is not a good thing, inquire!!!