DISORDERED SLEEP IN INFANTS AND CHILDREN
34
DISORDERED SLEEP IN 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
description
DISORDERED SLEEP IN 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. Disordered Sleep. BEHAVIORAL. - PowerPoint PPT Presentation
Transcript of DISORDERED SLEEP IN INFANTS AND CHILDREN
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
Disordered SleepBEHAVIORAL
Disordered SleepBEHAVIORAL
PSYCHOLOGICAL
Disordered SleepBEHAVIORAL
PSYCHOLOGICAL
BIOLOGICAL
NOSOLOGYSIMILAR TO ADULTS
NOSOLOGYSIMILAR TO ADULTS
Behavioral/Psychophysiological
NOSOLOGYSIMILAR TO ADULTS
Behavioral/PsychophysiologicalSleep Fragmentation
NOSOLOGYSIMILAR TO ADULTS
Behavioral/PsychophysiologicalSleep Fragmentation
Sleep Disordered Breathing
NOSOLOGYSIMILAR TO ADULTS
Behavioral/PsychophysiologicalSleep Fragmentation
Sleep Disordered BreathingMovement Disorders/Parasomnias
NOSOLOGYSIMILAR TO ADULTS
Behavioral/PsychophysiologicalSleep Fragmentation
Sleep Disordered BreathingMovement Disorders/Parasomnias
Pain Syndromes
NOSOLOGYSIMILAR TO ADULTS
Behavioral/PsychophysiologicalSleep Fragmentation
Sleep Disordered BreathingMovement Disorders/Parasomnias
Pain SyndromesEnvironmental
Nosology (cont.)Psychiatric
Nosology (cont.)Psychiatric
Drugs/Alcohol
Nosology (cont.)Psychiatric
Drugs/AlcoholCNS Disease/Disorders
Nosology (cont.)Psychiatric
Drugs/AlcoholCNS Disease/Disorders
Circadian Rhythm Abnormalities
Children are Different Different Diagnostic Categories
Different Diagnostic Criteria
Different Symptomatology – Often Paradoxical
Different Nosology?
The Sleepless Child Disorders of Initiating sleep
Disorders of Initiating and Maintaining Sleep
Disorders of Maintaining Sleep
The Most Important Historical Question
The Most Important Historical Question
Does the Child Sleep Well …
The Most Important Historical Question
Does the Child Sleep Well …
SOMEWHERE?
YES
BEHAVIORAL/CONDITIONED
NO
BIOLOGICAL
Initiating Sleep AGE DEPENDENT
Neonatal / Early InfancyNormal Ultradian Rhythm
45 - 60 minute cycles3 - 4 hour feedings
Total sleep time about 16 - 17 hours
Colic/Pain/teething/medical disorders
Sleepless Child: 9 - 12 Months
Parental Behaviors at child’s bedtime
&Parental response to normal
nocturnal wakings=
DISORDER OF INITIATING & MAINTAINING SLEEP
Sleepless Child: Toddler
Behavioral / Conditioned
Occasionally Biological
Sleepless Child: Adolescent
NORMAL PHYSIOLOGY
CIRCADIAN FACTORS
ANXIETY
MOTIVATED
Sleepless Child DISORDERS OF SLEEP
MAINTENANCE
ENVIRONMENTAL
BIOLOGICAL
Sleepless Child: Maintenance
DIFFERENTIAL DIAGNOSISPain Syndromes
AllergyApneaPLMD
NightmaresSeizures
Circadian Rhythm Abnormalities
Gastroesophageal Reflux/Disorder
Reflux into the esophagus– Level ??
Reflux into the pharynx Aspiration into the lungs
GER DIAGNOSIS
– pH Probe study– Swallow Studies– Age dependent approach
GER
GER does not = G.E.R.D.
GER & OSA Which comes first?
– Association– Vocal cord excoriation, swelling,
edema– Aspiration pneumonia– Changes in airway physiology
GER diagnosis
Diagnosis not made in sleep lab
Methods– pH Study
– Polysomnography– Probe + PSG– Endoscopy
GER Treatment
H2 Blockers(ranitidine)
Parasympathomimetics(cisapride)
![Sleep-disordered breathing: clinical features, …considered as sleep disordered breathing [7–10]. Based on the underlying pathophysiological mech-anisms, sleep-related breathing](https://static.fdocuments.net/doc/165x107/5fe0151cc0e57633260dbecd/sleep-disordered-breathing-clinical-features-considered-as-sleep-disordered-breathing.jpg)
