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, 153:866-878

Pediatric Sleep Disorders

http://www.egms.de/egms/servlet/Figure?id=cto000028&figure=f9&vol=2006-5

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 20-30 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!!!