Introduction: Why this is important State of alertness affects
a child's ability to Concentrate Focus Learn Succeed Sleepiness can
ruin a childs life Disorders causing sleepiness such as OSA can be
treated
Slide 3
Objectives Recognize the faces of sleepiness Understand the
causes of sleepiness What to do with a sleepy child suspected of
OSA
Slide 4
Overview Sleep breathing disorders in children are common They
can cause children to fail The symptoms can be easily recognized
The disorders can be treated Once treated performance can be
normal
Slide 5
Important principles in dealing with pediatric sleep problems
Children almost never bring a sleep problem to anyones attention
The medical encounter is started by a parent or a teacher What is
the problem? Whose problem is it?
Slide 6
How do children with apnea present? Behavioral symptoms
Manifestations of sleepiness Observations of their sleep What does
the parent see?
Slide 7
The faces of the sleepy child Falling asleep Difficulty
concentrating Memory lapses Loss of energy Lack of initiative
Emotional lability Hyperactivity
Slide 8
The differential diagnosis of sleepiness Reduced quantity of
sleep Deprivation, abnormal body clock Reduced quality of sleep
Sleep disruption Primary Sleep Disorder Sleep apnea Narcolepsy
Slide 9
Almost all students are sleep deprived!
Slide 10
Diary of a night owl Monday Tuesday Wednesday Thursday Friday
Saturday Sunday 024681012141618202224 Time
Slide 11
What the parent observes Noisy breather Snoring, snorting
Gasping Stopping breathing Restless Moves a lot Sweats
Slide 12
The HPI will cover Behavioral symptoms Manifestations of
sleepiness Observations of their sleep What does the parent see?
Medications Other illnesses
Slide 13
What illnesses? Congenital Skeletal structures Control of
breathing Acquired
Slide 14
14 Patient Central canal Spinal cord Spinal Cord Normal
Congenital: Syringomyelia
Slide 15
Congenital: Klippel Feil
Slide 16
16 Congenital: Down syndrome
Slide 17
Congenital: Mucopolysaccharidosis
Slide 18
18
Slide 19
19 Infiltration of airway
Slide 20
20 Congenital: mysteries
Slide 21
21 Acquired: enlarged tonsils
Slide 22
22 Acquired: enlarged tonsils
Slide 23
Slide 24
24 Acquired: (from parent) Small lower jaw
Slide 25
25 Acquired: obesity in toddler
Slide 26
Acquired: obesity in teen
Slide 27
Acquired: misdiagnosed
Slide 28
Confirming the diagnosis
Slide 29
What you end up doing depends on Beliefs of parents Beliefs of
referring clinician Beliefs of insurance companies Whether long
term treatment will be needed Most of the times youll end up doing
PSG
Slide 30
Nitty gritty of PSG in children Show child bedroom before they
come in Have them bring in whatever they use to fall asleep
(blankets, teddy bears) Parent/guardian in room One tech per
patient need experienced tech Dont do split in child
Slide 31
End tidal PCO2 Synchronized video Pediatric PSG
Slide 32
Slide 33
Pediatric PSG: may be classic
Slide 34
Pediatric PSG: may be classic with surprises
Slide 35
Pediatric PSG: with more surprises
Slide 36
Pediatric PSG: yet more surprises
Slide 37
What is observed: may be subtle
Slide 38
What is observed sped up
Slide 39
Restless sleep and apnea
Slide 40
Mask fitting in child may be difficult
Slide 41
3 case studies Presentation What is the problem? Whose problem
is it? Assessment What data is needed to find cause of problem?
Analysis How is data used to find cause of problem? Solution What
was done
Slide 42
Case 1: Falling asleep in class
Slide 43
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Sleep apnea occurs in children History of snoring Often have
big tonsils, obesity or overbite Check bite during health exam
Usually cured with treatment Remember the orthodontic window Take
home messages
Slide 50
Case 2: Hyperactive child
Slide 51
Slide 52
Slide 53
Slide 54
Sleepiness in a child may paradoxically present as
hyperactivity Do sleep evaluation in ADHD children Take home
messages
Slide 55
Case 3: Falling asleep in class
Slide 56
Slide 57
How do you put this case together? 1.Since the apnea episodes
are less than 20 seconds, no diagnosis of central apnea can be made
using pediatric rules 2.The patient has a neurological disease
3.The patient likely has cardiac valve disease. 4.The patient has
idiopathic central apnea
Slide 58
You have 10 seconds!!!!
Slide 59
Answer 3. The patient had a streptococcus B. infection of her
tonsils, followed by bizarre neurological symptoms. These symptoms
are those of Sydenham's Chorea, which is very frequently associated
with rheumatic fever, which in turn often causes valvular heart
disease. The Chorea (also called St. Vitus's dance) can come on up
to several months after the rheumatic fever.
Slide 60
What to expect with treatment
Slide 61
Summary You have learned sleep disorders common in children can
cause difficulty in school patterns can be recognized How you can
help the child suspect sleep problems when student falls asleep in
class or is hyperactive snores or jaw is small