1 / 12

Pediatric Neurology Quick Talks

Sleep Disorders Michael Babcock Summer 2013. Pediatric Neurology Quick Talks. -4 yo boy -screaming at night -lasts 30 minutes -occurs about 2 hours after going to bed -inconsolable during crying, then falls back asleep -no bed wetting -no limb shaking -eyes closed

donagh
Télécharger la présentation

Pediatric Neurology Quick Talks

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Sleep Disorders Michael Babcock Summer 2013 Pediatric Neurology Quick Talks

  2. -4 yo boy -screaming at night -lasts 30 minutes -occurs about 2 hours after going to bed -inconsolable during crying, then falls back asleep -no bed wetting -no limb shaking -eyes closed -no sedation in the AM Scenario

  3. Sleep Screen – BEARS • B – Bedtime issues • E – Excessive daytime sleepiness (can exhibit as motor over-activity, inattentiveness, irritability, oppositional defiance) • A – night Awakenings • R – Regularity and duration • S – Snoring • If concerns • Movements • Meds

  4. Insomnia • Onset or Maintenance? • Usually behavioral • Psychosocial • Anxiety (separation) • Depression • Medical problems – chronic pain, GERD, breathing problems, medications

  5. Limit-setting subtype • Older children • Active resistance to bedtime • Verbal protests and repeated demands • Can manifest as fearful behavior (crying, clinging) • Usually due to caregiver inconsistency with bedtime rules • Can have medical underlying causes – asthma, medications, sleep disorder – RLS, anxiety. • Tx – caregiver enforces rules Insomnia • Sleep onset Association • Prolonged night awakenings • Child has learned to fall asleep with Associations requiring parents – feeding, rocking, reading; can't self-soothe. • Tx – break connection; put child to be while drowsy but not asleep.

  6. Hx – children may have difficulty explaining this unpleasant feeling – pain should not be only feeling. Differential – Periodic leg movement disorder – actual leg movements during sleep without sensation – this can be due to other sleep disorders. Work-up – iron studies Tx – iron supplementation; off label use of gabapentin, benzo's, clonidine, dopamine agonist used less often in children. Restless Leg Syndrome • An urge to move legs, usually accompanied by unpleasant sensation in legs • These symptoms: • Begin or worsen during rest/inactivity • Relieved by movement • Occur exclusively or predominantly in evening • Not solely accounted for as symptoms of another medical/behavioral condition

  7. Excessive daytime sleepiness • A sleepy child may not appear sleepy – can be inattentive, hyperactive (trying to stay awake), aggressive, disruptive (sleep-deprived frontal cortex can't regulate emotion) • Insufficient sleep – insomnia • Inadequate sleep hygiene • Medication side-effects • Periodic limb movement disorder • Idiopathic hypersomnia • endocrine/metabolic problems • Narcolepsy • OSA

  8. Narcolepsy • Narcolepsy • Excessive daytime sleepiness • Sleep paralysis • Hypnagogic hallucinations • Cataplexy • Sudden loss of tone • Precipitated by emotion (laughing, anger) • REM creep • Dx – polysomnography, MSLT

  9. Who has OSA 2-3 % of normal development children have OSA 10% of normal children will be habitual snorers – don't have OSA 50% of children with Down's ~50% in obese children Why is it bad Hypertension, CHF, stroke, diabetes, difficulty losing weight. Obstructive Sleep Apnea • Excessive daytime sleepiness • Symptoms – Snoring, with apneic pauses • But also • Daytime nasal obstruction • Mouth breathing • Trouble eating/meat refusal • Behavior problems • Bed-wetting • Restless sleep • Sweaty sleep (needs fan on) • AM headache • Poor seizure control

  10. Sleep-related movement disorders Rhythmic movement infants/toddlers Start at sleep onset Head rolling/head banging/body rocking Bruxism RLS/PLMD Hypnic starts Brief jerks occurring with falling asleep/awakening May have sensation of falling Parasomnias • Disorders of Non-REM arousal • Sleep walking • Sleep terrors • Confusional arousals • REM sleep disorders • Nightmares • Sleep paralysis • REM sleep behavior disorder • Narcolepsy • SSRI • neurodevelopmental

  11. Differential – nocturnal seizures Anytime during night, more often in transition periods Last 30 seconds – 5 minutes Multiple events nightly Daytime seizures Daytime irritability/lethargy Older age of onset. Differential – panic attack, GERD. Dx -home videos, polysomnography or overnight EEG. Tx – low dose benzo. Non-REM arousal parasomnias • Usually during first 1/3 of night • Usually only one event/night • Increased arousals cause increased problems • OSA, RLS, GERD. • Triggered by sleep deprivation, fever. • Toddler and school-aged kids. • Usually resolve with time • sleep-walking most likely to persist. • Not tired the next day • No stereotypic motor movements • Last 5-30 minutes

  12. References -Uptodate articles – pediatric sleep, NREM sleep disorders, parasomnias, narcolepsy, RLS

More Related