340 likes | 523 Vues
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.
E N D
DISORDERED SLEEPININFANTS 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
Disordered Sleep BEHAVIORAL PSYCHOLOGICAL
Disordered Sleep BEHAVIORAL PSYCHOLOGICAL BIOLOGICAL
NOSOLOGY SIMILAR TO ADULTS
NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological
NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation
NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing
NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias
NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias Pain Syndromes
NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias Pain Syndromes Environmental
Nosology (cont.) Psychiatric
Nosology (cont.) Psychiatric Drugs/Alcohol
Nosology (cont.) Psychiatric Drugs/Alcohol CNS Disease/Disorders
Nosology (cont.) Psychiatric Drugs/Alcohol CNS 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 • 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 Infancy Normal Ultradian Rhythm 45 - 60 minute cycles 3 - 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 DIAGNOSIS Pain Syndromes Allergy Apnea PLMD Nightmares Seizures 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)