Sleep apnoea and neuromuscular respiratory failure in children Flashcards Preview

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Flashcards in Sleep apnoea and neuromuscular respiratory failure in children Deck (14)
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1
Q

What are respiratory patterns in newborns?

A
  • 16-18 hours asleep
  • Sleep-wake states alternate in 3-4 hour cycles
  • Then start to adapt to light-dark/social cues.
2
Q

What are respiratory patterns in infants: 6 months and 2nd year?

A

6 months

  • 14-15 hr asleep
  • 2 longer sleep periods at night
  • 1-2 daytime naps

2nd year

  • 12 hr asleep
  • 1 daytime nap
3
Q

Assessment methods of sleep in children?

A
  • Polysomnography
  • Oxygen/CO2 monitoring
  • Direct behavioural observation
  • Time-lapse video
  • Movement sensors in cot mattress
4
Q

Normal v Abnormal patterns of sleep

A
  • Napping and enuresis become relatively abnormal after 3-5y.
  • 1y old “abnormal” if sleeps 8h at night and does not nap.
  • Sleep walking normal in toddlers.
  • Abnormal if unmedicated adult is unrousable from sleep.
  • REM onset normal in first 3 months
5
Q

Other normal phenomena in sleep

A
  • Sleep walking: middle childhood.
  • Sleep terrors, “look of fear”
  • Hypnic jerks
6
Q

Features of sleeplessness

A
  • Mainly behavioural problems: infants 1+ arousal for 1-5 mins each night, self-soothers, signalers.
  • Medication
  • Neurological disorders e.g. melatonin
7
Q

What cause cause excessive sleepiness?

A
  • Insufficient sleep
  • OSAS
  • Narcolepsy: often not diagnosed in childhood, cataplexy, orexin deficiency.
8
Q

What is primary snoring?

A

Snoring without apnea, hypoventilation, hypoxia, hypercarbia, daytime symptoms.

Prevalence - 10%
May progress to adenotonsillectomy.

9
Q

Features of OSAS

A
  • Commonest pre-school child (adenoids)
  • Prevalence, 2%.
  • Morbidity: failure to thrive, neurocognitive defects/adhd, systemic hypertension, cor pulmonale.
10
Q

What is common in childhood OSAS?

A
  • Mouth breathing
  • Enlarged tonsils
  • Hyperventilation as an obstructive pattern
11
Q

Treatment for childhood ASOS

A
  • Adenotonsillectomy
  • (CPAP)
  • Weight loss
  • Avoid environmental tobacco smoke
12
Q

Respiratory disorders in children linked to sleep

A
  • Chronic neonatal lung disease: hypoxaemia in REM sleep (similar COPD), cardiac complications
  • Cystic fibrosis: FEV1 30-60% associated with decreased SaO2, less REM/more awakenings
  • Asthma
13
Q

Neurological disorders linked to sleep problems

A
  • Cerebral palsy: fragmented sleep/delayed onset , melatonin
  • Down syndrome: OSAS
  • Prader-Willi syndrome: excessive daytime sleepiness
  • Neuromuscular disease (Duchenne’s MD)
14
Q

Features of Neuromuscular disease (Duchenne’s MD)

A
  • Death due to respiratory failure
  • Nocturnal desaturation associated with FVC <1 litre
  • Increasing quality of life/survival with BiPAP