DISORDERED SLEEP IN INFANTS AND CHILDREN Stephen H. Sheldon, D.O., F.A.A.P. Professor of Pediatrics Northwestern University Feinberg School of Medicine.

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Presentation transcript:

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

BEHAVIORALPSYCHOLOGICAL

BEHAVIORALPSYCHOLOGICALBIOLOGICAL

NOSOLOGY SIMILAR TO ADULTS

NOSOLOGY Behavioral/Psychophysiological

NOSOLOGY 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

PsychiatricDrugs/Alcohol

PsychiatricDrugs/Alcohol CNS Disease/Disorders

Nosology (cont.) PsychiatricDrugs/Alcohol CNS Disease/Disorders Circadian Rhythm Abnormalities

Children are Different l Different Diagnostic Categories l Different Diagnostic Criteria l Different Symptomatology –Often Paradoxical l Different Nosology?

The Sleepless Child l Disorders of Initiating sleep l Disorders of Initiating and Maintaining Sleep l Disorders of Maintaining Sleep

The Most Important Historical Question

l Does the Child Sleep Well …

The Most Important Historical Question l Does the Child Sleep Well … SOMEWHERE?

YES l BEHAVIORAL/CONDITIONED

NO l BIOLOGICAL

Initiating Sleep l AGE DEPENDENT Neonatal / Early Infancy Normal Ultradian Rhythm minute cycles hour feedings Total sleep time about hours Colic/Pain/teething/medical disorders

Sleepless Child: 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 ANXIETYMOTIVATED

Sleepless Child l DISORDERS OF SLEEP MAINTENANCE ENVIRONMENTALBIOLOGICAL

Sleepless Child: Maintenance l DIFFERENTIAL DIAGNOSIS Pain Syndromes AllergyApneaPLMDNightmaresSeizures Circadian Rhythm Abnormalities

Gastroesophageal Reflux/Disorder l Reflux into the esophagus –Level ?? l Reflux into the pharynx l Aspiration into the lungs

GER l DIAGNOSIS –pH Probe study –Swallow Studies –Age dependent approach

GER GER does not = G.E.R.D.

GER & OSA l Which comes first? –Association –Vocal cord excoriation, swelling, edema –Aspiration pneumonia –Changes in airway physiology

GER diagnosis l Diagnosis not made in sleep lab l Methods –pH Study –Polysomnography –Probe + PSG –Endoscopy

GER l Treatment H2 Blockers ( ranitidine ) Parasympathomimetics ( cisapride )

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