1. 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

2. Disordered Sleep BEHAVIORAL

3. BEHAVIORALPSYCHOLOGICAL

4. BEHAVIORALPSYCHOLOGICALBIOLOGICAL

5. NOSOLOGY SIMILAR TO ADULTS

6. NOSOLOGY Behavioral/Psychophysiological

7. NOSOLOGY Behavioral/Psychophysiological Sleep Fragmentation

8. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing

9. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias

10. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias Pain Syndromes

11. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias Pain Syndromes Environmental

12. Nosology (cont.) Psychiatric

13. PsychiatricDrugs/Alcohol

14. PsychiatricDrugs/Alcohol CNS Disease/Disorders

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

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

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

18. The Most Important Historical Question

19. l Does the Child Sleep Well …

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

21. YES l BEHAVIORAL/CONDITIONED

22. NO l BIOLOGICAL

23. Initiating Sleep l 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

24. Sleepless Child: 9 - 12 Months Parental Behaviors at child’s bedtime & Parental response to normal nocturnal wakings = DISORDER OF INITIATING & MAINTAINING SLEEP

25. Sleepless Child: Toddler Behavioral / Conditioned Occasionally Biological

26. Sleepless Child: Adolescent NORMAL PHYSIOLOGY CIRCADIAN FACTORS ANXIETYMOTIVATED

27. Sleepless Child l DISORDERS OF SLEEP MAINTENANCE ENVIRONMENTALBIOLOGICAL

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

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

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

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

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

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

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