Pediatric Studies

• CHILDHOOD SLEEP APNEA
• INFANT SLEEP APNEA
• SUDDEN INFANT DEATH SYNDROME (SIDS)
• SLEEPWALKING (SOMNAMBULISM)
• NIGHT TERRORS
• NIGHTMARES
• NARCOLEPSY
• BEDWETTING
• RHYTHMIC MOVEMENT DISORDERS

Symptoms of sleep disorders in children are often very different from those associated with adult sufferers. This is an important point in your research as you evaluate your child and speak with your pediatrician, as many childhood sleep problems are related to irregular sleep habits or to anxiety about going to bed and/or falling asleep.

Fortunately, children usually get over more common sleep problems as they mature. However, parents with ongoing concerns should contact their pediatrician.

Associated symptoms include:

• Frequent arousals
• Talking in their sleep
• Trouble falling asleep
• Waking up crying
• Daytime sleepiness
• Teeth grinding
• Waking up early

Childhood Sleep Apnea:

The most common type of sleep apnea is Obstructive Sleep Apnea (OSA), characterized by frequent episodes of upper airway obstuction that occurs during sleep and associated with a reduction in oxygen saturation.

Symptoms:

• Excessive daytime sleepiness
• Frequent episodes of not breathing

Associated features may include:

• Snoring - long, squeaky or raspy
• Nighttime snorting, gasping or choking
• Restless sleep
• Heavy, irregular breathing
• Excessive sweating during sleep
• Severe bedwetting
• Bad dreams (or nightmares)
• Night terrors
• Sleeping with mouth open
• Dry mouth upon awakening
• Chest retraction during sleep in young children
• Sleeping in strange positions
• Confusion upon arousal
• Morning headaches
• Unrefreshing sleep
• May develop high blood pressure
• May be overweight or underweight
• Learning problems
• Excessive irritability
• Change in personality
• Depression
• Difficulty with concentration
• Developmental problems
• Failure to thrive or grow
• Frequent upper respiratory infections
• Hyperactive behavior

Sleep apnea is a potentially life-threatening condition requiring immediate medical attention. The risks of undiagnosed OSA in children create problems in a mirad of physical, emotional and social areas. The symptoms can easily become their reality, causing changes in pesonality and interpersonal relationship problems, depression and lost productivity in school. Lagging behind in many area of development, the child may become frustrated and angry. The severity of the symptoms may be mild, moderate or severe.

A sleep test is usually done to diagnose apnea, monitoring brainwaves, eye movement, muscle tension, limb movement, breathing, oxygen in the blood, and listening for snoring, gasping or grunting. They are painless and are parent-accompanied, as well as covered by most insurances.

Treatment:

In many children, simply removing the tonsils and/or adenoids may take care of the problem. In others, treatment with a Continuous Positive Airway Pressure (C-PAP) machine or with Bi-Level positive airway pressure, a simple device that blows air into the nose by way of a nose mask, opening the airway and eliminating the problem.

Surgeries for the most severe cases are available, but rare. Upon diagnosis, it may be discussed.

A common cause of sleep apnea in children is obesity. Weight loss may correct the problem.

Organizations:

Infant Sleep Apnea:

The characteristics of infant sleep apnea are marked by both central and obstructive periods that occur while asleep. An apnea is the cessation of airflow at the nostrils and mouth lasting at least 10 seconds. A central apnea is when the drive or effort to breath stop for more than 10 seconds (20 seconds in an infant). An obstructive apnea is when the upper airway becomes blocked.

The diagnosis of Apnea of Infancy is reserved for infants who are older that 37 weeks (approx 9 months) at the onset of the apnea, and for those whom there is no specific cause of apparent life threatening event (ALTE) or apnea that can be identified.

Apnea of Prematurity is restricted to apnea in infants younger than 37 weeks (approx 9 months) and not due to any explainable cause except respiratory immaturity.

Symptoms:

• Observed cessation of breathing during sleep (>10 seconds) that may include:
            Color change (Infant is pale or bluish)
            Tone change (limpness)
            Noisy breathing during sleep

Sudden Infant Death Syndrome (SIDS):

SIDS is the unexpected, unexplained and unpredictable death of an infant in which a thorough postmortem investigation fails to demonstrate an adequate cause of death.

Though there is agreement that apnea associated with Prematurity requires diagnosis, observation and, treatment, there is little agreement as to the boundaries of what is normal and abnormal in regards to sleep patterns in term or pre term infants, nor is there agreement as to the cause.

Most SIDS cases occur during a time when sleep is presumed and expected in and infant. However, even though infant sleep apnea has been implicated as a precursor to SIDS, there is, as yet no definite proof of a direct link, though most experts feel it is only a matter of time. The fear that respiratory instability in an infant during sleep may some how, predispose some infants to sudden infant death syndrome cries out for urgency in research and clinical management.

Below you will find research related sites where attention to detail, with regards to current research in the field of SIDS, can be obtained.

Organizations:

Sleepwalking (Somnambulism)

Sleepwalking (Somnambulisim) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep.

Somnambulisim is most common in prepubescent children, the act of moving about or walking while asleep is the sign and symptom of this disorder.

Associated Features Include:

• Difficulty in arousing the patient during an episode
• Amnesia following an episode
• Episodes typically occur in the first third of the sleep episode
• Polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 of sleep
• Other medical and psychiatric disorders can be present but do not account for the symptom
• The ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors
• Somniloquy or sleep talking may take place at the same time
• Incomprehensible mutterings are usually the case
• The range of the episode can be as simple as just sitting up in bed, or walking about the room to episodes where the child runs and screams
• In some sleepwalking cases, the child may urinate in an inappropriate place
• The child may use obscene words that would not be used when awake
• The child may fall and injure themselves

Sleep walking that starts at an early age, generally disappears as the child gets older. If the child outgrows the sleepwalking the age that it ended was approximately 13.8 years old. If the child begins sleepwalking after the age of 9, it often lasts into adulthood.

Medical reports show that about 18% of the population are prone to sleepwalking. It is more common in children than in adolescents and adults. Boys are more likely to sleepwalk than girls. The highest prevalence of sleepwalking was 16.7% at age 11 to 12 years of age. Sleepwalking can have a genetic tendency.

The majority of children who experience sleepwalking only have a mild display and frequency of the disorder. Therefore, most parents are relived to know that most children will outgrow the disorder.

If, however the sleepwalker is having frequent episodes and injuries are occurring, seek professional help from a Sleep Medicine Center in your area.

Night Terrors

Night terrors are characterized by a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by behavioral manifestations of intense fear. Also known as PAVOR NOCTURNUS- SLEEP TERRORS. The child will most likely awake, unable to explain what scared him or her. Some children who have night terrors remember a frightening image, but often they remember nothing. Night terrors are often more frightening for parents than for their child.

Symptoms of night terrors include:

• A sudden episode of Intense fear during sleep
• The episodes usually occur during the first third of the nights sleep
• Partial or total amnesia occurs for the events during the episode

Associated features include:

• Increased heart rate usually occurs in association with the episodes
• May occur once a month to once or more per week (injuries not likely)
• In the severest of cases, occurs almost nightly (injury may occur)
• Other medical disorders are NOT the cause, e.g., epilepsy
• Other sleep disorders can be present, e.g., nightmares.

Organizations:

Nightmares

Nightmares are sometimes referred to as dream anxiety attacks and differ radically from Night Terrors. While a Night Terror episode occurs during slow wave sleep (stage 3 or 4) a Nightmare occurs during REM sleep. Other differences include the fact that after a nightmare one will most likely have an immediate recall of the frightening event, where as, night terrors will not be remembered. Also after a nightmare one will be fully alert immediately upon awakening with little confusion or disorientation.

Associated features include:

• A feeling of impending doom upon awakening
• Feeling of anxiety and fear
• Immediate recall
• Immediate alertness, with little confusion
• Return to sleep after an episode is delayed and not rapid
• Episodes occur during the later half of the sleep period
• Rapid Heart rate and rapid breathing may occur during and after the episode

Organizations:

Infant Narcolepsy

Under construction.

Bedwetting

Sleep enuresis is the inability to maintain urinary control during sleep. Primary enureisi refers to inability to maintain control from infancy. Secondary enuresis is a relapse after control has been achieved.

Sleep enuresis can be caused by medical disorders like diabetes, urinary tract infections, sleep apnea or epilepsy. Psychiatric disorders can also be the cause.

To be considered sleep enuresis, there has to be at least two episodes per month in children 3 to 6 years and at least one episode per month for older individuals. Sleep- walking can also occur during an episode.

A full physical should be performed to rule out medical conditions. There are various techniques used when medical conditions have been ruled out. The most common are: behavior modification, alarm devices, and medications.

Research Sites:

Rhythmic Movement Disorder

Rhythmic Movement Disorder is a group of stereotyped, repetitive movements involving large muscles. Usually the head and neck, which typically occur immediately before sleep onset and are sustained into light sleep.

Also known as jactatio capitis nocturna, headbanging, headrolling, bodyrocking, bodyrolling, rythmie du sommell. The term rhythmic movement disorder is preferred as different body areas may be involved in the movement activity.

Symptoms Include:

• Rythmic body movements occurring during drowsiness or sleep
• At least one of the following types of movements is present:
  1. The head is forcibly moved in a back and forward direction- headbanging type
  2. The head is moved laterally while in a supine (lying on the back, face up) position (head rolling type)
  3. The whole body is rocked while on hands and knees (bodyrocking type)
  4. The whole body is moved laterally while in a supine position (bodyrolling type)

Research Sites: