Pediatric Sleep Medicine: Mechanisms and Comprehensive Guide to Clinical Evaluation and Management

✍ Scribed by David Gozal (editor), Leila Kheirandish-Gozal (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 719
• Category: Library

✦ Synopsis

This book provides comprehensive coverage of all aspects related to pediatric sleep and its associated disorders. It addresses the ontogeny and maturational aspects of physiological sleep and circadian rhythms, as well as the effects of sleep on the various organ systems as a function of development.
Organized into nine sections, the book begins with a basic introduction to sleep, and proceeds into an extensive coverage of normative sleep and functional homeostasis. Part three then concisely examines the humoral and developmental aspects of sleep, namely the emerging role of metabolic tissue and the intestinal microbiota in regulation. Parts four, five, and six discuss diagnoses methods, techniques in sleep measurement, and specific aspects of pharmacotherapy and ventilator support for the pediatric patient. Various sleep disorders are explored in part seven, followed by an in-depth analysis of obstructive sleep apnea in part eight. The book concludes with discussions on the presence of sleep issues in other disorders such as Down syndrome, obesity, cystic fibrosis, and asthma.
Written by recognized leaders in the field, Pediatric Sleep Medicine facilitates an extensive learning experience for practicing physicians who encounter specific sleep-related issues in their practice.

✦ Table of Contents

Preface
Contents
Contributors
Part I: Basic Introduction to Sleep
1: Normal Sleep in Humans
Introduction
Sleep Neurobiology: The Basics
Wakefulness
NREM Sleep
REM Sleep
Sleep Architecture in Adults
Changes in Sleep Architecture with Age
Total Sleep Time (TST)
Sleep Initiation, Maintenance, and Sleep Efficiency
Sleep Architecture
Changes in Circadian Rhythm with Age
Normal Sleep–Wake Cycle: The Circadian Rhythm and Sleep Homeostasis
Phase Advance, Reduced Circadian Amplitude, and Less Adaptation to Phase-Shift
Sleep in Children
Infants: 0–1 Year
Toddlers: 1–5 Years
Middle Childhood: 6–12 Years
Adolescents: 12–18 Years
Summary
References
Part II: Physiologic Regulation in Sleep and During Development
2: Control of Breathing During Sleep and Wakefulness in the Fetus, Newborn, and Child
Introduction
Influence of Sleep on the Respiratory Control System
Control of Breathing in the Fetus
Regulation of FBM by Chemoreflex Drives
Hypoxic Drive and Peripheral Chemoreceptors
Hypercapnic Drive and Central Chemoreceptors
Control of Breathing in the Newborn
Regulation of Breathing in Neonates in Relation to Sleep, Chemoreflex Drives
Normoxic Breathing Pattern in Neonates in Relation to Sleep States
Hypoxic Ventilatory Responses (HVR) in Neonates in Relation to Sleep State
Hypercapnic Ventilatory Response (HcVR) in Neonates in Relation to Sleep State
Alteration of Ventilatory Chemoreflexes in Neonates by Chronic Intermittent Hypoxia
Sex and Control of Breathing at Neonatal Ages
Respiratory Control in Older Children and Effects of Sleep State
Respiratory Rate, Tidal Volume, and Minute Ventilation: Effects of Age and Sleep
Ventilatory Response to Hypoxia and Hypercapnia: Effects of Age and Sleep
References
3: Normal Respiratory Physiology During Wakefulness and Sleep in Children
Introduction
Lung Volumes
Chest Wall—Developmental Changes
Lung and Respiratory System Compliance—Developmental Changes
Importance of FRC
Contribution of Rib Cage Versus Abdomen to Tidal Volume—Effect of Sleep
Dynamic Maintenance of End-Expiratory Lung Volume
Paradoxical Inward Rib Cage Motion (PIRCM) During Inspiration
Normal Response to Respiratory Mechanical Loading During Sleep
Resistive Inspiratory Loading—Effect of Sleep
Elastic Loading—Effects of Sleep
Responses to Respiratory System Loading—Complete Airway Occlusion
Summary
References
4: Upper Airway and Motor Control During Sleep
Introduction
Anatomy of the Upper Airways
Maturational Anatomy of the Upper Aerodigestive Tract
Innervation of the Upper Airway Muscles
Motor Function of the Upper Airways
Motor Function of the Upper Airway Muscles During Breathing
Upper Airway Motor Responses to Subatmospheric Intraluminal Airway Pressure
Mechanisms of Increased Upper Airway Resistance to Breathing During Sleep
Control of Upper Airway Diameter During Central Apneas and Periodic Breathing
Concluding Remarks
References
5: Endocrinology of Sleep
Introduction
The Circadian System—A Brief Overview
Interplays of the Endocrine System with Sleep and Circadian Rhythms
Hypothalamic-Pituitary Axes and Sleep
The Hypothalamic-Pituitary-Adrenal (HPA) Axis
Hypothalamic Circadian Influence
Circadian Activity of the Adrenal Glands
Circadian Rhythmicity of the Glucocorticoid Receptors and Their Actions
Influences of Sleep on HPA Axis
Growth Hormone
The Hypothalamic-Pituitary-Gonadal/Ovarian (HPG/HPO) Axis
The Hypothalamic-Pituitary-Thyroid Axis
Circadian Rhythmicity of the HPT Axis
Sleep and the Thyroid
Prolactin
The Pineal Gland and Melatonin
Endocrine Impact of Melatonin Action
Insulin Secretion and Glucose Metabolism
Melatonin and Prolactin
Melatonin and Growth Hormone
Melatonin and the HPG Axis
Summary
References
6: Thermoregulation and Metabolism
Introduction
Thermoregulation in Neonates and Infants
Basic Principles
Thermoregulatory Parameters and Sleep Stage Effects in the Thermoneutral Range
Physiological Adjustments to Cold, and Sleep Stage Effects
Physiological Adjustments to Heat, and Sleep Stage Effects
Behavioral Thermoregulation
Sleep Is Influenced by Non-thermoneutral Conditions
Sleeping in a Cool Environment
Sleeping in a Warm Environment
Impacts of Thermal Transients on Sleep
Sleeping at Thermoneutrality
Temperature Circadian Rhythm in Infants and Its Relationship to Sleep
Body Temperature Rhythm According to Sleep
Body Temperatures and Sleep Onset
Conclusion
References
7: Sleep and Immunity
Introduction
The Function of Sleep
Sleep Deprivation
Immune System
Sleep, Brain, and Immune System
The Role of Sleep in Regulating the Immune System
Effect of Sleep Deprivation on the Immune System
Immune System Effect on Sleep
Sleep During Infection
References
8: Sleep and the Gastrointestinal System
Sleep Related Changes in Upper Gastrointestinal Physiology
Sleep and Gastroesophageal Reflux: Sleep Is a Vulnerable State for GERD
GERD and OSA: Bidirectional Relationship?
Laryngopharyngeal Reflux: LPR
Modulation of Cardiorespiratory Events in Neonates and Infants: Role of Sleep and GER
Protective Airway Reflexes
Apnea of Prematurity (AOP)
Brief Resolved Unexplained Event (BRUE) (Apparent Life-Threatening Event: ALTE)
References
9: Circadian Rhythms in Children
Endogenous Origin of Circadian Rhythm: The Circadian Timing System
Examples of Interactions Between Circadian Timing System and the Environment
Preterm Birth
Chrononutrition
Photoperiod at Birth
Emergence and Consolidation of Circadian Sleep/Wake Cycle
Circadian Sleep/Wake Cycle and the Two-Process Model of Sleep Regulation
Developmental Changes According to the Two-Process Model of Sleep Regulation
Individual Differences in Circadian Rhythm
Conclusions
References
Part III: Sleep Mechanisms: Developmental Aspects
10: Developmental Aspects of Sleep
Introduction
Developmental Profile of Sleep
Stressed Maternal Conditions Leading to Malformed S-W and Neurobehavioural Development in the Newborn
Maternal Sleep Restriction Affecting Neural Development in the Newborn
Micro-Architecture Based on Differences in Development of EEG Bands
Clues From Modelling of Distribution Patterns of S-W Bouts During Development
References
11: Humoral and Other Sleep-Promoting Factors
Proinflammatory Cytokines
Adipokines
Gastrointestinal Hormones
Prolactin
Sleep Signaling by Metabolic Organs
Conclusions
References
Part IV: Measurement of Sleep
12: Survey Tools and Screening Questionnaires to Pediatric Sleep Medicine
Introduction
Adolescent Sleep-Wake Scale
Behavioral Evaluation of Disorders of Sleep (BEDS) (Fig. 12.1)
Brief Infant Sleep Questionnaire (BISQ)
Center for Epidemiological Studies Depression Scale for Children (CES-DC) (Fig. 12.2)
Children’s Morningness-Eveningness Scale (Fig. 12.3)
Children’s Sleep Habits Questionnaire (CSHQ)
Cleveland Adolescent Sleepiness Questionnaire (CASQ) (Fig. 12.4)
Pediatric Daytime Sleepiness Scale (PDSS) (Fig. 12.5)
Pediatric Sleep Questionnaire (PSQ)
Pictorial Sleepiness Scale Based on Cartoon Faces (Fig. 12.6)
School Sleep Habits Survey (Fig. 12.7)
Sleep Disorders Inventory for Students (SDIS): Children’s Form (SDIS-C) and Adolescent Form (SDIS-A)
Tayside Children’s Sleep Questionnaire (TCSQ)
Teacher’s Daytime Sleepiness Questionnaire (TDSQ)
Adolescent Sleep Habits Survey
BEARS Sleep Screening Tool
Obstructive Sleep Apnea-18 (OSA-18)
IF SLEEPY/I SLEEPY/I’M SLEEPY Questionnaires
Obstructive Sleep Apnea-5 (OSA-5) (Table 12.1)
Conclusion
References
13: Pediatric Patients with Sleep Complaints: Initial Interview and Diagnostic Planning
Introduction
Screening for Sleep Disorders
The Two Major Presenting Problems: Insomnia and Hypersomnia
Start Simple
Age Matters
The First 5 minutes
What Is the Chief Complaint at Night?
What Else Is Going On in the Day?
Supporting Data?
The Sleepy Seven
Sleep-Related Breathing Disorder
Hypersomnia
Sleep-Related Movement Disorders
Parasomnia
Insomnia
Circadian Rhythm Sleep Disorder
Miscellaneous
The Bedroom and Bedtime Routines
Current and Past Interventions
Family and Social History
The Physical Examination
Decision-Making
Know What Is Normal
When Only Hand Holding May Be Needed
Investigative Decisions
Sleep-Related Breathing Disorder
Hypersomnia
Sleep-Related Movement Disorder
Parasomnia
Insomnia
Circadian Rhythm Sleep Disorder
Parting Thoughts
References
14: Best Practices for Accommodating Children in the Polysomnography Lab: Enhancing Quality and Patient Experience
Introduction
Indications for Polysomnography in Children
A Family-Centered Approach
Preparing the Sleep Lab for Children and Families
Scheduling and Considerations in the Pediatric Sleep Study Orders
Medical History Information Needed for Planning
PSG Planning and Preparatory Education for Families
Emotional Preparation
Special Needs Populations
Physical Set Up, Protocols, Staffing
During the Procedure
Technologist Considerations: Initial Greeting and Hook-Up
Safe Sleep Practices
The PSG Procedure, Scoring, and PSG Interpretation
After the PSG Procedure
Patient Experience
Quality Measures
Conclusion
References
15: Technologies in the Pediatric Sleep Lab: Present and Future
Introduction
Polysomnography
Ambulatory Unattended Polysomnography
Oximetry
Capnography
EEG Spectral Analysis
Actigraphy
Autonomic Signal Assessment
ECG Analyses: HRV
PAT
PTT
Sound Analyses
Wrist Consumer-Wearable Activity Trackers
Smart Phone Applications
References
16: Upper Airway Imaging in Pediatric Obstructive Sleep Apnea
Introduction
Lateral Neck Radiography
Cephalometry
Magnetic Resonance Imaging (MRI)
Normal-Weight Children
Obese Children
Children with DS
Cine MRI
Computerized Tomography (CT)
Cone Beam CT (CBCT)
Functional Respiratory Imaging (FRI)
Normal-Weight Children
Obese Children
Children with DS
(Long-Range) Optical Coherence Tomography
Drug-Induced Sleep (Sedation) Endoscopy (DISE)
Future Developments
Summary
References
17: Laboratory Tests in Pediatric Sleep Medicine
Introduction
Pediatric Obstructive Sleep Apnea
Diagnostic Tests
OSA-Associated Urinary Proteins
High Sensitivity C-Reactive Protein (hs-CRP)
OSA-Associated Inflammatory Biomarkers/Cardiovascular Biomarkers
OSA-Associated Metabolic Biomarkers/Metabolic Morbidity Biomarkers
Excessive Daytime Sleepiness in OSA
Restless Leg Syndrome (RLS)/Periodic Leg Movement Disorder of Sleep (PLMDS)
Iron-Related Markers
Narcolepsy/Idiopathic Hypersomnia/Primary Excessive Sleepiness
Orexin Levels in Cerebrospinal Fluid
Thyroid Panel
Human Leukocyte Antigen (HLA)-DQB1*06:02
References
18: The Nocturnal Polysomnogram – Approaches to Recording, Scoring, and Interpretation in Infants and Children
Indications for Nocturnal Polysomnography in Children
Classification of Sleep Studies
Advantages, Disadvantages, and Contraindications for Pediatric Level 1 Polysomnography
Standards and Guidelines Used by Accredited Sleep Centers in the USA to Record and Score Nocturnal Pediatric Polysomnograms
Child-Friendly Polysomnography Techniques
Preparing a Child for In-Laboratory Polysomnogram
Creating a Sleep Laboratory Welcoming to Children
Applying Polysomnographic Sensors in Children
Overnight Level 1 Pediatric Polysomnographic Recording Procedure
Which Biophysiologic Signals Are Recorded in Level 1 Polysomnography and Why
Electroencephalography (EEG)
Electro-Oculography (EOG)
Mentalis Electromyography (Chin EMG)
Multiple Biological Signals Recorded to Assess Breathing During Sleep
Thermal and Nasal Pressure Sensors Monitor Airflow
Respiratory Effort Monitored Using Respiratory Inductance Plethysmography
Pulse Oximetry
Carbon Dioxide Monitoring (Capnometry)
End-Tidal Carbon Dioxide Monitoring
Transcutaneous Carbon Dioxide Monitoring
Electrocardiography (ECG)
Other Biological Variables Recorded During Level 1 PSG
Split Night or Full Night Positive Airway Pressure Titration Level 1 PSG
Capped Tracheostomy and Mechanical Ventilation Overnight Level 1 PSG
Abbreviated 4-Hour Nap Level 1 PSG
Scoring of Level 1 Nocturnal Polysomnogram First Done by Sleep Technologists
Scoring Sleep/Wake States in Children 2 Months to 18 Years of Age
The Dominant Posterior Rhythm of Wakefulness Develops with Age
Drowsiness/Wake-Sleep Transition
Scoring NREM 1 Sleep
Recognizing and Scoring NREM 2 Sleep in a Nocturnal Polysomnogram in Children
Scoring NREM 3 Sleep in Children
Scoring REM Sleep in Children
Scoring Arousals in Children of Ages 2 Months to 18 Years
Scoring Respiratory Events in Children of Ages 2 Months to 18 Years
Scoring Pediatric Periodic Limb Movements in Sleep
Scoring REM Sleep Without Atonia
Scoring Sleep/Wake States in Infants 0–2 Months of Age
Crucial to Know the Infant’s Gestational and Chronological Age
Technical Considerations When Recording Level 1 PSG in Infants 0–2 Months Old
Scoring Sleep/Wake States in Infants 0–2 Months Old
AASM Rules for Scoring Sleep/Wake States in Infants 0–2 Months Old
Sleep Cycle Patterns in Infants 0–2 Months of Age
Scoring Respiratory Events in Level 1 PSG in Infants of Ages 0–2 Months Is Challenging
Review and Interpretation of Nocturnal Pediatric Polysomnograms
Review Biocalibration, Hypnogram, and Technologist’s Comments
Now Review the Video-Polysomnogram
Once Reviewed and Revised, Generate a Report of the Polysomnogram
Provide a Summary and Interpretation of the Polysomnogram
Interpreting Pediatric Polysomnogram Cognizant Normative Data
First Night Effect in Children
Night-to-Night Variability in Pediatric Polysomnogram
Normative Single Overnight Level 1 PSG Data for Pediatric Sleep Architecture and Arousals
Normative Single Overnight Level 1 PSG Sleep-Related Respiratory Data
Cutoff Values for Diagnosing OSA on PSG in Children of Ages 1–23 Months
Excessive Periodic Limb Movements
REM Sleep Without Atonia and REM Sleep Behavior Disorder
Recognizing REM Sleep Behavior Episodes in Video-Polysomnography
Summary
References
19: Multiple Sleep Latency Test
Multiple Sleep Latencies in Adults
Introduction: Excessive Daytime Sleepiness (EDS) and Repercussions
Subjective Diagnostic Methods
Objective Diagnostic Methods
Normative MSLT Data
Factors Influencing MSLT
Age
Sleep Deprivation
Stimulants or Drugs, Exercise, Meals
Treatments
Fourth or Fifth Nap
Conditions During the Test
Pathologies Influencing MSLT
Central Hypersomnias
Narcolepsy
Idiopathic Hypersomnia
Secondary Excessive Daytime Sleepiness
Primary Insomnia
Sleep-Related Breathing Disorders
Sleep Fragmentation/Periodic Leg Movements
Other Neurological Disorders
Reliability
Indications of MSLT
MSLT in Children
Introduction
Subjective Diagnostic Methods
Objective Diagnostic Methods
Factors Influencing MSLT
Age-Puberty
Sleep Restriction/Deprivation
Stimulants or Treatments
Pathologies Influencing MSLT
Central Hypersomnia
Narcolepsy
Idiopathic Hypersomnia
Secondary Excessive Daytime Sleepiness
Obstructive Sleep Apnea
Periodic Leg Movements
Other Sleep Pathologies
Attention-Deficit/Hyperactivity Disorder
Indications of MSLT
Conclusions
References
20: Actigraphy
Current Professional Recommendations for Clinical Use
Validity of Actigraphy for Estimating Pediatric Sleep
Clinical and Research Considerations
When Not to Use Actigraphy
When to Use Actigraphy
Pediatric Actigraphy Considerations and Challenges
Device Placement
Artifact
Recording Time
Care and Return of the Device
Reference Values
Publishing and Reporting
Consumer-Marketed Wearable Trackers
References
21: Defining Normal in Pediatric Sleep: Some Thoughts and Things to Think About
References
Part V: Pharmacotherapy of Sleep Disorders in Children
22: Stimulants
Introduction
Amphetamines and Amphetamine-Like Compounds
Pharmacological Effects
Chemical Entities
Pharmacokinetics
Mechanisms of Action
Pharmacodynamics
Indications
Side Effects
Drug Abuse and Misuse
Contraindications
Management
Dosage
Initiation
Monitoring
Modafinil
Pharmacological Effects
Pharmacokinetics
Mechanism of Action
Indications
Side Effects
Management
Contraindications
Mazindol
Other Waking Promoting Agents
Pitolisant
Pharmacological Effects
Pharmacokinetics
Mechanism of Actions
Indications
Side Effects
Management
Contraindications
Sodium Oxybate
Indications
Side Effects
Management
Solriamfetol
Conclusion
References
23: Somnogenic Agents in Children
Introduction
Medical History
Over-the-Counter Substances Used for Sleep
Melatonin and Agonists
Hypnotics
Benzodiazepines
Nonbenzodiazepine Hypnotics
Conclusion
References
24: Drugs which affect Sleep
Introduction
Analysis
Sleep–Wake Disorders and Their Pharmacotherapy: An Ambiguous Perspective
Insomnia
Parasomnia
Central Disorders of Hypersomnolence
Circadian Rhythm Sleep–Wake Disorders
Sleep-Related Breathing Disorders
Sleep Apnea
Sleep-Related Movement Disorders
What Pediatric Somnologists Should Take into Consideration When Drugs Used in Common Pediatric Practice Impact Sleep
Internal Medicine
Surgery and Anesthesia
Neurology and Psychiatry
Vaccines
Discussion
References
Part VI: Acute and Chronic Ventilatory Support in Children
25: Non-invasive Respiratory Support in Children with Sleep Disordered Breathing
Introduction
Continuous Positive Airway Pressure
Bilevel Positive Pressure Ventilation
Neuromuscular Diseases
Congenital Central Hypoventilation Syndrome
Hybrid Modes
Neuromuscular Disease
Obesity Hypoventilation
Congenital Central Hypoventilation Syndrome
High-Flow Nasal Cannula Therapy
Supplementary Oxygen
Conclusion
References
Part VII: Disorders of Sleep
26: Pediatric Insomnia: Etiology, Impact, Assessment, and Treatment
Introduction
Prevalence
Etiology
Impact
Assessment
Treatment
Future Directions
Summary
References
27: Apnea of Infancy, Apparent Life-Threatening Events, and Sudden Unexplained Death in Infancy
Apnea of Infancy
Definition
Physiology of Breathing in Early Infancy
Pathophysiology
Diagnostic Approaches: History and Examination
Differential Diagnoses: Causes
Management
Apparent Life-Threatening Events (ALTE)
Definition
Pathophysiology
Diagnostic Approaches: History and Examination
Differential Diagnoses: Causes
Management
Sudden Unexplained Death in Infancy (SUDI)
Definition
Pathophysiology
Diagnostic Approaches
Differential Diagnosis
Management
Primary Prevention
Creating a Safe Sleep Environment
Illustrative Cases
Apnea of Infancy: Case 1
Apnea of Infancy: Case 2
ALTE Case
SUDI Case
References
28: Apnea of Prematurity
Introduction
Significance
Pathophysiology
Hypoxic Ventilatory Depression
CO2 Apneic Threshold
Relationship Between Apnea, Bradycardia, and Desaturation
Changes in Lung Volume, Apnea, and Desaturation
The Role of Feeding and Gastroesophageal Reflux
Chest Wall Distortion, Anatomic Dead Space, and Diaphragmatic Fatigue
Treatment
Head-Elevated Positioning
Nasal Respiratory Support Systems
Caffeine
Doxapram
Interventions to Reduce IH Independent of Apnea
References
29: Disorders of Respiratory Control and Central Hypoventilation Syndromes
Introduction
Definitions
Pathophysiology
Differential Diagnosis
Congenital Central Hypoventilation Syndrome (CCHS)
ROHHAD/ROHHADNET
Clinical Management
Chiari Malformation and Myelomeningocele
Clinical Presentation
Clinical Management
Prader-Willi Syndrome
Clinical Respiratory Features
Clinical Management
Achondroplasia
Clinical Respiratory Features
Management
Leigh Syndrome
Joubert Syndrome
Clinical Management
Familial Dysautonomia
Clinical Respiratory Features
Acquired Central Hypoventilation Syndromes
Management
Illustrative Case
References
30: Disorders of Excessive Sleepiness
Introduction
Narcolepsy
Definitions
Epidemiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Approach
Management
Illustrative Case
Idiopathic Hypersomnia
Definitions
Epidemiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Approaches
Management
Prognosis
Kleine-Levin Syndrome
Definitions
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Approach
Management
Prognosis
Insufficient Sleep Syndrome
Definitions
Epidemiology
Etiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Approach
Management
Illustrative Case
References
31: Restless Legs Syndrome and Periodic Leg Movements of Sleep
Definitions
Pathophysiology
Diagnostic Approaches
Differential Diagnosis
Management
Illustrative Cases
Case 1
Case 2
References
32: Circadian Sleep Disorders
Definitions and Background
Pathophysiology
Diagnosis
Summary of Disorders and Diagnostic Approaches
Differential Diagnosis
Treatment
Consistent Light/Dark Timing
Prescribed Sleep/Wake Scheduling
Resetting Agents
DSWPD
ASWPD
N24SWD
ISWRD
Illustrative Cases
Case One
Clinical History
Physical Exam
Discussion
Treatment Options
Outcome
Case Two
Clinical History
Physical Exam
Discussion
Outcome
References
33: Parasomnias
Definitions of Parasomnia
NREM-Related Parasomnias
Diagnostic Approaches to NREM Parasomnia
Disorders of Arousal From NREM Sleep
Confusional Arousal
Sleepwalking
Sleep Terrors
Sleep-Related Eating Disorder (SRED)
Pathophysiology of NREM Parasomnias
Differential Diagnosis of NREM Parasomnia
REM Parasomnias
Sleep-Related Hypermotor Epilepsy
Management of NREM Parasomnia
Non-pharmacological Treatment
Pharmacological Treatment
REM-Related Parasomnias
REM Sleep Behavior Disorder (RBD)
Recurrent Isolated Sleep Paralysis
Nightmare Disorder
Other Parasomnias
Exploding Head Syndrome (EHS)
Sleep-Related Hallucinations
Sleep Enuresis
Nocturnal Panic Attacks
Illustrative Cases
Case 1
References
Part VIII: Obstructive Sleep Apnea
34: Obstructive Sleep Apnea: Definition
First Description and Consensus Definitions for Obstructive Sleep Apnea in Pediatrics
Additional Elements of Sleep-Related Respiratory Disturbance Not in the Definitions
A Look Forward: Challenges to Define Early Signals of Pediatric OSA
References
35: Pathophysiology of Obstructive Sleep Apnea Syndrome in Childhood
Introduction
Pharyngeal Development
Pharyngeal Anatomy
Anatomic Considerations
Infancy
Craniofacial Anomalies
Altered Soft Tissue Size
Neurological Disorders
Childhood
Anatomical Assessment of the Upper Airway
Airway Size
Region of Vulnerability and Overlap Region
Airway Dynamics Depicted by MRI
Soft Tissues
Craniofacial Structure
Childhood Obesity
Adolescence
Summary of Anatomic Considerations
Functional Considerations
Central Ventilatory Drive
Ventilatory Response to Inspiratory Resistive Loading
Arousals from Sleep
Upper Airway Neuromotor Tone
Upper Airway Sensation
Summary of Functional Consideration
Biomechanical Considerations
Additional Considerations
Edema
Myopathy
Gender
Genetics
Research Questions
References
36: Obstructive Sleep Apnea: Clinical Presentation and Differential Diagnosis
Clinical Presentation
Clinical History
Physical Examination
Differential Diagnosis
References
37: Surgical Treatment of Pediatric Obstructive Sleep Apnea
Introduction
Adenotonsillectomy
Preoperative Evaluation in Children with Persistent OSA
Drug-Induced Sleep Endoscopy
Cine MRI
Nasal and Nasopharyngeal Surgery
Oropharyngeal Surgery
Surgery to Address Tongue Base Collapse
Tongue Base Reduction
Tongue Repositioning Procedures
Supraglottoplasty
Tracheostomy
Perioperative Considerations in Pediatric OSA
Conclusion
References
38: Obstructive Sleep Apnea: Treatment – Anti-inflammatory Therapy
Introduction
Mechanisms of Action
Nasal Corticosteroids
Montelukast
Comparison of Treatment Efficacy: Nasal Corticosteroids Versus Montelukast
Combination Therapy of Nasal Corticosteroids and Montelukast
Side Effects
Anti-inflammatory Medications After Adenotonsillectomy
Identification of Patients Susceptible for Medical Treatment
Conclusions
References
39: Pediatric Obstructive Sleep Apnea: Orthodontic Management
Pathophysiology Assessment in an Oral Health Office
Assessment of Craniofacial Features, Airway Space, and Weight
Differences in Syndromic Children
Screening of POSA: Prediction of Likely Presence or Absence by Oral Health Professionals – Clinical and Imaging Assessment
Management of POSA by Oral Health Providers
Indication
Maxillary Expansion
Mandibular Repositioning
Maxillary Advancement
Other Considerations
Specific Craniofacial Diagnosis Prior OSA Management
Outcomes of Orthodontic-Orthopedic Approaches
MAD Appliances
RME Appliances
Prediction of Orthodontic-Orthopedic Management Outcomes
Follow-Up
Success Rates of Treatment
Recurrence of Craniofacial Discrepancies
Guiding Recommendation on Long-Term Reassessments
References
40: Myofunctional Approaches to Pediatric Sleep Medicine
Introduction
Craniofacial Growth and SDB
Orofacial Myofunctional Evaluation
Orofacial Myofunctional Exercises
Obstructive SDB and Orofacial Myofunctional Therapy
Other New Evidences
Conclusions
References
41: Illustrative Clinical Cases
Case #1
ADHD and Delayed Sleep-Wake Phase Syndrome with RLS
Biographic Data
Chief Complaint
Family History
Personal History
Sleep-Specific History
General Examination
Complementary Tests Performed
Using Melatonin with Tryptophan and Vitamin B6
Conclusion
Case #2
Epilepsy and Sleep Disturbances (Insomnia)
Biographic Data
Sleep-Specific History
Evolution
Conclusion
Case #3
Central Congenital Hypoventilation Syndrome (Late Onset)
Specific Sleep History
Central Sleep Apnea (CSA)
Congenital Central Hypoventilation Syndrome (CCHS): Late Onset
Case #4
Narcolepsy
Case #5
OSA and ADHD
Case #6
Behavioral Insomnia of Childhood
Case #7
Sleep and Seizure Disorder
References
Part IX: Sleep in Other Disorders
42: Sleep-Disordered Breathing in Neuromuscular Diseases
Introduction
Pathophysiology and Clinical Presentation
Sleep Studies in NMD: Findings
Spinal Muscular Atrophy
Duchenne Muscular Dystrophy
Congenital Muscular Dystrophy
Spinal Cord Injury
Other Diseases
Management Approaches
Nocturnal Ventilation
Diurnal Ventilation
Interfaces for Ventilation
Mask Interface
Mouthpiece
Tracheostomy
Conclusions
References
43: Obstructive Sleep Apnea and Asthma
Introduction
Epidemiology
Prevalence of Asthma and OSA
Severity of Asthma and OSA
Common Clinical Features
Obesity, Allergic Rhinitis, GERD, and Inflammation
Mechanisms of Increased Risk of OSA in Asthma
Clinical Implications
Treatment
Conclusion
References
44: Cystic Fibrosis
Case Vignette
Introduction
Insufficient Sleep and Poor Sleep Quality
Obstructive Sleep Apnea (OSA)
Abnormalities in Gas Exchange
Nocturnal Hypoxemia
Nocturnal Hypercapnia
Effects on Sleep Quality
Etiologies for Poor Sleep
Impact of Sleep Disturbances
Treatment of Sleep Disorders
Conclusions and Implications for Clinical Practice
References
45: Bronchopulmonary Dysplasia
Introduction
Definition of BPD
New Directions: New Definition, New Studies
New BPD Definition (Table 45.2)
Pathophysiology
Inflammation
Infection
Immaturity
Ventilator Injury Pressure/Volume
Current Management Strategies
Medications
Steroids
Long-Term Implications
Outpatient Management Strategies
References
46: Down Syndrome
Introduction
Sleep Disturbance in Children with Down Syndrome
Sleep-Disordered Breathing in Children with Down Syndrome
Epidemiology
Evaluation and Diagnosis
Morbidity and Management
Conclusion
References
47: Sleep in Obese Children and Adolescents
Introduction
Sleep Duration and Obesity
Sleep Quality, Sleep Timing, Sleep Variability, and Obesity
Sleep Timing and Obesity
Sleep Variability, Sleep Quality, and Obesity
Obstructive Sleep Apnea (OSA)
Obesity Hypoventilation Syndrome
Sleep Interventions and Health in Youth
References
48: Sleep in Sickle Cell Disease
Introduction
Pathophysiology
Nocturnal Hypoxemia
Oxidative Stress
Nitric Oxide Bioavailability
Inflammatory Cascade Activation
Cell Adhesion Molecules
Autonomic Nervous System Imbalance
Clinical Manifestations
Sleep Quality and Duration
Pain and Sleep Quality
Respiratory Manifestations
Upper Airway Obstruction and OSA
Lower Airway Obstruction and Asthma
Cardiovascular Disease
Pulmonary Hypertension
Left Ventricular Dysfunction
Neurological Complications
Urological Complications
Priapism
Nocturnal Enuresis
Erectile Dysfunction
Summary
References
49: Epilepsy and Sleep, Common Bedfellows
Introduction
Sleep-Wake State and Circadian Rhythm Effects on EEG, Seizures, and Cortical Excitability
Epilepsy Syndromes and Sleep
Epilepsy Treatment and Sleep
Sudden Unexplained Death in Epilepsy Patients
Epilepsy and Comorbid Sleep Disorders
References
50: Autism Spectrum Disorder
Autism Spectrum Disorder Defined
Epidemiology of Sleep Problems in ASD
Prevalence
Developmental Course
Correlates
Predictors and Consequences
Sleep in Autism – Ontogeny of Sleep Problems in ASD
Neurobiological Mechanisms
Medical Contributors
Environmental and Behavioral Contributors
Assessment
Objective Measures
Polysomnography
Actigraphy
Subjective Measures
Questionnaires
Sleep Diaries
Assessment Considerations
Treatment – Practice Pathway
Sleep Disorders
Insomnia
Development and Risk Factors
Assessment
Treatment
Circadian Rhythm Disorders
Development and Risk Factors
Assessment and Treatment
Sleep-Disordered Breathing
Development and Risk Factors
Assessment and Treatment
Sleep Movement Disorders
Development and Risk Factors
Assessment and Treatment
Parasomnias
Development and Risk Factors
Assessment and Treatment
Bruxism
Development and Risk Factors
Assessment and Treatment
Summary, Conclusions, and Future Directions
References
51: Sleep and Attention-Deficit/Hyperactivity Disorder
Introduction
ADHD and Sleep-Onset Insomnia/Sleep Delayed Phase Syndrome (SDPS)
ADHD and Narcolepsy-Like Symptoms
ADHD and OSA
ADHD Sleep and Epilepsy
ADHD and RLS/PLMs
Effect of ADHD Therapy on Sleep and the Effect of Sleep Therapy on ADHD Symptomatology
Conclusion
References
52: Sleep and Mood Disorder
Introduction of Sleep, Behavior, and Mood
Sleep and Psychiatry
Study of Sleep in Psychiatric Disorders
Sleep and Depressive Disorders
Sleep and Bipolar Disorder
Sleep and Suicide
Sleep, Mood, and Early Intervention
Conclusion
References
53: Prader–Willi Syndrome
Introduction
Genetics
Clinical Manifestations
Sleep and Respiration in PWS Patients
Growth Hormone Therapy and PWS
Summary
References
54: Craniofacial Syndromes
Historical Perspective and General Considerations
Specific Craniofacial Conditions
Cleft Lip/Palate Without Micrognathia
Diagnosis/Treatment
Micrognathia with or Without Cleft Palate
Presentation/Evaluation
Nonsurgical Management
Surgical Airway Management
Syndromes with Other Mandibular Anomalies
Syndromic Craniosynostosis
Evaluation
Management
Conclusion
References
55: Sleep Problems and Developmental Delay
Introduction
Comorbid Factors
Biomedical Factors
Psychological Factors
Contextual Factors
Assessment of Sleep Problems Associated with Developmental Delay
Informant-Report Measures
Direct Objective Measures
Clinical Considerations
Formulation: Biological and Behavioural Models of Sleep
Formulation: Priorities for Intervention
Intervention
Sleep Hygiene
Behavioural Interventions
Bedtime Fading
Extinction and Graduated Extinction
Medical Interventions
Conclusions
References
56: Sleep in Children Following Brain Concussion
Introduction
Defining Concussion
Overview of Sleep Outcomes Following Pediatric Concussion
Prevalence of Sleep Disturbances Following Pediatric Concussion
The Nature of Sleep Disturbances in Pediatric Concussion
Factors Contributing to Sleep Disturbances in Pediatric Concussion
The Impact of Sleep Disturbance on Daily Functioning and Quality of Life
Assessment of Sleep Disturbances in Pediatric Concussion
Treatment of Sleep Disturbances Post-pediatric Concussion
Summary and Conclusions
References
57: Diabetes
Type 1 Diabetes
Epidemiology
Treatment Guidelines
T1D Challenges and Complications
Type 1 Diabetes and Sleep Behaviors
Sleep and Glycemia
Nocturnal Hypoglycemia
Sleep and Treatment Monitoring
Closed-Loop Systems
Prevalence of Sleep Disorders in T1D
Type 2 Diabetes
Epidemiology
Treatment Guidelines
T2D Challenges and Complications
Type 2 Diabetes and Sleep Behaviors
Sleep and Insulin Resistance
Sleep and Inflammatory Pathways
Sleep and Appetite
Prevalence of Sleep Disorders in T2D
Conclusion
References
58: Cerebral Palsy
Cerebral Palsy: The Most Common Cause of Physical Disability Among Children Worldwide
Prevalence of Sleep Disorders in Children with CP
Types of Sleep Disorders in Children with CP
Behavioral Insomnia
Sleep-Disordered Breathing
Other Sleep Disorders
Impact of Sleep Problems on Children with CP and Their Families
Physical Exam and Diagnostic Measures for Sleep Disorders in Children with CP
Sleep Interventions for Children with CP and Sleep Disorders
References
59: Sleep in Children with Myelomeningocele
Medical and Surgical Care of the Child with Spina Bifida
Neurosurgical Considerations
Pathophysiology of Sleep-Disordered Breathing in Children with Spina Bifida
Overview of Treatment Options for Sleep-Disordered Breathing
Special Considerations for Noninvasive Support
Sleep Disorders Beyond Sleep-Disordered Breathing
References
60: Inborn Errors of Metabolism: Mucopolysaccharidoses and Others
Introduction
MPS Disorders and Sleep
Overview
Clinical Characteristics
Sleep Disorders
Sleep Complaints
Sleep-Disordered Breathing
Sleep Architecture
Circadian Rhythm
Others: Movements and Nocturnal Events
Management
Other IEMs and Sleep Disorders
IEM Predominantly Involves Central Nervous System
Aspartylglucosaminuria
Cystinuria
Medium Chain Acyl-CoA Dehydrogenase Deficiency
Neuronal Ceroid Lipofuscinoses
Nonketotic Hyperglycinemia
Niemann-Pick Disease Type C
Phenylketonuria
Succinic Semialdehyde Dehydrogenase Deficiency
Wilson Disease
IEM Predominately Involved in Peripheral Nervous System and/or Non-neurological Systems
Fabry Disease
Pompe Disease
Pseudohypoparathyroidism Type 1A
Smith-Lemli-Opitz Syndrome
Conclusion
References
Index