Pediatric Sleep Pearls E-Book

Lourdes Del Rosso, Richard B. Berry, Suzanne Beck, Mary H Wagner, Carole L. Marcus

• Publisher: Elsevier
• Year: 2016
• ISBN:
  9780323428330
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

Following in the steps of the bestselling Sleep Medicine Pearls, this practical resource provides authoritative guidance on the evaluation and management of common pediatric sleep medicine problems using concise clinical vignettes. Experts in this rapidly growing field, led by Drs. Lourdes M. Del Rosso, Richard B. Berry, Suzanne E. Beck, Mary H. Wagner, and Carole L. Marcus, provide a hands-on, case-based approach, perfect for physicians studying for the sleep boards, fellows learning sleep medicine, and physicians who see children in their practice.

• Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
• Over 95 cases review key elements in the evaluation and management of a wide variety of pediatric sleep disorders.
• An easy-to-read "pearls" format summarizes 2 to 5 major teaching points for maximum retention. Short, templated chapter s are ideal for use by busy physicians.
• Current scoring criteria from the American Academy of Sleep Medicine manual for sleep and associated events version 2.2, as well as the current International Classification of Sleep Disorders, 3rd Edition (ICSD-3).
• Expert coverage of normal sleep in children, as well as sleep disorders associated with common medical, neurologic, psychiatric, neurodevelopmental, and genetic conditions.
• Up-to-date information on pediatric obstructive sleep apnea syndrome diagnosis and management.
• Numerous illustrations of polysomnographic fragments and pictures of clinical findings help you quickly recognize key pediatric sleep patterns that lead to an accurate diagnosis. All illustrations online are in full color.
• An ideal resource for pediatric sleep medicine specialists, adult sleep medicine specialists, pediatric pulmonologists, pediatric neurologists, pediatric otolaryngologists, general pediatricians, and pediatric psychologists.

Part 1

Introduction to Pediatric Sleep Medicine

Outline

Section 1. Evaluation of the Pediatric Sleep Patient

Case 1. Pediatric sleep history: A 4 year-old with snoring, gasping and witnessed apneas

Case 2. A 6-year-old girl with tonsillar hypertrophy, high-arched palate, and snoring

Case 3. A 10-year-old girl with an unusual finding on physical exam

Section 2. Pediatric Polysomnography

Case 4. Overview of pediatric polysomnography: A newborn infant with snoring and witnessed apnea

Case 5. A 2-week-old infant with some challenging epochs on polysomnography

Case 6. A 14-year-old with an abnormal end-tidal CO2 waveform during polysomnography

Section 3. Common Polysomnographic Findings in Children

Case 7. A 3-year-old boy with rhythmic activity on electroencephalogram

Case 8. A 3-month-old infant with monomorphic waves on electroencephalogram

Case 9. A newborn infant with an alternating electroencephalogram pattern

Case 10. A 2-month-old infant with sleep-onset REM period on polysomnography

Case 11. An infant with high amplitude on an electroencephalogram recording

Case 12. A 7-month-old infant with a series of central apneas

Case 13. A 15-month-old with central apnea

Case 14. A 19-month-old child with irregular, heavy breathing during sleep

Case 15. A 4-week-old infant with jerking movements during sleep

Case 16. An 8-year-old boy with abnormal capnography on polysomnogram

Section 4. Artifacts in Pediatric Polysomnography

Case 17. A 13-year-old boy with snoring and abnormal eye movements on polysomnogram

Case 18. A 3-month-old infant who sleeps with a pacifier

Case 19. A 24-month-old girl with uneventful desaturation

Case 20. A 5-year-old child with unusual leg movements on polysomnography

Case 21. A 16-year-old with snoring and diaphoresis

Case 22. A polysomnography finding in an 8-year-old with history of seizures

Section 1

Evaluation of the Pediatric Sleep Patient

Outline

Case 1. Pediatric sleep history: A 4 year-old with snoring, gasping and witnessed apneas

Case 2. A 6-year-old girl with tonsillar hypertrophy, high-arched palate, and snoring

Case 3. A 10-year-old girl with an unusual finding on physical exam

Case 1

Pediatric sleep history

A 4 year-old with snoring, gasping and witnessed apneas

Lourdes M. DelRosso

Case Presentation

A 4-year-old boy presented for evaluation of loud snoring, gasping during sleep, witnessed apnea, and increased work of breathing during sleep. The parents noted that the child often sleeps with his neck hyperextended. During the daytime, he is active and playful. He goes to bed at 8 PM and falls asleep within 15 minutes. He does not wake up during the night. He wakes up spontaneously at 8 AM. During the day, he takes a 1-hour nap at noon. He does not have any medical problems and does not take any medication. The review of systems was noncontributory.

Question

Can you diagnose this child with obstructive sleep apnea syndrome (OSAS) based on history alone?

Answer

No. History is helpful in screening patients for OSAS and determining which need further evaluation, but polysomnography (PSG) is the gold standard for the diagnosis of pediatric OSAS.

Discussion

Multiple studies have demonstrated that clinical history alone fails to accurately predict OSAS in children. Although snoring is the most common symptom in children who are diagnosed with OSAS, not all children who snore have OSAS. Indeed, although about 10% of young children snore every night,¹ only 1% to 4% of children have OSAS.² A study of 222 children with symptoms suggestive of OSAS demonstrated that snoring for more than five nights a week had a sensitivity of 77% and a specificity of 48% in detecting pediatric OSAS³; other studies have had similar findings. The American Academy of Pediatrics recommends screening children for snoring at each well-child visit.¹ Children who snore every night and have additional symptoms or signs suggestive of OSAS should be evaluated further (Box 1-1). Clinical history alone does not discriminate between habitual snorers and patients with OSAS.⁴ Other nocturnal symptoms of OSAS include gasping, neck hyperextension, mouth breathing, diaphoresis, sleeping sitting up, and secondary enuresis (bedwetting in a child who was previously dry at night). Parents often describe that the child has increased work of breathing during sleep, with retractions and paradoxical breathing (parents notice the chest caving in or the abdomen moving forcefully). Diurnal symptoms may include inattention, hyperactivity, daytime sleepiness, morning headaches, and poor academic performance.¹ Witnessed apneas have a sensitivity of 42% and a specificity of 88%, whereas mouth breathing has a sensitivi...