Pediatric Sleep Disorders:
Things that go Bump in the
Night
Kristen H. Archbold, RN, PhD
Pediatric Sleep Disorders
• Common sleep disorders of childhood
• Sleep disorders of infancy:
– SIDS
– ALTEs
– Central apnea of infancy
Pediatric Sleep Disorders
• Overview of pediatric sleep
• Obstructive Sleep Apnea
• Other sleep disorders:
– Restless leg syndrome (RLS)
– Periodic limb movement disorder (PLMD)
• Parasomnias
• Disorders of Sleep Onset and
Maintenance
Sleep: Overview
• Electroencephalographic (EEG)
frequencies
• Non-Rapid Eye Movement Sleep (NREM)
– Stage 1
– Stage 2
– Stages 3 & 4 (Slow wave sleep)
• Rapid Eye Movement Sleep (REM)
Pediatric Sleep: Function
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Restoration Theory
Evolutionary/Adaptation Theory
Energy Conservation Theory
Learning Theory
UN-Learning Theory
Children are different from adults,
depending on age and developmental
level
Pediatric Sleep: Norms
• Varies according to age:
– Between ages 2 and 5, children spend equal
amounts of time asleep and awake
– Throughout childhood sleep accounts for 40%
of an average day
– At birth, REM sleep is 50% of total sleep time,
by adulthood, drops to 25%
– SWS declines from 45% in late childhood to
3% in older aged adults
Pediatric sleep lab:
• Developed in the 1960’s
• Accredited by the American Academy of
Sleep Medicine
• First pediatric sleep lab: 1987
• American Academy of Pediatrics position
statement on obstructive sleep apnea in
2002
Pediatric Sleep Disorders
• Obstructive Sleep Apnea Syndrome
(OSAS)
• “disorder of breathing during sleep
characterized by prolonged partial upper
airway obstruction and/or intermittent
complete obstruction (obstructive apnea)
that disrupts normal ventilation and sleep
patterns” American Thoracic Society, 1996, Am J Respir Crit
Care Med, 153:866-878
Pediatric Sleep Disorders
http://www.egms.de/egms/servlet/Figure?id=cto000028&figure=f9&vol=2006-5
OSAS: Consequences
• Medical
– Enuresis
– Failure to thrive, stunted growth
– CV cor pulmonale at severe end
• Behavioral
– Inattention
– Distractibility
– Scholastic and cognitive difficulties
Other Pediatric Dyssomnias
• Disturbances in the amount, timing or
quality of sleep
– Restless Legs Syndrome
– Periodic Limb Movements & Disorder
– Insomnias
– Circadian Rhythm Disorders
– Narcolepsy
Restless Legs Syndrome (RLS)
• Prevalence estimated at 2% in U.S.
• Hereditary evidence
• Severe leg pain is main symptom, often
dismissed as ‘growing pains’.
• Disturbs sleep, subsequent consequences
– Inattention
– Scholastic and cognitive difficulties
Periodic Limb Movements &
Disorder
• PLMD present in up to 60% of people with
RLS
• People with PLMD don’t have RLS in most
cases
• Jerks or kicks of limbs (legs and arms)
every 20-30 seconds
• Disrupts sleep, results in sleep deprivation
INSOMNIA
• Difficulties initiating or maintaining sleep
• Children do experience insomnia
– Mainly treated with behavioral interventions
• Limit setting
• Media removed from bedroom, use bedroom only
for sleeping
• Avoid caffeine
• Consistent bedtime routine and positive
reinforcement from parents/caregivers
Circadian Rhythm Disorders
• Main onset in adolescence
• Delay of sleep phase, later to bed later to
rise.
• Evidence that there may be a biological
basis for this behavior
• Treatment is primarily behavioral
Narcolepsy
• Present in 0.5 percent of the population
• Genetic component
• Lack of gene which produces
orexin/hypocretin. Neurons are there, just
don’t produce the neurotransmitter on their
own
• Treatment with modafanil
Pediatric Parasomnias
• Disturbances in arousal and sleep stage
transitions that interfere with the sleep
process
– Bruxism
– Sleep terrors
– Sleep walking
Conclusions
• Children do experience sleep disorders
• No one-size-fits-all treatment approach
• Snoring is not a good thing, inquire!!!