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
Disordered Sleep
BEHAVIORAL
Disordered Sleep
BEHAVIORAL
PSYCHOLOGICAL
Disordered Sleep
BEHAVIORAL
PSYCHOLOGICAL
BIOLOGICAL
NOSOLOGY
SIMILAR TO ADULTS
NOSOLOGY
SIMILAR TO ADULTS
Behavioral/Psychophysiological
NOSOLOGY
SIMILAR TO ADULTS
Behavioral/Psychophysiological
Sleep Fragmentation
NOSOLOGY
SIMILAR TO ADULTS
Behavioral/Psychophysiological
Sleep Fragmentation
Sleep Disordered Breathing
NOSOLOGY
SIMILAR TO ADULTS
Behavioral/Psychophysiological
Sleep Fragmentation
Sleep Disordered Breathing
Movement Disorders/Parasomnias
NOSOLOGY
SIMILAR TO ADULTS
Behavioral/Psychophysiological
Sleep Fragmentation
Sleep Disordered Breathing
Movement Disorders/Parasomnias
Pain Syndromes
NOSOLOGY
SIMILAR TO ADULTS
Behavioral/Psychophysiological
Sleep Fragmentation
Sleep Disordered Breathing
Movement Disorders/Parasomnias
Pain Syndromes
Environmental
Nosology (cont.)
Psychiatric
Nosology (cont.)
Psychiatric
Drugs/Alcohol
Nosology (cont.)
Psychiatric
Drugs/Alcohol
CNS Disease/Disorders
Nosology (cont.)
Psychiatric
Drugs/Alcohol
CNS Disease/Disorders
Circadian Rhythm Abnormalities
Children are Different

Different Diagnostic Categories

Different Diagnostic Criteria

Different Symptomatology
– Often Paradoxical

Different Nosology?
The Sleepless Child

Disorders of Initiating sleep

Disorders of Initiating and Maintaining
Sleep

Disorders of Maintaining Sleep
The Most Important
Historical Question
The Most Important
Historical Question

Does the Child Sleep Well …
The Most Important
Historical Question

Does the Child Sleep Well …
SOMEWHERE?
YES

BEHAVIORAL/CONDITIONED
NO

BIOLOGICAL
Initiating Sleep

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
Sleepless Child: 9 - 12
Months
Parental Behaviors at child’s bedtime
&
Parental response to normal nocturnal
wakings
=
DISORDER OF INITIATING &
MAINTAINING SLEEP
Sleepless Child: Toddler
Behavioral / Conditioned
Occasionally Biological
Sleepless Child: Adolescent
NORMAL PHYSIOLOGY
CIRCADIAN FACTORS
ANXIETY
MOTIVATED
Sleepless Child

DISORDERS OF SLEEP
MAINTENANCE
ENVIRONMENTAL
BIOLOGICAL
Sleepless Child: Maintenance

DIFFERENTIAL DIAGNOSIS
Pain Syndromes
Allergy
Apnea
PLMD
Nightmares
Seizures
Circadian Rhythm Abnormalities
Gastroesophageal
Reflux/Disorder

Reflux into the esophagus
– Level ??
Reflux into the pharynx
 Aspiration into the lungs

GER

DIAGNOSIS
– pH Probe study
– Swallow Studies
– Age dependent approach
GER
GER does not = G.E.R.D.
GER & OSA

Which comes first?
–
–
–
–
Association
Vocal cord excoriation, swelling, edema
Aspiration pneumonia
Changes in airway physiology
GER diagnosis

Diagnosis not made in sleep lab

Methods
– pH Study
– Polysomnography
– Probe + PSG
– Endoscopy
GER

Treatment
H2 Blockers
(ranitidine)
Parasympathomimetics
(cisapride)