Pediatric Sleep Disorders

Posted by e-Medical PPT Friday, July 27, 2012
Children’s Sleep Architecture Differs from Adults
More REM
Earlier REM
More frequent REM
More Total Hours of Sleep

Sleep in Preemies
“Indeterminate Sleep”
Neither REM nor NREM
Characterized by “Delta Brushes” and temporal spikes
Predominant pattern at 34 wks
Disappears by 3 months of age

As gestational age increases…
 maximum EEG sleep activity switches from temporal to frontal
 Indeterminate Sleep decreases
 Synchrony between the 2 hemispheres increases
 The preemie’s sleep legacy is easier arousal later on.

Normal Infant Sleep Patterns
18 hours a day, 50% REM, at birth
Infants start sleep with REM
Most sleep through night by 3 months
 25 % still have not by 6 months of age
Naps
 Usually 2 / day until 1st Birthday
 2nd nap usually given up by age 3

Parasomnias
Impressive Phenomena
Positive Family History
Usually Deep NREM Sleep (Stages 3/4)
Common in childhood, decrease with age
Persistence into adulthood NOT a sign of psychopathology
Can be induced or precipitated by fever, sleep deprivation, and certain medications

Night Terrors
5 % of pre-schoolers.
Starts between ages 4-12 and resolves spontaneously
Increased FHx of enuresis / sleepwalking in 1st degree relatives
During Stage 3-4 during 1st third of night.
Sits upright, stares, appears frightened, screams, cries, autonomic arousal, unresponsiveness
Lasts ~ 10 minutes then child returns to undisturbed sleep.  No recall.
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