Paediatric Sleep Disorders: Case-based Practical Guide

Preface
Contents
Part I: Introduction
1: Functions and Control of Sleep
1.1 The Need to Sleep
1.2 Control of Sleep
1.2.1 Generation of Circadian Rhythm
1.2.2 Sleep and Arousal
1.2.3 The NREM and REM Sleep
1.2.3.1 NREM Circuit
1.2.3.2 REM Circuit
1.2.3.3 The Role of Hypocretin/Orexin
1.3 Functions of Sleep
1.3.1 Sleep and EEG Recovery
1.3.2 Sleep, Brain Energy Replenishment, Molecular Regeneration
1.3.3 Sleep and Toxin Removal Within the Brain
1.3.4 Sleep and Memory
1.3.5 Sleep and Immunity
1.3.6 Sleep, Mood, and Emotion
1.3.7 Sleep: The Developmental Perspective
References
2: Sleep Physiology and Architecture
2.1 Sleep Architecture
2.2 Sleep Physiology
References
3: Sleep Needs: Cross-Cultural Comparisons and Problems with Sleep Deprivation
3.1 Introduction
3.2 Sleep Duration
3.2.1 Developmental Alteration of Sleep Duration
3.2.2 Cross-Cultural Difference of Sleep Duration
3.2.3 Factors Associated with Sleep Duration
3.2.4 Problems Associated with Decreased Sleep Duration
3.3 Sleepiness
3.3.1 Sleepiness vs. Sleep Duration
3.3.2 Factors Associated with Sleepiness
3.4 Sleep Need Index (SNI)
3.5 Conclusion
References
Part II: Evaluation of Sleep Disorders
4: Clinical Assessment
4.1 Preparation
4.2 History Taking
4.2.1 Chief Complaint and Associated Symptoms
4.2.2 Sleep Patterns and Sleep-Wake Schedule
4.2.3 Treatment History, Medical History, Developmental History, and Psychiatric History
4.2.4 Family History
4.3 Physical Examination
4.3.1 Sleep-Associated Physical Examination
4.4 Questionnaire and Scale
4.4.1 Bedtime Problems, Excessive Daytime Sleepiness, Awakenings, Regularity and Snoring Screener (BEARS)
4.4.2 Children’s Sleep Habit Questionnaire: Preschool and School Ages (CSHQ)
4.4.3 Sleep Disturbance Scale for Children (SDSC)
4.4.4 Pediatric Daytime Sleepiness Scale (PDSS)
4.4.5 Children’s Sleep Comic
4.4.6 Sleep Diary and Sleep Log
4.4.7 Structured Interview
4.5 Laboratory Test
4.5.1 Blood Test
4.5.2 Dim Light Melatonin Onset (DLMO)
4.5.3 Cerebrospinal Fluid (CSF) Hypocretin (Orexin) Level
4.6 Imaging Test
4.6.1 Cephalometry
4.6.2 Magnetic Resonance Imaging (MRI)
4.7 Conclusions
References
5: Sleep Diagnostics
5.1 Diagnosis
5.2 Home Audio and Video Recording
5.3 Pulse Oximetry
5.3.1 Technology Behind Pulse Oximetry
5.3.2 Limitations of Pulse Oximetry
5.4 Actigraphy
5.4.1 Indications for Actigraphy
5.4.2 Limitations
5.5 Paediatric Polysomnography
5.5.1 Mechanics of Polysomnography
5.5.2 Interpretation and Scoring
5.5.3 Indications for Paediatric Polysomnography
5.5.4 Limitations of Polysomnography
5.5.5 Multiple Sleep Latency Test (MSLT)
5.6 Drug Induced Sleep Endoscopy (DISE)
References
Part III: Specific Sleep Disorders
6: Paediatric Insomnia
6.1 Case Vignettes
6.2 Overview
6.3 Classification and Diagnostic Criteria of Childhood Insomnia
6.4 Prevalence and Consequences of Insomnia
6.5 Aetiology of Insomnia
6.5.1 Biological Factors
6.5.2 Medical Factors
6.5.3 Psychosocial and Behavioural Factors
6.6 Assessment
6.6.1 Sleep History
6.6.2 Medical and Psychiatric History
6.6.3 Subjective Measures
6.6.4 Objective Measures
6.7 Interventions for Paediatric Insomnia
6.7.1 Non-pharmacological Treatment of Paediatric Insomnia
6.7.2 Pharmacological Treatment of Paediatric Insomnia
6.8 Summary and Take-Home Points
References
7: Primary Snoring
7.1 Vignette of Typical Presentation/Real Life Example
7.2 Epidemiology
7.3 Pathophysiology
7.4 Diagnosis
7.4.1 Clinical Features
7.4.2 Physical Examination
7.4.3 Diagnostic Testing
7.5 Complications
7.5.1 Neurocognitive and Behavioral Impairment
7.5.2 Cardiovascular System
7.5.3 Others
7.6 Treatment
7.6.1 Adenotonsillectomy
7.6.2 Non-Surgical Treatment Options
7.6.2.1 Medication
7.6.2.2 Sleep Position Therapy
7.6.2.3 Weight Loss
7.6.2.4 Oral Appliances
7.6.3 Follow-Up
7.7 Research Gaps
References
8: Obstructive Sleep Apnoea
8.1 Vignette of Typical Presentation/Real Life Example
8.2 Introduction
8.2.1 What Is OSAS
8.2.2 Spectrum of SDB: Primary Snoring to OSAS
8.3 Epidemiology
8.4 Risk Factors
8.5 Presenting Features
8.5.1 OSAS in Childhood vs. Adulthood
8.6 Diagnosis
8.7 Severity Grading and AHI Classification
8.8 Complications
8.9 Treatment
8.9.1 Adenotonsillectomy (T&A)
8.9.2 Positive Airway Pressure Therapy (CPAP/BiPAP)
8.9.3 Weight Management
8.9.4 Medical Treatment
8.9.5 Others
8.10 Clinical Course and Prognosis
8.11 Some Potential Research Areas
Further Reading
9: Central Sleep Apnoea Syndromes in Infants
9.1 Introduction
9.2 Apnoea of Prematurity
9.2.1 Epidemiology
9.2.2 Aetiology
9.2.3 Clinical Significance
9.3 Short Central Apnoeas
9.3.1 Treatment
9.3.2 Research Gaps
9.3.3 Summary
9.4 Periodic Breathing
9.4.1 Epidemiology
9.4.2 Aetiology
9.4.3 Clinical Significance
9.4.4 Treatment
9.4.5 Research Gaps
9.5 Periodic Breathing Clinical Vignette
9.6 A Note on Obstructive Apnoea in Infants
9.7 Summary
References
10: Sleep-Related Hypoventilation Syndromes
10.1 Congenital Central Alveolar Hypoventilation Syndrome (CCHS)
10.1.1 Vignette of Typical Presentation/Real-Life Example
10.1.2 Introduction
10.1.3 Epidemiology
10.1.4 Pathophysiology
10.1.5 Silent Presenting Features
10.1.6 Diagnosis
10.1.7 Treatment
10.1.8 Research Gaps
10.2 Obesity Hypoventilation Syndrome (OHS)
10.2.1 Vignette of Typical Presentation/Real-Life Example
10.2.2 Introduction
10.2.3 Epidemiology
10.2.4 Pathophysiology
10.2.5 Silent Presenting Features
10.2.6 Diagnosis
10.2.7 Treatment
10.2.8 Research Gaps
References
11: Childhood Narcolepsy
11.1 Typical Presentation of Childhood Narcolepsy
11.2 Epidemiology
11.3 Etiology and Pathophysiology
11.4 Presentation and Diagnosis
11.5 Management
11.6 Prognosis
11.7 Summary of the Key Findings and Research Gaps
References
12: Circadian Rhythm Sleep Wake Disorders
12.1 Case Vignette
12.2 The Molecular Clock
12.2.1 Circadian Entrainment
12.2.2 Human Phase Response Curve
12.2.3 Circadian Influence on Sleep
12.3 Overview of Circadian Sleep Wake Disorders
12.4 Diagnosis
12.5 Delayed Sleep-Wake Phase Disorder (DSWPD)
12.5.1 Epidemiology
12.5.2 Pathophysiology
12.5.3 Presenting Features
12.5.3.1 Poor School Performance
12.5.3.2 Insomnia
12.5.3.3 Neuropsychiatric Presentations
12.5.4 Diagnosis
12.5.4.1 Actigraphy
12.5.4.2 Biological Measurements
12.5.4.3 Melatonin
12.5.4.4 Standardized Chronotype Questionnaires
12.5.5 Treatment
12.5.5.1 Timed Light Therapy
12.5.5.2 Timed Melatonin
12.5.5.3 Light Avoidance
12.5.5.4 Chronotherapy
12.5.5.5 Treatment in Co-Morbid Conditions
12.6 Non-24 H Sleep-Wake Disorder (N24SWD)
12.7 Irregular Sleep-Wake Rhythm Disorder (ISWRD)
12.8 Advanced Sleep-Wake Phase Disorder (ASWPD)
12.9 Conclusion
References
13: NREM Parasomnias: Disorders of Arousal
13.1 Vignette
13.2 Epidemiology
13.3 Aetiology
13.4 Presentation and Diagnosis
13.5 Management
13.6 Summary of Take-home Messages
References
14: REM-Sleep Parasomnia: Nightmare Disorder
14.1 Case
14.2 Epidemiology
14.3 Aetiology
14.4 Presentation and Diagnosis
14.5 Management
14.5.1 Summary of Key Take-home Messages and Research Gaps
14.5.2 Research Gaps
References
15: Enuresis
15.1 A Vignette of Typical Presentation of the Sleep Disorder
15.2 Epidemiology
15.3 Aetiology
15.4 Presentation and Diagnosis
15.4.1 History
15.4.2 Physical Examination
15.4.3 Investigations
15.5 Management
15.5.1 Education and General Advice
15.5.2 Motivational Therapy
15.5.3 Behavioral
15.5.3.1 Alarm Treatment
15.5.4 Pharmacological
15.5.4.1 Desmopressin
15.5.4.2 Tricyclic Antidepressants
15.5.4.3 Anti-Cholinergics
15.5.5 Choice of Active Treatment
15.5.6 Refractory Enuresis
15.6 Summary of Key Take-Home Messages and Research Gaps
References
16: Restless Legs Syndrome and Periodic Limb Movement Disorder
16.1 Vignette
16.2 Physical Examination
16.3 Diagnostic Evaluation
16.4 Sami’s Progress
16.5 Sami’s Treatment and Progress
16.6 Summary
References
17: Bruxism
17.1 Definition and Epidemiology
17.2 Pathophysiology
17.3 Etiology
17.4 Presentation and Diagnosis
17.5 Management
17.6 Summary
17.7 Research Gaps
References
18: Benign Neonatal Sleep Myoclonus
18.1 Epidemiology
18.2 Etiology
18.3 Presentation and Diagnosis
18.4 Management
18.5 Cross Cultural Perspective
18.6 Summary of Key-Take-Home Messages and Research Gaps
References
Part IV: Sleep in Special Populations
19: Sleep and Neuromuscular Diseases: Management and Use of NIV
19.1 Vignette of Typical Presentation/Real Life Example
19.2 Epidemiology
19.3 Aetiology
19.3.1 Decrease in Lung Function
19.3.2 Increase in Respiratory Loads
19.3.3 Reduced Chemoreceptors Sensitivity
19.4 Presentation
19.5 Diagnosis and Assessment
19.5.1 Symptoms Evaluation
19.6 Pulmonary Function Tests
19.6.1 Cough Peak Flow
19.6.2 Spot Oxygen Saturation
19.6.3 Blood Tests
19.6.4 Polysomnography
19.6.4.1 Polysomnographic Characteristics of SDB in NMD
19.6.4.2 Diagnosis of Nocturnal Hypoventilation
19.6.4.3 Changes in Sleep Architecture
19.6.4.4 Alternatives to PSG
19.7 Management
19.7.1 Respiratory Care: Physiotherapy and Cough Assist Devices
19.7.2 Non-invasive Ventilation
19.7.3 Invasive Ventilation
19.8 Summary of Key Take-Home Messages and Directions for Future Research
References
20: Sleep in Children with Neurodevelopmental Disorders
20.1 Autism Spectrum Disorder
20.2 Attention Deficit Hyperactivity Disorder
20.3 Neurodevelopmental Disorders with a Known Genetic Origin
20.3.1 X Linked Disorders
20.3.2 Chromosome 15 Imprinting Disorders
20.4 Assessment and Treatment of Sleep Difficulties in Children with Neurodevelopmental Disorders
20.5 Behavioural Interventions
20.6 Pharmacological Interventions
20.7 Other Treatments
20.7.1 Summary and Research Gaps
20.8 Vignette
References