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ICSD-2 Classification
Pediatric Section
•
Behavioral Insomnia of Childhood –
(Sleep Onset Type) –
(Limit-Setting Type) •
Primary Sleep Apnea of Infancy •
Obstructive Sleep Apnea, Pediatric •
Congenital Central Hypoventilation Syndrome •
Sleep Enuresis •
Sleep Related Rhythmic Movement Disorder Behavioral Insomnia of Childhood
•
Diagnostic Criteria –
Symptoms meet criteria for insomnia –
Sleep onset association type •
Falling asleep is an extended process requiring special
conditions •
Sleep onset associations are highly problematic or
demanding •
In the absence of associated conditions, sleep onset is
significantly delayed or sleep is otherwise disrupted •
Night-time awakenings require the intervention of the
caregiver –
Limit setting type •
The individual has difficulty initiating or maintaining
sleep •
The individual stalls or refuses to go to bed at an
appropriate time or return to bed after an awakening •
The caregiver demonstrates insufficient or inappropriate
limit setting to establish appropriate sleep in the child Primary Sleep Apnea of Infancy
•
Prolonged central respiratory pauses of 20sec or more (or
shorter duration events that include obstructive or mixed respiratory
patterns associated with physiologic compromise including decreased HR,
hypoxemia, clinical sxs, need for nursing
intervention) •
Two categories –
Apnea of Prematurity (< 37 wks) –
Apnea of Infancy (>= 37 wks) •
Numerous other names including ALTE –
Undesirable terms such as near-SIDS should not be used
(connection between apnea and SIDS not supported by extensive research) •
Strongly connected to conceptional
age: –
25% of infants < 2500 gm and 84% of infants < 1000 gms may experience apneas –
92% of preterm infants sx free
by 37 wks conceptional age –
98% sx free by 40 wks conceptional age •
Apneas need to be distinguished from normal pauses which
are < 20 sec and are not associated with bradycardia,
hypoxemia Obstructive Sleep Apnea, Pediatric
•
Diagnostic Criteria (part 1) –
Caregiver reports snoring, labored or obstructed breathing
during child’s sleep –
Caregiver reports at least one: •
Paradoxical inward rib cage movement during inspiration •
Movement arousals •
Diaphoresis •
Neck hyperextension during sleep •
EDS, hyperactivity or aggressive behavior •
Slow rate of growth •
Morning headaches •
Secondary enuresis –
PSG demonstrates one or more score able respiratory events
per hr ( i.e. apnea or hypopnea of at least 2 respiratory cycles in duration –
PSG demonstrates at either i or
ii: •
i: at least
one of the following •
Frequent arousals from sleep associated with increased
respiratory effort •
Arterial oxygen desaturation in
association with apneic episodes •
Hypercapnia during
sleep •
Markedly negative esophageal pressure swings •
ii: periods of hypercapnia
and/or desaturation associated with snoring,,
paradoxical inward rib-cage movement during inspiration and at least one: •
Frequent arousals •
Markedly negative esophageal pressure swings •
Several patterns are typical –
Cyclic episodes of obstructive apnea (like adults) –
Obstructive hypoventilation with long periods of
persistent partial upper airway obstruction with hypercarbia
+/- desats –
UARS with snoring without identifiable airflow obstruction
and increasingly negative esophageal pressure swings •
Children often do not have cortical arousals but more
likely to have autonomic or movement arousals •
Paradoxical rib-cage movement is very typical due to the
compliance of the chest wall in kids •
Risk factors: large tonsils, obesity, micrognathia,
midface hypoplasia, hypotonia, Down’s syndrome, cerebral palsy, mucopolysaccharidoses, sickle cell, pharyngeal flap
operations for cleft palate; family history Congenital Central Hypoventilation Syndrome
•
Diagnostic Criteria –
Exhibits shallow breathing or cyanosis and apnea, of perinatal onset during sleep –
Hypoventilation is worse during sleep than wakefulness –
Rebreathing ventilatory response to hypoxia and hypercapnea
is decreased or absent –
PSG demonstrates severe hypercapnea
and hypoxia, predominantly without apnea •
May breath adequately when awake or may hypoventilate Sleep Enuresis
•
Diagnostic Criteria –
Patient is > 5 yrs old –
Recurrent involuntary voiding occurring at least twice per
week –
Primary •
Pt has never been consistently dry –
Secondary •
Pt has been consistently dry for at least 6 months •
Psychosocial problems are rare, but primary is more common
with ADHD and secondary is more common with stress •
Sleep enuresis common with UTI, DM; may be seen with
nocturnal epilepsy •
In adults, increased in CHF, OSA, depression, dementia Benign Myoclonus of Infancy
•
Repetitive myoclonic jerks
involve the whole body, trunk or limbs •
Occur early in infancy, typically birth to 6 months •
Only occur during sleep •
Movements stop abruptly and consistently when aroused •
<100 case reported •
Lasts days to months, spontaneously resolves •
Needs to be distinguished from seizures Sleep Related Rhythmic Movement Disorder
•
Diagnostic Criteria –
Repetitive stereotyped and rhythmic motor behavior –
Involves large muscle groups –
Predominately sleep related –
Results in at least one: •
Interference with normal sleep •
Impairment of daytime function •
Self-inflicted body injury requiring medical treatment •
Typically seen in infants and children –
Common movements in kids – if it doesn’t
disturb sleep it is normal •
Body rocking, head banging, head rolling •
Movements related to autism and pervasive developmental
disorders occur during wakefulness Reference:
The International Classification of Sleep Disorders,
Second Edition. The |
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