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DISORDERED SLEEP IN INFANTS AND CHILDREN

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.

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DISORDERED SLEEP IN INFANTS AND CHILDREN

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  1. DISORDERED SLEEPININFANTS 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

  2. Disordered Sleep BEHAVIORAL

  3. Disordered Sleep BEHAVIORAL PSYCHOLOGICAL

  4. Disordered Sleep BEHAVIORAL PSYCHOLOGICAL BIOLOGICAL

  5. NOSOLOGY SIMILAR TO ADULTS

  6. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological

  7. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation

  8. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing

  9. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias

  10. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias Pain Syndromes

  11. NOSOLOGY SIMILAR TO ADULTS Behavioral/Psychophysiological Sleep Fragmentation Sleep Disordered Breathing Movement Disorders/Parasomnias Pain Syndromes Environmental

  12. Nosology (cont.) Psychiatric

  13. Nosology (cont.) Psychiatric Drugs/Alcohol

  14. Nosology (cont.) Psychiatric Drugs/Alcohol CNS Disease/Disorders

  15. Nosology (cont.) Psychiatric Drugs/Alcohol CNS Disease/Disorders Circadian Rhythm Abnormalities

  16. Children are Different • Different Diagnostic Categories • Different Diagnostic Criteria • Different Symptomatology • Often Paradoxical • Different Nosology?

  17. The Sleepless Child • Disorders of Initiating sleep • Disorders of Initiating and Maintaining Sleep • Disorders of Maintaining Sleep

  18. The Most Important Historical Question

  19. The Most Important Historical Question • Does the Child Sleep Well …

  20. The Most Important Historical Question • Does the Child Sleep Well … SOMEWHERE?

  21. YES • BEHAVIORAL/CONDITIONED

  22. NO • BIOLOGICAL

  23. 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

  24. Sleepless Child: 9 - 12 Months Parental Behaviors at child’s bedtime & Parental response to normal nocturnal wakings = DISORDER OF INITIATING & MAINTAINING SLEEP

  25. Sleepless Child: Toddler Behavioral / Conditioned Occasionally Biological

  26. Sleepless Child: Adolescent NORMAL PHYSIOLOGY CIRCADIAN FACTORS ANXIETY MOTIVATED

  27. Sleepless Child • DISORDERS OF SLEEP MAINTENANCE ENVIRONMENTAL BIOLOGICAL

  28. Sleepless Child: Maintenance • DIFFERENTIAL DIAGNOSIS Pain Syndromes Allergy Apnea PLMD Nightmares Seizures Circadian Rhythm Abnormalities

  29. Gastroesophageal Reflux/Disorder • Reflux into the esophagus • Level ?? • Reflux into the pharynx • Aspiration into the lungs

  30. GER • DIAGNOSIS • pH Probe study • Swallow Studies • Age dependent approach

  31. GER GER does not = G.E.R.D.

  32. GER & OSA • Which comes first? • Association • Vocal cord excoriation, swelling, edema • Aspiration pneumonia • Changes in airway physiology

  33. GER diagnosis • Diagnosis not made in sleep lab • Methods • pH Study • Polysomnography • Probe + PSG • Endoscopy

  34. GER • Treatment H2 Blockers (ranitidine) Parasympathomimetics (cisapride)

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