Disorders of Sleep Timing, Arousals, and State: Childs Circadian ...

June 25th | Treatment.of.Pediatric.Neurologic.Disorders

1. Establish limits disorder. Since the invention of electric lighting, bedtime delay has been a temptation for children and adults. According behavior management is the treatment. 2. Syndrome phase delay of sleep. In this condition, the circadian rhythm of a child led to sleep late, but steady and offset, a common pattern in adolescence. Treatments include bedtime gradually delayed to reset the internal clock, light therapy and melatonin. 3. Slow disturbances. Arousals that occur often in slow wave sleep include sleepwalking, night terrors, and confusional arousals. Treatment consists of education = reassurance, scheduled awakenings, protection against 4. 5. 6. Relationship = A parasomnia sleep stage awakenings. techniques of injuries, and relaxation at bedtime. Clonazepam in small doses can be helpful if symptoms are frequent or dangerous. REM disorders. Arousals associated with REM sleep are nightmares and rarely sleep paralysis or motor disorder in REM sleep. Non-state specific. Somniloquy and enuresis can occur in any stage of sleep. Somniloquy does not usually require treatment. Enuresis is particularly common in children with ADHD. This problem can be solved by preventive measures, humidity alarm, and medications such as imipramine, DDAVP and oxybutynin. Narcolepsy. Narcolepsy can be considered a disorder in which sleep and wakefulness are not distinguished and rather encroaching on the other. Recent studies have shown an association with low levels of CSF hypocretin-1, probably indicating a deficit in the wake of promotion channels. Symptoms include excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Although the onset of symptoms is often in late childhood or adolescence, the manifestations may be partial and, unfortunately, the diagnosis of narcolepsy is commonly delayed for years. PSG and MSLT showed rapid sleep onset latency and reduced REM onset. The treatment is scheduled naps, education, good sleep habits, stimulants or modafinil for improving daytime alertness, selective inhibitors of serotonin reuptake inhibitors, tricyclic antidepressants, trazodone, zolpidem, zaleplon or improve sleep patterns. 536 Disorders of breathing Hart 1. Primary snoring. Five to ten percent of children snore every night, and many of them have primary snoring. This is a benign condition which consists of snoring without apnea associated, hypopnea, sleep disorders, or daytime symptoms. History and physical examination have not been accurate in distinguishing PS and obstructive sleep apnea hypopnea =, so PSG can be justified. Treatment for the PS is usually not necessary, but it may be a risk factor for later OSA. About a third of children with ADHD have PS, and about a third of snoring children have ADHD. 2. Obstructive sleep apnea hypopnea =. One to three percent of children have clinically significant OSA. Upper airway muscle tone and the chest wall, respiratory rate, tidal volume, and responses to changes in pCO2 and pO2 decreased in all sleep. Symptoms include snoring, restlessness, mouth breathing, secondary enuresis, and daytime sleepiness. As mentioned above, the PSG is warranted for suspected OSA. Polysomnogram normative values ??for children are not firmly established, but an apnea index greater than 1 per hour is usually abnormal. Normal end-tidal CO2 must not be greater than 50 mmHg for more than 10% of TST. Hypopneas are more frequent than apnea in children, and children are less likely to wake up because of a respiratory event. Children with OSA often have a tonsillectomy or adenoidectomy although some patients experience symptoms recurred after this procedure. Other measures include continuous positive airway pressure, nasal steroids, elevating the head of the bed and other positioning strategies, oral appliances, and other surgical procedures. 3. The central apnea. Central apneas are common and usually benign in infants and children. If symptoms or severe neuroimaging with attention to the posterior fossa and brainstem and treatment with continuous positive airway pressure or may be considered.

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Tags: Arousals, Childs, Circadian, disorders, leads, rhythm, Sleep, state, Timing

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