Diagnostic sleep study Non-invasive overnight testing of sleep and respiratory parameters

Large tonsils and adenoids Facial dysmorphism Muscle weakness Obesity

Unrefreshed on waking Irritable during the day Poor concentration

Snoring or heavy breathing Laboured breathing Choking or gagging Pauses in breathing Excessive sweating Nocturnal cough

Occurs in Non-REM sleep Screaming/confusion/disoriented No recall of events Common age 4-12 years

Occurs in REM sleep Peak age 3-6 years Able to recall dream Frequent nightmares associated with underlying medical problems

Common after 18 months Separation anxiety Limit setting disorder Prolonged sleep latency

FAQs

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Any Take Home Message?

Snoring is not cute
If a child snores most nights – exclude OSA

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What is the Treatment of OSA

Adenotonsillectomy (70-80% cure)
Continuous positive airway pressure (CPAP)

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How is it Diagnosed?

Diagnostic sleep study
Non-invasive overnight testing of sleep and respiratory parameters

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Long Term Complications

Poor weight gain
Poor concentration and behaviour problems
Learning difficulties
Increased risk of hypertension and heart failure

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What About Family History

If both parents snore it increases the risk of the child having OSA three fold

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Causes of OSA

Large tonsils and adenoids
Facial dysmorphism
Muscle weakness
Obesity

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Day Symptoms

Unrefreshed on waking
Irritable during the day
Poor concentration

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Night Symptoms

Snoring or heavy breathing
Laboured breathing
Choking or gagging
Pauses in breathing
Excessive sweating
Nocturnal cough

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How It Is Recognized?

Snoring is the main symptom
10% of children snore and 1 out of 3 have OSA
Common under the age of 6 years

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Head Banging / Body Rocking

Rhythmic movement disorder
Onset before 1 year of age
More common in boys
Disappears by 4 years
If persistent – exclude underlying medical problems

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Sleep Terror

Occurs in Non-REM sleep
Screaming/confusion/disoriented
No recall of events
Common age 4-12 years

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Nightmare

Occurs in REM sleep
Peak age 3-6 years
Able to recall dream
Frequent nightmares associated with underlying medical problems

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Delayed Sleep Phase Disorder

5-10% of adolescents
Difficulty falling asleep
Significant difficulty waking
Day time sleepiness
Poor school performance
School avoidance

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Sleep Maintenance Disorder

Any age group
Difficulty in remaining asleep
Several wake ups during the night
Exclude medical problems such as sleep apnoea, developmental delay

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Sleep Onset Disorder

Common after 18 months
Separation anxiety
Limit setting disorder
Prolonged sleep latency

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Sleep Association Disorder

Common under 12 months
More than 40% of infants
Inappropriate environmental cues
Requires parental input to fall asleep

Sydney Sleep Service