Daytime performance and school grades might be impaired by sleep apnea (absence of breathing during sleep) and poor sleep habits.
Daytime sleepiness, hyperactivity and aggressive behavior can often be noted in children that snore.
Obstructive sleep apnea is present in up to 20 percent of children in the lowest 10th percentile of their school class.
Infants should sleep on their backs in a crib with a firm, tight-fitting mattress to reduce the risk of the child rolling over and suffocating on bedding.
ACH is one of only a few pediatric hospitals in the nation to receive full service accreditation from the Association of Sleep Disorders Centers. Our staff works exclusively with children and adolescents. We have both specialized medical expertise and a unique understanding of the educational and comfort needs of children and their parents. ACH offers advanced techniques for diagnosis and management of sleep problems such as: infant, central and obstructive apnea (absence of breathing during sleep); sleep hygiene; and parasomnias such as sleep walking, sleep talking, night terrors, insomnia, excessive daytime sleepiness, periodic limb movements and sleep phase delay.
Infant Apnea
Sometimes, infants may stop breathing for longer time periods (longer than 15 seconds) or show a color change. This is called "apnea"; it is not normal and may indicate a serious medical condition that needs diagnosis and treatment. Premature infants are especially likely to have frequent or prolonged apnea, but apnea may also occur in full term infants. We may use a home heart/breathing monitor on the child, which sounds an alarm should the infant stop breathing or drop the heart rate below an age appropriate limit. Monitors are used in babies believed to be at risk for apnea and bradycardia (low heart rate). Modern infant monitors have a computer chip that records apnea or low heart rates, allowing a physician to download and review the information to see what occured with the baby at the time the alarm sounded.
An Apparent Life Threatening Event (ALTE) is what used to be called "near-miss SIDS." An ALTE occurs when a baby or infant appears to stop breathing and turns blue, pale or sometimes red. Such episodes are very frightening to the observer who may fear that the infant is dead or is in danger of death.
Sudden Infant Death Syndrome (SIDS) is the sudden death of an apparently healthy infant 1 year of age or less that cannot be explained after a postmortem examination, clinical history and death scene investigation.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) implies that breathing stops because of obstruction. This is more common during sleep, because the muscles in the throat relax and the throat partially closes. Obstruction results in a drop in the blood oxygen. The obstruction is resolved when low blood oxygen causes the brain to arouse and the muscle tone in the throat to increase, relieving the obstruction. As a result of OSA, children don’t get enough oxygen, which may stress the heart and lungs, and may cause the child to have daytime behavior problems caused by their poor sleep. We often see babies/children that may have sleep apnea caused by Downs Syndrome, achondroplasia, asthma, Cerebral Palsy, seizures or facial abnormalities such as small jaw, receding jaw, large tongue, cleft palate and/or deviated septum. Noticeable symptoms might include loud snoring, difficulty breathing, respiratory pauses and/or snorts, restless sleep, daytime irritability, and occasional sleepiness. It is not normal for children to snore. Overnight studies are recommended for an accurate diagnosis of OSA. Treatment may be surgical, such as tonsillectomy and/or adenoidectomy. Mechanical treatment with a CPAP (a mask worn at night which balloons the throat open with a small amount of positive pressure) is also very effective. The addition of oxygen is sometimes necessary. Weight loss, medications and other treatments are sometimes recommended.
Parasomnia
Parasomnia is a dysfunction associated with sleep, sleep state or partial arousal. It includes problems like sleep walking, nightmares and night terrors. These problems are often developmental in nature and worsen with stress. Severe cases require education, removal of the causes of parasomnias and behavioral interventions. Medication is prescribed in some cases.
Poor Sleep Hygiene Infants and/or children may develop poor sleeping habits. These may include difficulty putting the child to sleep, late sleep onset time, frequent arousal that requires intervention and difficulty waking up. Poor sleep habits are more common in sick children with other medical problems including recurring ear infections and sleep apnea. Comprehensive education and training programs can be provided for families and patients on how to improve sleep hygiene.
Insomnia
Disorders of initiating and maintaining sleep, or chronic insomnia, are often managed in our clinic. Symptoms of insomnia may include daytime fatigue, irritability, anxiety, mild depression, difficulty in awake attention span and excessive daytime sleepiness. Behavior modification and medical therapy are often successful in the treatment of insomnia.
Excessive Sleep Disorders of excessive sleep (insomnolence) include Obstructive Sleep Apnea (OSA) & narcolepsy. OSA may result in daytime sleepiness because of disrupted night sleep. Narcolepsy is an unusual disorder of excessive daytime sleepiness originating in abnormalities in the sleep centers in the brain. Symptoms may include excessive daytime sleepiness, cataplexy (periodic inability to perform voluntary movements secondary to a sudden inhibition of muscle tone), daytime microsleep attacks with automatic behavior and amnesia, hallucinations, sleep paralysis and disrupted nocturnal sleep. Many of these problems may be evaluated with a Polysomnography (a sleep test where a child is monitored during his/her sleep) to rule out breathing related problems, followed by a Multiple Sleep Latency Test (MSLT) to evaluate how long it takes the child to fall asleep and enter into the rapid eye movement (REM) stage of sleep. Treatments may consist of individualized medication management, scheduled naps and modifications of work/school schedules.
Periodic Leg Movements Repetitive leg movements, when they occur every 15-40 seconds, may cause a person to complain of frequent awakening or non-refreshing sleep. Roommates may complain of the sufferer kicking during the night.
Restless Leg Syndrome This may occur while a person is awake and relaxing. It is described as an uncomfortable sensation or feeling within the legs. The feelings require movement to provide relief.
Idiopathic Hypersomnolence With this condition, a person feels a constant need to sleep, but, they are able to refrain if they must. Some people may sleep an excessive amount at night and be difficult to waken. They may appear confused and disoriented upon awakening.
During an inpatient stay, a consultation from the Sleep Center may be obtained. This includes a visit of the patient by the Sleep Team physician and possibly the nurse. After assessing the child’s history and completing a physical, a diagnostic and treatment plan will be devised. This may include recommendations for labwork, portable studies for children under one year and/or polysomnography in the Sleep Lab. Results from the lab/studies will be communicated to the physician that ordered the consultation.
Our clinic is available by physician referral. If you feel your child may need treatment, please talk to your child’s primary care physician and request a referral to our service. If your child does not have a primary care physician, please call 501-364-5901 and we will recommend one in your area.
An outpatient clinic visit consists of a comprehensive evaluation. A complete history from the caregiver is of utmost importance. The history will be combined with the findings of a physical exam and/or any results from x-rays and/or labwork to determine the diagnosis and make treatment recommendations. All necessary diagnostic tests are available on-site in the Sleep Disorders Center. Some of the testing can be performed the day of the consult, other tests are scheduled for a subsequent visit.
Findings from an individualized physical, a well as the results from specific diagnostic procedures, determine the diagnosis and treatment of each patient. After appropriate data is gathered, the
team, consisting of physicians from several specialties, the sleep disorders nurse and specialized
sleep technicians meets to review the diagnosis and make a multi-specialty treatment plan. Treatment options may include family teaching/instruction by the staff, providing positive airway pressure, providing behavioral counseling and/or medication and surgical procedures such as a tonsillectomy, adenoidectomy, uvulpapatoplasty and tracheostomy. As part of the diagnostic process, we will take a family history and then may perform some of the following:
Radiology
X-rays most often are ordered to assess the soft tissue of the neck to see if there is obvious obstruction.
Lab Work Blood work may be ordered to rule out endocrine and metabolic disorders.
MRI Scan Scans may be ordered to rule out brain stem abnormalities.
EKG of the Heart This may be ordered to assess any potential damage to the heart from untreated or undertreated breathing obstruction.
Memory Monitor Painless memory monitors may be worn for a period of time so that staff can analyze specific brain functions recorded by the monitors.
Polysomnography
Overnight sleep studies are done in a soundproof bedroom in the sleep lab. A technician
monitors the patient throughout the night and video equipment is utilized to record the entire procedure. A computerized sleep system records EEG, ECG, respiratory effort, muscle tone, tidal volume, oxygen saturation and entidal CO2.
Multiple Sleep Latency Testing Objective measurement of the tendency to fall asleep is performed on patients with disorders of excessive sleepiness during multiple opportunities to nap. This test is particularly valuable in diagnosing narcolepsy.
Portable Studies These studies can be done on the nursing unit or in the lab. They are often done with a
pH probe and are performed at night when the patient is asleep. An apnea monitor is interfaced with a multi-channel recorder to monitor patient’s respiratory effort, airflow, heart rate and oxygen saturation.
Actigraphy
This is a study done with a small biomedical instrument, typically worn on the wrist, that measures and records body movement. It can be used to define sleep-wake cycles clearly and objectively based on documenting the body movement during wake and lack of movement during sleep periods.
The Bottom Line...Why You Should Choose Our Hospital
Care for children is different than care for adults. We know that at Arkansas Children’s Hospital. For over 80 years, we have dedicated ourselves to bringing the latest pediatric medical expertise and technology to the children of all ages. We provide services not usually found at other hospitals: pediatric-trained anesthesiologists, radiologists, nutritionists, pain managers, respiratory therapists, nurses, etc. We even have Child Life and Education staff to explain procedures to children and to incorporate play and schoolwork into the hospital stay where appropriate. Best of all, we center our care around the family. Your team of physicians, nurses, and other staff will work tirelessly to make sure your entire family has the resources it needs to better your child’s health. We are dedicated to changing children’s lives!
How to Contact Us
For more information or to schedule a visit, please call 501-364-1893.
