Evaluation and Treatment For Sleep Disorders

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The professional team at St. John’s Mercy Medical Center works with your child’s primary physician or specialist to evaluate and treat several conditions that uniquely affect infants and children. These include:

Obstructive Sleep Apnea Syndrome
This clinical condition can occur at any age. It is usually associated with snoring and is manifested by increased work of breathing and repeated episodes of partial or complete obstruction to airflow through the mouth or nose during sleep. Daytime manifestations are quite varied and include decreased school performance, hyperactivity, excessive daytime sleepiness, irritability and abnormal weight.

Central Apnea
Cessation of airflow at the nose and mouth because of decreased or absent respiratory effort, most commonly seen in infants and in children with neurological disorders.

Central Alveolar Hypoventilation
Inadequate respiratory drive that is more pronounced during sleep, resulting in retention of carbon dioxide and inadequate oxyhemoglobin saturation. More severely affected patients require artificial respiratory support.

Narcolepsy
A cause of excessive daytime sleepiness that may be associated with cataplexy, sleep paralysis or hypnagogic hallucinations. Narcolepsy peaks during adolescence but symptoms in younger children can include drowsiness, inattention or hyperactivity.

Chronic Respiratory Failure
Select infants and children with underlying disorders of the neuromuscular (e.g. muscular dystrophy) or respiratory (e.g. bronchopulmonary dysplasia) systems may require respiratory support in the form of supplemental oxygen or mechanical ventilation. Due to the associated physiological changes, an important time to assess the adequacy of a patient’s ventilatory support is during sleep.

Gastroesophageal Reflux
This often conspicuous cause of restlessness, awakenings and nighttime cough is detectable using an indwelling esophageal pH probe in conjunction with sleep testing.

Sleep Walking and Sleep Terrors
Parasomnias arising from deeper stages of sleep where a child may partially arouse and appear agitated or walk about without fully awakening.

Testing Procedure
During an overnight stay in the Pediatric Sleep Lab, simultaneous recordings of several physiological parameters including heart rate, breathing, brain waves, muscle movements, oxygen saturation and carbon dioxide level, are obtained in a non-invasive and painless procedure using special electrodes placed on the surface of the skin. Each room is also wired with infrared video and audio monitors that permit direct patient observation. Our goal is to obtain a minimum of six hours of sleep with the sensors in place.

The data is collected and analyzed by specialized computer software. Each study is then personally reviewed and interpreted by a physician trained in Pediatric Respiratory and Sleep Medicine. Results are communicated to the referring physician and the primary care physician (when requested) within 24 to 48 hours. A parent or guardian must remain in the hospital while the study is performed. Separate sleeping accommodations are provided nearby.

Specialized Testing Capabilities
Standard Polysomnography includes a basic recording of 16 to 20 parameters including:

• Modified EEG channels
• Electrooculogram channels
• Submental EMG
• ECG channel
• Chest wall movement
• Abdominal wall movement
• Intercostal muscle activity
• Oxyhemoglobin saturation
• Nasal/oral airflow
• End tidal carbon dioxide via sampling of nasal or oral exhalation
• Transcutaneous carbon dioxide monitoring as needed
• Body position channel
• Microphone used to measure snoring

In addition, the laboratory offers:

• Pulse transit time – a highly sensitive parameter reflective of intrathoracic pressure, respiratory effort and respiratory effort-related arousal events that aid the diagnosis of upper airway resistance syndrome, a variant of obstructive sleep apnea.
• Esophageal pH monitoring – an indwelling catheter is placed through the nose to detect gastroesophageal reflux and its relationship to nocturnal symptoms.
• Titration studies – to assess the adequacy of either noninvasive or invasive mechanical ventilatory support prescribed for children with respiratory insufficiency.
• Multiple Sleep Latency Testing – used to evaluate degree of daytime somnolence and a diagnostic tool for narcolepsy.
• Expanded nocturnal EEG monitoring – for detection of nocturnal seizures that is reviewed by a Pediatric Neurologist.

Preparation for the Study
It is important that your child is tired and ready to sleep for the study. No naps should be taken for at least six hours before the start of the study. You are asked to arrive between 8 and 9 p.m., depending upon the age of your child. It usually takes about an hour to complete paper work and apply the sensors before the study can begin. You should bring any supplies such as diapers, formula and personal care items that your child normally uses at home as well as his or her favorite blanket, pillow or stuffed animal.

If your child is scheduled for a special pH probe study, please limit food and drink for four hours prior to arrival. This is to minimize vomiting and risk of aspiration during placement of the catheter. Medications that affect stomach acid secretion such as antacids, H2-blockers, (ranitidine, famotidine), and proton pump inhibitors, (omeprazole, and lansoprazole) must be discontinued 72 hours prior to the test.