Following in the steps of the bestselling Sleep Medicine Pearls, this practical resource provides authoritative guidance on the evaluation and management of common pediatric sleep medicine problems using concise clinical vignettes. Experts in this rapidly growing field, led by Drs. Lourdes M. Del Rosso, Richard B. Berry, Suzanne E. Beck, Mary H. Wagner, and Carole L. Marcus, provide a hands-on, case-based approach, perfect for physicians studying for the sleep boards, fellows learning sleep medicine, and physicians who see children in their practice.
1. Part 1. Introduction to Pediatric Sleep Medicine - p. v 2. Section 1. Evaluation of the Pediatric Sleep Patient - p. v 3. Case 1. Pediatric sleep history: A 4 year-old with snoring, gasping and witnessed apneas - p. 2 4. Case 2. A 6-year-old girl with tonsillar hypertrophy, high-arched palate, and snoring - p. 5 5. Case 3. A 10-year-old girl with an unusual finding on physical exam - p. 8 6. Section 2. Pediatric Polysomnography - p. 9 7. Case 4. Overview of pediatric polysomnography: A newborn infant with snoring and witnessed apnea - p. 10 8. Case 5. A 2-week-old infant with some challenging epochs on polysomnography - p. 12 9. Case 6. A 14-year-old with an abnormal end-tidal CO2 waveform during polysomnography - p. 16 10. Section 3. Common Polysomnographic Findings in Children - p. 19 11. Case 7. A 3-year-old boy with rhythmic activity on electroencephalogram - p. 20 12. Case 8. A 3-month-old infant with monomorphic waves on electroencephalogram - p. 23 13. Case 9. A newborn infant with an alternating electroencephalogram pattern - p. 25 14. Case 10. A 2-month-old infant with sleep-onset REM period on polysomnography - p. 27 15. Case 11. An infant with high amplitude on an electroencephalogram recording - p. 29 16. Case 12. A 7-month-old infant with a series of central apneas - p. 31 17. Case 13. A 15-month-old with central apnea - p. 35 18. Case 14. A 19-month-old child with irregular, heavy breathing during sleep - p. 39 19. Case 15. A 4-week-old infant with jerking movements during sleep - p. 42 20. Case 16. An 8-year-old boy with abnormal capnography on polysomnogram - p. 45 21. Section 4. Artifacts in Pediatric Polysomnography - p. 48 22. Case 17. A 13-year-old boy with snoring and abnormal eye movements on polysomnogram - p. 49 23. Case 18. A 3-month-old infant who sleeps with a pacifier - p. 52 24. Case 19. A 24-month-old girl with uneventful desaturation - p. 55 25. Case 20. A 5-year-old child with unusual leg movements on polysomnography - p. 57 26. Case 21. A 16-year-old with snoring and diaphoresis - p. 59 27. Case 22. A polysomnography finding in an 8-year-old with history of seizures - p. 61 28. Part 2. Clinical Pediatric Sleep Medicine Pearls - p. 62 29. Section 5. Sleep Requirements and Sleep Hygiene - p. 62 30. Case 23. A 14-year-old girl who watches TV to fall asleep - p. 64 31. Case 24. An 8-year-old with a return to daytime napping - p. 67 32. Case 25. A 10-year-old girl sleeps with her parents and her sister - p. 69 33. Section 6. Insomnia - p. 71 34. Case 26. A 4-year-old boy with frequent nocturnal awakenings - p. 72 35. Case 27. A 14-year-old with difficulty falling asleep - p. 74 36. Section 7. Disorders of Hypersomnolence - p. 77 37. Case 28. A 10-year-old boy with excessive sleepiness and new-onset parasomnia - p. 78 38. Case 29. A 9-year-old girl with excessive daytime sleepiness and slurred speech - p. 80 39. Case 30. A 13-year-old boy with excessive sleepiness who falls asleep watching television - p. 83 40. Case 31. A 16-year-old boy who cannot stay up late on weekends - p. 86 41. Section 8. Circadian Sleep Disorders - p. 88 42. Case 32. A 4-year-old girl with septo-optic dysplasia and fragmented sleep - p. 89 43. Case 33. A 13-year-old boy who falls asleep in school - p. 93 44. Section 9. Sleep-Related Breathing Disorders - p. 96 45. Case 34. A 1-month-old premature infant on an apnea monitor - p. 97 46. Case 35. A 2-month-old infant turns blue in front of his parents - p. 101 47. Case 36. A 1-week-old infant with severely abnormal blood gases - p. 104 48. Case 37. A child with central sleep apnea treated with supplemental oxygen - p. 107 49. Case 38. A toddler headed for tracheostomy decannulation - p. 111 50. Case 39. A school-aged child with snoring - p. 115 51. Case 40. Double trouble: Tween siblings with obesity, daytime somnolence, and snoring - p. 119 52. Case 41. An infant with respiratory muscle weakness and lethargy - p. 124 53. Case 42. A 7-year-old boy with snoring, restless sleep, and obstructive sleep apnea - p. 128 54. Case 43. A 2½-year-old girl with snoring, restless sleep, and severe obstructive sleep apnea - p. 133 55. Case 44. A school-aged boy with snoring and attention-deficit hyperactivity disorder - p. 137 56. Case 45. A 7-year-old boy with obesity and persistent hypoventilation - p. 141 57. Case 46. A 6-month-old with laryngomalacia and stridor in sleep - p. 146 58. Case 47. Disturbed sleep in a patient with Duchenne muscular dystrophy - p. 151 59. Case 48. A 17-year-old with morning headaches - p. 156 60. Case 49. A 6-month-old with chronic lung disease of infancy, intermittent snoring, and failure to thrive - p. 160 61. Section 10. Titration Studies in Children - p. 163 62. Case 50. A 5-year-old boy with obstructive sleep apnea not tolerating continuous positive airway pressure - p. 164 63. Case 51. A child referred for positive airway pressure initiation and titration - p. 167 64. Case 52. An adolescent referred for bi-level positive airway pressure titration awakens with leg cramps - p. 171 65. Case 53. A 3-year-old girl with irregular breathing on bilevel positive airway pressure - p. 175 66. Case 54. Why is the continuous positive airway pressure no longer working? - p. 179 67. Section 11. Sleep and Genetic Syndromes - p. 181 68. Case 55. A 3-year-old girl with Down syndrome, chronic otitis media, and snoring - p. 182 69. Case 56. An 18-month-old with snoring and achondroplasia - p. 186 70. Case 57. A 9-month-old girl with Pfeiffer syndrome and snoring - p. 189 71. Case 58. A 3-year-old girl with Prader-Willi syndrome and obesity - p. 192 72. Case 59. A 12-day-old infant with Pierre Robin sequence and difficulty breathing - p. 196 73. Case 60. A 12-year-old girl with Williams syndrome and frequent nocturnal awakenings - p. 200 74. Case 61. A 9-year-old female with Joubert syndrome and breath-holding spells - p. 203 75. Case 62. A 4-year-old female with early morning awakenings - p. 206 76. Section 12. Parasomnias - p. 209 77. Case 63. A 6-year-old girl who goes to school while sleeping - p. 210 78. Case 64. A 3-year-old girl with disruptive nocturnal awakenings - p. 214 79. Case 65. An 11-year-old boy with obesity and secondary enuresis - p. 217 80. Case 66. A 13-year-old boy with Moebius sequence and violent nocturnal behaviors - p. 221 81. Case 67. Brain tumor presenting as somnambulism in an adolescent - p. 225 82. Section 13. Movement Disorders - p. 228 83. Case 68. A 9-year-old boy with snoring and leg movements - p. 229 84. Case 69. A 5-year-old girl with a rush of energy at bedtime - p. 233 85. Case 70. A 4-year-old boy with tooth grinding during sleep - p. 236 86. Case 71. A 5-year-old boy with repetitive nocturnal movements - p. 239 87. Section 14. Sleep in Medical Conditions - p. 241 88. Case 72. A patient with sickle cell disease and a low baseline sleeping oxygen saturation - p. 242 89. Case 73. A 5-month-old baby who wakes and spits up through the night - p. 246 90. Case 74. A 3-year-old boy with trisomy 21 and unchanged apnea–hypopnea index after tonsillectomy and adenoidectomy - p. 250 91. Case 75. A 10-year-old with snoring and hypoxemia - p. 252 92. Case 76. A 13-year-old girl with multiple nocturnal awakenings - p. 255 93. Case 77. A 5-year-old with nocturnal cough and daytime fatigue - p. 258 94. Section 15. Sleep and Neurologic Conditions - p. 261 95. Case 78. A 16-year-old boy with intractable seizure disorder and snoring - p. 262 96. Case 79. A 15-year-old girl with Lennox-Gastaut syndrome and breathing pauses - p. 266 97. Case 80. A 2-year-old girl with abnormal nocturnal events - p. 270 98. Case 81. A 13-year-old boy with snoring and headaches - p. 273 99. Case 82. A 13-year-old boy with facial weakness and severe obstructive sleep apnea - p. 277 100. Case 83. A 13-year-old girl with medulloblastoma and breathing pauses - p. 281 101. Case 84. An 11-year-old with Rett syndrome and cyanotic spells - p. 285 102. Case 85. An 11-year-old boy with morning headaches - p. 289 103. Case 86. An 11-year-old boy with history of concussion and insomnia - p. 292 104. Section 16. Sleep and Psychiatric Conditions - p. 294 105. Case 87. A 16-year-old girl with panic attacks and multiple nocturnal awakenings - p. 295 106. Case 88. A 12-year-old girl with fatigue and difficulty falling asleep - p. 297 107. Section 17. Sleep and Neurodevelopmental Disorders - p. 300 108. Case 89. An 8-year-old boy with attention-deficit/hyperactivity disorder and multiple nocturnal awakenings - p. 301 109. Case 90. A 13-year-old boy with autism spectrum disorder and difficulty falling asleep - p. 304 110. Section 18. Drug Effects on Sleep - p. 306 111. Case 91. A 13-year-old girl with excessive daytime sleepiness - p. 307 112. Case 92. A 12-year-old girl with narcolepsy and motor tics - p. 311 113. Case 93. A 15-year-old girl with narcolepsy type 1 needs sedation for dental work - p. 314 114. Case 94. A 14-year-old boy with short stature and snoring - p. 316 115. Case 95. A 17-year-old boy with both insomnia and excessive daytime sleepiness - p. 319 116. Case 96. A 10-year-old with acute pancreatitis and snoring - p. 322 117. Common Abbreviation List - p. 324 118. Thematic Table of Contents - p. 325 119. Index - p. 327
Following in the steps of the bestselling Sleep Medicine Pearls, this practical resource provides authoritative guidance on the evaluation and management of common pediatric sleep medicine problems using concise clinical vignettes. Experts in this rapidly growing field, led by Drs. Lourdes M. Del Rosso, Richard B. Berry, Suzanne E. Beck, Mary H. Wagner, and Carole L. Marcus, provide a hands-on, case-based approach, perfect for physicians studying for the sleep boards, fellows learning sleep medicine, and physicians who see children in their practice.
1. Part 1. Introduction to Pediatric Sleep Medicine - p. v 2. Section 1. Evaluation of the Pediatric Sleep Patient - p. v 3. Case 1. Pediatric sleep history: A 4 year-old with snoring, gasping and witnessed apneas - p. 2 4. Case 2. A 6-year-old girl with tonsillar hypertrophy, high-arched palate, and snoring - p. 5 5. Case 3. A 10-year-old girl with an unusual finding on physical exam - p. 8 6. Section 2. Pediatric Polysomnography - p. 9 7. Case 4. Overview of pediatric polysomnography: A newborn infant with snoring and witnessed apnea - p. 10 8. Case 5. A 2-week-old infant with some challenging epochs on polysomnography - p. 12 9. Case 6. A 14-year-old with an abnormal end-tidal CO2 waveform during polysomnography - p. 16 10. Section 3. Common Polysomnographic Findings in Children - p. 19 11. Case 7. A 3-year-old boy with rhythmic activity on electroencephalogram - p. 20 12. Case 8. A 3-month-old infant with monomorphic waves on electroencephalogram - p. 23 13. Case 9. A newborn infant with an alternating electroencephalogram pattern - p. 25 14. Case 10. A 2-month-old infant with sleep-onset REM period on polysomnography - p. 27 15. Case 11. An infant with high amplitude on an electroencephalogram recording - p. 29 16. Case 12. A 7-month-old infant with a series of central apneas - p. 31 17. Case 13. A 15-month-old with central apnea - p. 35 18. Case 14. A 19-month-old child with irregular, heavy breathing during sleep - p. 39 19. Case 15. A 4-week-old infant with jerking movements during sleep - p. 42 20. Case 16. An 8-year-old boy with abnormal capnography on polysomnogram - p. 45 21. Section 4. Artifacts in Pediatric Polysomnography - p. 48 22. Case 17. A 13-year-old boy with snoring and abnormal eye movements on polysomnogram - p. 49 23. Case 18. A 3-month-old infant who sleeps with a pacifier - p. 52 24. Case 19. A 24-month-old girl with uneventful desaturation - p. 55 25. Case 20. A 5-year-old child with unusual leg movements on polysomnography - p. 57 26. Case 21. A 16-year-old with snoring and diaphoresis - p. 59 27. Case 22. A polysomnography finding in an 8-year-old with history of seizures - p. 61 28. Part 2. Clinical Pediatric Sleep Medicine Pearls - p. 62 29. Section 5. Sleep Requirements and Sleep Hygiene - p. 62 30. Case 23. A 14-year-old girl who watches TV to fall asleep - p. 64 31. Case 24. An 8-year-old with a return to daytime napping - p. 67 32. Case 25. A 10-year-old girl sleeps with her parents and her sister - p. 69 33. Section 6. Insomnia - p. 71 34. Case 26. A 4-year-old boy with frequent nocturnal awakenings - p. 72 35. Case 27. A 14-year-old with difficulty falling asleep - p. 74 36. Section 7. Disorders of Hypersomnolence - p. 77 37. Case 28. A 10-year-old boy with excessive sleepiness and new-onset parasomnia - p. 78 38. Case 29. A 9-year-old girl with excessive daytime sleepiness and slurred speech - p. 80 39. Case 30. A 13-year-old boy with excessive sleepiness who falls asleep watching television - p. 83 40. Case 31. A 16-year-old boy who cannot stay up late on weekends - p. 86 41. Section 8. Circadian Sleep Disorders - p. 88 42. Case 32. A 4-year-old girl with septo-optic dysplasia and fragmented sleep - p. 89 43. Case 33. A 13-year-old boy who falls asleep in school - p. 93 44. Section 9. Sleep-Related Breathing Disorders - p. 96 45. Case 34. A 1-month-old premature infant on an apnea monitor - p. 97 46. Case 35. A 2-month-old infant turns blue in front of his parents - p. 101 47. Case 36. A 1-week-old infant with severely abnormal blood gases - p. 104 48. Case 37. A child with central sleep apnea treated with supplemental oxygen - p. 107 49. Case 38. A toddler headed for tracheostomy decannulation - p. 111 50. Case 39. A school-aged child with snoring - p. 115 51. Case 40. Double trouble: Tween siblings with obesity, daytime somnolence, and snoring - p. 119 52. Case 41. An infant with respiratory muscle weakness and lethargy - p. 124 53. Case 42. A 7-year-old boy with snoring, restless sleep, and obstructive sleep apnea - p. 128 54. Case 43. A 2½-year-old girl with snoring, restless sleep, and severe obstructive sleep apnea - p. 133 55. Case 44. A school-aged boy with snoring and attention-deficit hyperactivity disorder - p. 137 56. Case 45. A 7-year-old boy with obesity and persistent hypoventilation - p. 141 57. Case 46. A 6-month-old with laryngomalacia and stridor in sleep - p. 146 58. Case 47. Disturbed sleep in a patient with Duchenne muscular dystrophy - p. 151 59. Case 48. A 17-year-old with morning headaches - p. 156 60. Case 49. A 6-month-old with chronic lung disease of infancy, intermittent snoring, and failure to thrive - p. 160 61. Section 10. Titration Studies in Children - p. 163 62. Case 50. A 5-year-old boy with obstructive sleep apnea not tolerating continuous positive airway pressure - p. 164 63. Case 51. A child referred for positive airway pressure initiation and titration - p. 167 64. Case 52. An adolescent referred for bi-level positive airway pressure titration awakens with leg cramps - p. 171 65. Case 53. A 3-year-old girl with irregular breathing on bilevel positive airway pressure - p. 175 66. Case 54. Why is the continuous positive airway pressure no longer working? - p. 179 67. Section 11. Sleep and Genetic Syndromes - p. 181 68. Case 55. A 3-year-old girl with Down syndrome, chronic otitis media, and snoring - p. 182 69. Case 56. An 18-month-old with snoring and achondroplasia - p. 186 70. Case 57. A 9-month-old girl with Pfeiffer syndrome and snoring - p. 189 71. Case 58. A 3-year-old girl with Prader-Willi syndrome and obesity - p. 192 72. Case 59. A 12-day-old infant with Pierre Robin sequence and difficulty breathing - p. 196 73. Case 60. A 12-year-old girl with Williams syndrome and frequent nocturnal awakenings - p. 200 74. Case 61. A 9-year-old female with Joubert syndrome and breath-holding spells - p. 203 75. Case 62. A 4-year-old female with early morning awakenings - p. 206 76. Section 12. Parasomnias - p. 209 77. Case 63. A 6-year-old girl who goes to school while sleeping - p. 210 78. Case 64. A 3-year-old girl with disruptive nocturnal awakenings - p. 214 79. Case 65. An 11-year-old boy with obesity and secondary enuresis - p. 217 80. Case 66. A 13-year-old boy with Moebius sequence and violent nocturnal behaviors - p. 221 81. Case 67. Brain tumor presenting as somnambulism in an adolescent - p. 225 82. Section 13. Movement Disorders - p. 228 83. Case 68. A 9-year-old boy with snoring and leg movements - p. 229 84. Case 69. A 5-year-old girl with a rush of energy at bedtime - p. 233 85. Case 70. A 4-year-old boy with tooth grinding during sleep - p. 236 86. Case 71. A 5-year-old boy with repetitive nocturnal movements - p. 239 87. Section 14. Sleep in Medical Conditions - p. 241 88. Case 72. A patient with sickle cell disease and a low baseline sleeping oxygen saturation - p. 242 89. Case 73. A 5-month-old baby who wakes and spits up through the night - p. 246 90. Case 74. A 3-year-old boy with trisomy 21 and unchanged apnea–hypopnea index after tonsillectomy and adenoidectomy - p. 250 91. Case 75. A 10-year-old with snoring and hypoxemia - p. 252 92. Case 76. A 13-year-old girl with multiple nocturnal awakenings - p. 255 93. Case 77. A 5-year-old with nocturnal cough and daytime fatigue - p. 258 94. Section 15. Sleep and Neurologic Conditions - p. 261 95. Case 78. A 16-year-old boy with intractable seizure disorder and snoring - p. 262 96. Case 79. A 15-year-old girl with Lennox-Gastaut syndrome and breathing pauses - p. 266 97. Case 80. A 2-year-old girl with abnormal nocturnal events - p. 270 98. Case 81. A 13-year-old boy with snoring and headaches - p. 273 99. Case 82. A 13-year-old boy with facial weakness and severe obstructive sleep apnea - p. 277 100. Case 83. A 13-year-old girl with medulloblastoma and breathing pauses - p. 281 101. Case 84. An 11-year-old with Rett syndrome and cyanotic spells - p. 285 102. Case 85. An 11-year-old boy with morning headaches - p. 289 103. Case 86. An 11-year-old boy with history of concussion and insomnia - p. 292 104. Section 16. Sleep and Psychiatric Conditions - p. 294 105. Case 87. A 16-year-old girl with panic attacks and multiple nocturnal awakenings - p. 295 106. Case 88. A 12-year-old girl with fatigue and difficulty falling asleep - p. 297 107. Section 17. Sleep and Neurodevelopmental Disorders - p. 300 108. Case 89. An 8-year-old boy with attention-deficit/hyperactivity disorder and multiple nocturnal awakenings - p. 301 109. Case 90. A 13-year-old boy with autism spectrum disorder and difficulty falling asleep - p. 304 110. Section 18. Drug Effects on Sleep - p. 306 111. Case 91. A 13-year-old girl with excessive daytime sleepiness - p. 307 112. Case 92. A 12-year-old girl with narcolepsy and motor tics - p. 311 113. Case 93. A 15-year-old girl with narcolepsy type 1 needs sedation for dental work - p. 314 114. Case 94. A 14-year-old boy with short stature and snoring - p. 316 115. Case 95. A 17-year-old boy with both insomnia and excessive daytime sleepiness - p. 319 116. Case 96. A 10-year-old with acute pancreatitis and snoring - p. 322 117. Common Abbreviation List - p. 324 118. Thematic Table of Contents - p. 325 119. Index - p. 327
