PSG 212: Infant/Pediatric Polysomnography

• RPSGT to AAS in PSG Transition Program

• Study Guide for Credit by Exam
Bedtime Routine - Highlights
• Consistent Sleep Habits
• Important to put child to bed when they are DROWSY but AWAKE

• Children normally develop sleep habits from their Parents

• Bedtime routines should be consistent & occur in the same order
• Bedtime routines should last between 20-45 minutes and consist of
3-4 soothing activities
• A common activity for pre-schooled age children would be Bedtime Reading
Sleep Onset
• Sleep Onset Association – conditions children learn to need at
bedtime in order to fall asleep
• Being rocked
• Being held
• Being soothed
• Feeding
Children who suffer from Sleep Onset Association Disorder usually awaken ever
90-120 minutes
• Limit-Setting Disorder
• Include:
• Non Compliant Behavior
• Curtain Calls – asking for extra bathroom trip or another glass of water

• Children with parents exhibiting marital discord are at a higher risk of limit-
setting disorder
Movement Disorders
• Body Rocking – child rocks head back and forth, without
headbanging, usually while on hands & knees
• Head Rolling – involves Side to side movements of the head, usually
in supine position
• Body Rolling – involves rolling of the entire body in a lateral manner
• Periodic Limb Movements – commonly associated with Restless Leg
Syndrome “only during sleep”
• It is common practice to order and overnight PSG for patients clinically
diagnosed with RLS
Partial Arousal Parasomnia
• May Lead to physical harm
• Can be triggered by:
• Sleep deprivation
• Fever or illness
• Stress or anxiety

Hypnagogic Hallucinations – vivid or visual hallucinations, often

described as dreams at sleep onset
Recommended Sleep Times
• Toddlers – 2-4 years old
12 to 13 hours per night

• Preschool-Aged - 3-5 years old

11 to 12 hours per night

• School Aged - 6-12 Year Olds

10 to 11 hours per night
Age Group Specific
• Newborns should be placed Supine to decrease risk of SIDS
• Allowing newborns to sleep with their parents increases rick of
Suffocation
• Most children normally awaken 4-6 times per night
• Caffeine intake becomes a common sleep issue for School-Aged
Children
• Naps are common for:
• Infants
• Toddlers
• Preschool Aged
Age Specific – EEG Characteristics

• Sleep Spindles
Normally seen at 2-3 months of age

• Slow Wave Sleep

Normally seen at 5-6 months of age
Bruxism
• May lead to:
• Dental erosion
• Jaw pain
• Tissue damage
• Risk Factors include:
• Anxiety
• Cerebral Palsy
• SSRI
• Mental Retardation
Narcolepsy
• Requires a PSG & MSLT to be diagnosed
• 10% of cases patients have a First degree relative that is also positive
• Often includes:
• Cataplexy: Sudden loss of muscle tone provoked by a strong emotion

REM Movement Disorders

• Parents are encouraged to regularly tighten screws and bolts on child’s bed

Somnambulism & Pavor Nocturnus

• Occur during Stage 3

Hypoventilation
• Scored when 25% of sleep time has PaCO2 > 55mmHg

Hypercapnia
• Described CO2 > 45mmHg
Pediatric Sleep Study Evaluation
• Physical Examination includes: Head, Eyes, Ears, Nose, Throat
• Evaluation generally includes:
• Sleep History
• Behavioral Assessment
• Developmental Screening
• Psychosocial History

*Always note history of Tonsillectomy

Children with Sleep Disordered breathing commonly suffer from Deviated
Septum & Enlarged Adenoids
Night Awakenings
• Should document:
• Duration of awakenings
• Behaviors that occur during
• Manner in which child goes back to sleep
• Presence of nightmares
Delayed Sleep Phase Syndrome
• Most Common in Adolescents
• General treated with Chronotherapy
Phase Advancement: Advancing bedtimes earlier by 15 minutes per day
Phase Delay: Involves delaying bedtime and wake time by 2-3 hours
daily
*Used in severe cases of Delayed Sleep Phase Syndrome

Newborn Day/Night Reversal: treated with increasing Infants activity

during the day