[Sleep disorders in infancy--aspects of diagnosis and somatic background].
Sleep-related disturbed breathing and parasomnia in very young children are in the focus of epidemiological interest. The cardinal symptom, i.e. snoring, in connection with nocturnal perspiration, mouth breathing, susceptibility to infection of the upper respiratory tract and tiredness during the day or hypermotility, can be an indication of obstructive sleep apnea (OSA). The common treatment is adenotomy unless there is indication of allergic swelling of the nasal mucous membrane. Other anatomic predispositions for OSA must be considered (tonsillar hypertrophy, midfacial hypoplasia, micro- and retrognathia, e.g. in patients with Down's syndrome or patients with preoperated cleft lip face palate). Inhalative nasal corticoids are a possible alternative to adenotomy in light to medium grade cases of OSA. Tonsillotomy is indicated only in serious OSA cases, tonsillectomy is only justified in cases of chronic tonsillitis or more than 4-6 cases of angina in the last 12 months. Treatment with nasal CPAP is tolerated well also in childhood. Patients with central hypoventilation syndromes, insufficiency of the respiratory musculature or obesitas hypoventilation syndrome can usually be ventilated by non-invasive approach using a nasal mask. Patients suffering from parasomnia should always be asked if they snore at night because if OSA is diagnosed and treated, there are very good prospects of curing somnambulism as well. Like with narcolepsy and REM sleep, a close HLA association has also been identified for family somnambulism. In cases of parasomnia which becomes manifest only after very young age frontal lobe epilepsy should be suspected and searched by polysomnographic and simultaneous continuous nocturnal video surveillance. If reversive development or unclear motoric and utterance phenomena are observed, sleep-bound convulsive disorder should be looked for. Syncopal events can require comprehensive cardiological diagnosis, including exclusion of nightly disorders of the cardiac rhythm.
Klinik und Poliklinik für Kinder- und Jugendmedizin der Medizinischen Fakultät Carl Gustav Carus der Technischen Universität Dresden. ekkehart.paditz@uniklinikum-dresden.de
Ekkehart
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Paditz
D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D020447:Parasomnias / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012017:Referral and Consultation; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012913:Snoring / Q000209:etiology; D013398:Sudden Infant Death / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control