RESTLESS SLEEP IN CHILDREN. Lourdes DelRosso, M.D. MS Associate Professor of Pediatrics AASM, Scoring Manual Editorial Board

Transcription

1 RESTLESS SLEEP IN CHILDREN Lourdes DelRosso, M.D. MS Associate Professor of Pediatrics AASM, Scoring Manual Editorial Board

2 To identify the clinical characteristics of children who present with restless sleep and daytime symptoms To describe the polysomnographic findings in children with restless sleep AIMS To compare the clinical and polysomnographic findings in restless sleepers, children with restless leg syndrome and normal controls To propose a diagnostic category of Restless Sleep Disorder

3 BACKGROUND

4 SLEEP DISORDERS Parasomnia Hypersomnia Insomnia Circadian rhythm disorders Sleep disordered breathing Movement disorders

5 MOVEMENT DISORDERS Restless leg syndrome Periodic leg movement disorder Sleep related rhythmic movement disorder Bruxism Sleep related leg cramps Benign sleep myoclonus of infancy Propiospinal myoclonus

6 Wherefore to some, on being a bed, they betake themselves to sleep, presently in the arms and legs, leapings and contractions of the tendons, and so great a restlessness, and tossing of the members ensue that the diseased are no more able to sleep than if they were in the place of the greatest torture WILLIS

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9 RESTLESS LEG SYNDROME Urge to move the legs Inactivity Evening Relieved by movement Distress, sleep disturbance Rule out mimics

10 GROWING PAINS

11 RLS OR GROWING PAINS? EKBON 1972 Growing Pains Restless Legs Syndrome

12 RESTLESS LEGS SYNDROME IN CHILDHOOD AND ADOLESCENCE PEDIATRIC DAN PICCHIETTI ET. AL NEUROLOGY VOLUME 11 NUMBER 3, 1974

13 SIMILARITIES AND DIFFERENCES BETWEEN RLS AND GROWING PAINS

14 STUDIES SUMMARIZING FINDINGS IN RLS AND GROWING PAINS

15 GROWING PAINS AND PERIODIC LIMB MOVEMENTS OF SLEEP IN CHILDREN MAN WAI WONG ET AL. JOURNAL OF PAEDIATRICS AND CHILD HEALTH 50 (2014)

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19 ADULT

20 NARCOLEPSY

21 FREQUENT DIAGNOSIS IN PATIENTS WITH PLMS

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23 SCORING EVENTS Leg movement. A burst of anterior tibialis muscle activity with a duration between onset and resolution of seconds and with an amplitude of at least 25% of the bursts recorded during calibration is defined and scored as a "leg movement PLM sequence. A sequence of four or more LMs, separated by at least 5 and not more than 90 seconds (see Figs ). This separation is measured from LM onset to LM onset and is different from inter- LM interval, which is measured from LM offset to LM onset. Computation of the inter-lm interval histogram

24 PERIODIC LEG MOVEMENTS

25 AASM SCORING OF PLMS

26 IRLSSG SCORING RULES

27 Total LMS (TLMS) index, n per hour; PLMS index, n per hour, LMS included in regular and noninterrupted sequences of at least four with onset-to-onset intermovement interval (IMI) s; Short-interval LMS (SILMS) index, n per hour, LMS with preceding IMI < 10 s; Isolated LMS (ISOLMS) index, n per hour, LMS with IMI > 90 s and LMS with IMI s not meeting all the criteria for PLMS; Bilateral PLMS index, n per hour, PLMS formed by two to four monolateral LMS from the two legs overlapping each other within 0.5 s windows with a combined total duration of <15 s;

28 PERIODICITY IN ADULTS WITH PLMD

29 WHAT HAPPENS IN CHILDREN

30 PLMS? ISOLMS?

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32 IMI IN SCHOOL AGE CHILDREN

33 IMI IN ADOLESCENTS

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36 MOVEMENT DISORDERS Restless leg syndrome Periodic leg movement disorder Sleep related rhythmic movement disorder Bruxism Sleep related leg cramps Benign sleep myoclonus of infancy Propiospinal myoclonus

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38 METHODS-1 Children seen in the Sleep Center at BCHO from 7/ /2017 Consult for: restless sleep with daytime symptoms n=29 Clinically evaluated by a board certified sleep doctor (LDR)

39 METHODS-2 Exclusion Criteria AGE younger than 6 (n=3) Medical, psychiatric or sleep disorder (n=4) Medications that alter sleep (n=3) Use of caffeine

40 METHODS-3 Clinical Characteristics n=4 AHI >1 Polysomnography N = 15 RSD

41 15 Children with RSD 15 Children with RLS 37 Normal controls

42 RESULTS 1: CLINICAL FEATURES

43 RESULTS 2: IRON STUDIES

44 RESULTS 3: PSG DATA

45 RESULTS 4: LEG MOVEMENTS

46 DISTRIBUTION OF INTER-MOVEME NT INTERVALS

47 RSD RLS No Yes Movements Yes No Discomfort no Yes Awakenings No Yes Daytime symptoms Yes Yes Ferritin mean ISOLMS 8 11 SILMS Bilat. PLMS Clinical Parameter Family History Iron Studies: Polysomnographic Finding (mean) Total leg movements index COMPARISON RSD-RLS

48 CONCLUSION-1 Children with RSD with respect to controls tend to have decreased TST and increased awakenings per hour, comparable to children with RLS but without the leg motor activity and without prolonged sleep latency.

49 STEP 2 Do children with RSD really move as much as the parents report?

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51 VIDEO ANALYSIS OF MOVEMENTS

52 NIGHT DISTRIBUTION OF MOVEMENTS

53 TOTAL MOVEMENT INDEX

54 COMPARISON MOVEMENT DISORDERS

55 PROPOSED DIAGNOSTIC CRITERIA

56 Video-Polysomnographic Characterization of Sleep Movements in Children with Restless Sleep Disorder Raffaele Ferri, MD Oasi Research Institute (IRCCS), Troina, Italy Caroline Jackson, MD Seattle Children s Hospital Seattle, WA Kimberly Trotter, MA, RPSGT University of California San Francisco, CA Oliviero Bruni, MD Department of Social and Developmental Psychology, Sapienza University, Rome, Italy

57 Questions/Comments

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59 The duration of the R R interval decrease with SILMS doublets was significantly longer than that with PLMS, whereas the maximal decrease in R R interval was similar. Scoring SILMS in RLS patients may therefore be relevant from a cardiac autonomic perspective.

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