Sleep In Normal Children Research Articles

Verification for Diagnosis of Sleep-Related Hypoventilation and Carbon Dioxide Partial Pressure During Sleep in Children Using End-Tidal Carbon Dioxide

Background and Objective From the past, several researchers have studied and measured the partial pressure of carbon dioxide during sleep in normal children to establish diagnostic criteria for hypoventilation in children. Here we tried to verify the existing definition of sleep-related hypoventilation in Asian by evaluating and analyzing the carbon dioxide partial pressure in pediatric subjects who underwent polysomnography.Methods We retrospectively analyzed clinical information of 196 children who underwent polysomnography at our hospital from Feb 2011 to Apr 2021. Among Asian pediatric subjects, those with serious chronic or genetic diseases, craniofacial deformities, and hypoventilation confirmed by polysomnography were excluded. We evaluated partial pressure of carbon dioxide in target group by end-tidal carbon dioxide (EtCO2) measured with a stream capnometer through nasal cannula. The target group was classified by apnea-hypopnea index and analyzed.Results The mean value of the time with EtCO<sub>2</sub> ≥ 45 mm Hg in total sleep time was 47.00% which is higher than previous studies. The mean value of the time with EtCO<sub>2</sub> ≥ 50 mm Hg in total sleep time was 2.77% which is similar to previous studies. Also, our subjects showed the highest mean EtCO<sub>2</sub> value in non-rapid eye movement (NREM) stage and lowest mean EtCO<sub>2</sub> value when wake.Conclusions In this study, the diagnostic criteria for sleep-related hypoventilation at the American Academy of Sleep Medicine (AASM) in 2017 established by measuring the EtCO<sub>2</sub> in western children seems appropriate to apply to Asian children to define hypoventilation.

Normal Sleep in Children and Adolescence.

Adequate sleep is essential for healthy development in childhood and adolescence. Healthy sleep contributes to good physical health, immune function, mental health, and academic performance. The regulation and architecture of sleep change greatly across childhood and adolescence, and the ability to obtain sufficient sleep is impacted by a range of factors that change with maturation. This article describes normal sleep across childhood and adolescence and discusses some of the most common barriers to adequate sleep, including early school start times, technology use, and changes to circadian rhythms, and sleep homeostasis across puberty.

The Inconsistent Nature of Heart Rate Variability During Sleep in Normal Children and Adolescents.

Introduction: Cardiac function is modulated by multiple factors including exogenous (circadian rhythm) and endogenous (ultradian 90–110 min sleep cycle) factors. By evaluating heart rate variability (HRV) during sleep, we will better understand their influence on cardiac activity. The aim of this study was to evaluate HRV in the dark phase of the circadian rhythm during sleep in healthy children and adolescents.Methods: One 3 min segment of pre-sleep electrocardiography (EEG) and 3, 6 min segments of electrocardiography recorded during polysomnography from 75 healthy children and adolescents were sampled during progressive cycles of slow wave sleep (SWS1, SWS2, SWS3). Three, 3 min segments of rapid eye movement sleep (REM) were also assessed, with REM1 marked at the last REM period before awakening. Studies that recorded REM3 prior to SWS3 were used for assessment. HRV variables include the following time domain values: mean NN (average RR intervals over given time), SDNN (Standard Deviation of RR intervals), and RMSSD (root Mean Square of beat-to-beat Differences). Frequency domain values include: low frequency (LF), high frequency (HF), and LF:HF.Results: Mixed linear effects model analysis revealed a significant difference in time and frequency domain values between sleep cycles and stages. Mean NN was lowest (highest heart rate) during pre—sleep then significantly increased across SWS1-3. Mean NN in SWS1 was similar to all REM periods which was significantly lower than both SWS2 and SWS3. SDNN remained at pre-sleep levels until SWS3, and then significantly increased in REM1&2. There was a large drop in LF from pre-sleep to SWS1. As cycles progressed through the night, LF remains lower than awake but increases to awake like levels by REM2. RMSSD and HF were lowest in pre-sleep and increased significantly by SWS1 and remain high and stable across stages and cycles except during the REM3 period where RMSSD decreased.Conclusion: Our results demonstrate that there are considerable changes in the spectral analysis of cardiac function occurring during different sleep stages and between sleep cycles across the night. Hence, time of night and sleep stage need to be considered when reporting any HRV differences.

Sleep and obstructive sleep disordered breathing in early childhood

Sleep is a physiological condition with changes in brain activity, muscle tone and autonomic function (cardiac and respiratory control). Sleep architecture and sleep stages differ and change from fetal life to adulthood. Sleep and breathing are related functions and this relationship is important to the understanding of sleep disordered breathing in children (SDB). Sleep disordered breathing (SDB) encompases a group of disorders characterized by abnormal respiratory patterns or insufficiency of ventilation during sleep. It is a broad spectrum of diseases ranging from snoring to sleep apnea. Investigation of normal sleep in children and violations in breathing during sleep are essential for proper diagnosis and adequate treatment of SDB in pediatric population.

Prevalence of periodic limb movements during sleep in normal children.

Although the American Academy of Sleep Medicine (AASM) mandates that periodic limb movements during sleep (PLMS) be scored on every polysomnogram, and considers a periodic limb movement index (PLMI) > 5/h abnormal in children, there is a lack of community-derived data regarding the prevalence of PLMS in children, and no data to support this cutoff value. Therefore, the aim of this study was to determine the prevalence of PLMS in a sample of normal children. Retrospective study. 195 healthy, non-snoring children aged 5-17 years, recruited from the community, who underwent polysomnography for research purposes. PLMS were scored using the AASM 2007 criteria. The group age (median [IQR]) was 12.9 [10-15] years, and 58% were male. Sleep architecture was normal, and the obstructive apnea hypopnea index was 0.1 [0-0.3]/h. The median PLMI was 0/h, ranging from 0 to 35.5/h. Fifteen (7.7%) subjects had a PLMI > 5/h, and only 3 (1.5%) met the adult pathologic criterion of more than 15/h. Use of the 95th percentile PLMI cutoff of 7.2/h produced little difference in categorization between groups. Children with a PLMI > 5/h had a higher arousal index than those with a lower PLMI (11.6 [8.8-14.6] vs 8.1 [6.1-9.9]/h, respectively, P = 0.003). This study provides normative data to the field and supports the clinical periodic limb movement index cutoff of > 5/h based on both prevalence and the correlate of increased sleep fragmentation. Periodic limb movements during sleep are infrequent in normal children recruited from the community. Marcus CL, Traylor J, Gallagher PR, Brooks LJ, Huang J, Koren D, Katz L, Mason TB, Tapia IE. Prevalence of periodic limb movements during sleep in normal children.

Development and preliminary evaluation of video analysis for detecting Gross movement during sleep in children

Purpose Obtaining an adequate amount of sleep is a necessity for normal childhood development. Gross body movements (GMs) during sleep in normal children vary by sleep stage and developmental state, and abnormalities in GMs characterize specific developmental pathophysiologies. Therefore, GM monitoring in children is of great importance when tracking normal development. While videosomnography is a widely used technique for monitoring GMs, it is qualitative, and a quantitative method for assessing GMs is required. We developed a novel, simple noncontact method based on video analysis for the detection of GMs during sleep.

Influence of Airway Pressure on Genioglossus Activity during Sleep in Normal Children

Most children with obstructive sleep apnea are able to sustain stable breathing during portions of sleep, despite an anatomic predisposition toward airway collapse. This suggests that additional determinants of airway patency are active, such as neuromuscular compensation. Using a custom intraoral surface electrode to record pharyngeal dilator muscle activity (the genioglossus [EMGgg]), we evaluated the muscle, ventilatory, and arousal responses to negative-pressure challenges during sleep in 19 healthy control children. In response to these challenges, we observed (1) marked variability in individual EMGgg responsiveness (peak EMGgg [mean+/-SD], 214+/-101% baseline), which was consistent within subjects; (2) a relationship between EMGgg activity and inspiratory flow and airway collapsibility; (3) reflex increases in flow (peak flow increase from challenge breaths 1-5 [mean+/-SD], 49+/-41% baseline) and respiratory rate often sufficient to sustain minute ventilation near baseline levels, without arousal; and (4) arousal threshold to be highest in stage 4, intermediate in stage 2, and lowest in REM sleep. Healthy children have wide variation in upper airway neuromuscular compensatory responses and arousal thresholds that could represent intermediate phenotypes affecting the expression of sleep apnea. Children with robust upper airway neuromuscular responsiveness, or a very high arousal threshold, may be able to sustain minute ventilation when challenged with negative airway pressure.

Correlación clínica de la hipersincronía hipnagógica durante el sueño, en niños normales y con problemas de aprendizaje

One of the electroencephalographic (EEG) patterns that can be mistaken for paroxysmal clinical activity, when not taken into account and especially in children, is hypnagogic hypersynchrony (HH). This consists in generalised, paroxysmal, synchronic, symmetrical, slow, high voltage waves lasting 2 8 seconds, which appear in drowsiness and in stage I. It was observed that this pattern often appeared in children with learning disability (LD). AIMS. To correlate clinical data with the presence of HH during sleep in normal children and those with LD. We assessed 180 children between the ages of 6 12 years with normal neurological development, 130 of which suffered LD and 50 who did not have LD. EEG was performed with sleep deprivation, following the International Federation of Clinical Neurophysiology guidelines. The presence or absence of HH, together with its characteristics, was assessed. Of the children with LD, 35.38% displayed HH and of the children without LD, only 4% displayed HH. Since the characteristics of HH in the children with LD were different to previous descriptions, we put forward criteria with which to evaluate those differences. HH appeared more often in children with LD than in normal children. Qualitative, quantitative (p< 0.05) and morphological changes were found in the paroxysmal activity of HH during the stages of sleep in children with LD.

Response to inspiratory resistive loading during sleep in normal children and children with obstructive apnea.

The response to inspiratory resistance loading (IRL) of the upper airway during sleep in children is not known. We, therefore, evaluated the arousal responses to IRL during sleep in children with the obstructive sleep apnea syndrome (OSAS) compared with controls. Children with OSAS aroused at a higher load than did controls (23 +/- 8 vs. 15 +/- 7 cmH(2)O. l(-1). s; P < 0.05). Patients with OSAS had higher arousal thresholds during rapid eye movement (REM) vs. non-REM sleep (P < 0.001), whereas normal subjects had lower arousal thresholds during REM (P < 0.005). Ventilatory responses to IRL were evaluated in the controls. There was a marked decrease in tidal volume both immediately (56 +/- 17% of baseline at an IRL of 15 cmH(2)O. l(-1). min; P < 0.001) and after 3 min of IRL (67 +/- 23%, P < 0.005). The duty cycle increased. We conclude that children with OSAS have impaired arousal responses to IRL. Despite compensatory changes in respiratory timing, normal children have a decrease in minute ventilation in response to IRL during sleep. However, arousal occurs before gas-exchange abnormalities.

Transition veille—sommeil chez le nouveau-ne et le nourrisson avant l'age de 3 mois

The mode of transition from waking to sleeping was studied using two methods: (1) by the simple observation of behavioural criteria (opening and closing of eyes, crying, motility), and in particular, rapid eye movements (REM); (2) from combined behavioural and polygraphic criteria (recorded REM, chin EMG, respiratory rhythm, EEG). This study shows that sleep may begin without complete eye closure, with half closed eyes or with brief, alternating opening and closing of the eyes. The modifications of the various polygraphic and behavioural parameters depend on the stage of sleep which is the outcome. The changes which most often condition the passage to a given stage of sleep are the following: (a) inhibition of the tonic chin EMG in the transition towards active sleep (AS); (b) modifications of the EEG in the transition towards quiet sleep (QS); (c) stopping of crying and of agitation in the transition towards indeterminate sleep (IS). The comparison of results obtained using the two methods of analysis shows that the simple observation of behavioural parameters overestimates the number of sleep inductions in AS. This method does not take into account discordances between polygraphic parameters. This study confirms the reduction with age of sleep onsets in AS, with a concomitant increase in sleep onsets in QS. It stresses the variability in the mode of onset of sleep in normal children of the same age group, as well as in successive sleep inductions in the same child.

Rolandic activity and its asymmetry during sleep in the child (author's transl)

Asymmetrical electrical activity was noted during sleep in normal children both during "mixed patterns" of sleep and during paradoxical sleep. This phenomenon is particularly striking between the ages of 3 and 5 years.

Auditory evoked potentials during sleep in normal children from ten days to three years of age

Auditory evoked potentials (AEPs) to clicks of moderate intensity were studied in 130 normal sleeping children from 10 days to 3 years of age. Latencies of the principal response components were found to decrease with log age, i.e., change was most rapid during the first year of life. From 15 days of age to 3 years, mean latencies decreased as follows: P 2 from 230 to 150, N 2 from 535 to 320 and P 3 from 785 to 625 msec. Variance was quite high, especially at younger ages. The fact that decreases in the latencies of the various components proceeded at different rates suggests that the components reflect quasi-independent neural substrates. The components of shortest latency displayed the weakest relationship to age. Findings with respect to latency for the subset of data obtained during stage 2 sleep were similar to those for the total population which contained responses recorded during several sleep stages. The amplitude of AEP components increased with age with the exception of N 1P 2 which decreased. Observations with regard to amplitude held both for the overall data recorded during several sleep stages and stage 2 data for components N 0P 1, N 1P 2 and N 2P 3. The amplitude trends for P 1N 1 and P 2N 2 were, however, not significant for the stage 2 subset. The maturation of the morphology of the AEP was characterized by a relative increase in the prominence of long latency components. The most striking change was the development of P 3. High amplitude, V shaped P 3 waves were also associated with stage 3–4 sleep. The changes which were delineated by this study for infancy and early childhood appear to be continuations of developmental trends reported for premature infants and neonates. AEPs are a reliable elicited measure which correlate well with maturation. They, therefore, can be a useful tool both in the study of central nervous system development and in the diagnosis of sensory and neurologic abnormalities.

The recovery cycle of the averaged auditory evoked response during sleep in normal children

1. 1. The recovery cycle of the averaged auditory evoked response (AER) to paired clicks was studied during Stage 2 and REM sleep in 23 normal 22–67-month-old children. Stimulus separations of 250, 160, 80, 40, 20 and 10 msec were used. The paired clicks were alternated with single clicks every 2.0 sec througout the night. The amplitude and latency of wave N 2 of the averaged response to the second click of each pair was measured after subtraction of the overlapping components of the averaged response to the first click. 2. 2. the 50% or greater attenuation of amplitude recovery reported for the waking state with stimulus separations of 500 msec was not obtained during sleep until stimulus separations shorter than 40 msec were used. 3. 3. In Stage 2 sleep, significant reduction of amplitude recovery occurred at stimulus separations of 250 and 20 msec. During REM sleep, there was significant reduction of amplitude recovery at all stimulus separations. The reduction of amplitude recovery was significantly greater during REM sleep than during Stage 2 sleep at stimulus separations equal to and shorter than 80 msec. However, the amplitude recovery cycle in the two sleep stages was similar, with lows of relative suppression at 250 msec and 40-20 msec separated by a peak of relative facilitation at 160-80 msec. The amplitude recovery cycle was best described by a combination of linear and cubic components. 4. 4. In Stage 2 sleep, the only significant effect on latency recovery was a slight delay at an 80 msec stimulus separation. During REM sleep, significant delays in recovery occurred at 80, 40 and 20 msec. There were no significant differences in latency recovery between the two sleep stages at any stimulus separation. The latency recovery cycle showed a significant linear delay in recovery with shorter stimulus separations in both sleep stages. In Stage 2 sleep a cubic component was also required to describe the latency recovery cycle while in REM sleep there was also a strong quadratic component. 5. 5. Within the age range of the subjects, significant age-related effects were limited to increased amplitude recovery and delay in recovery during REM sleep at a 250 msec stimulus separation with increasing age.

The effect of vestibular and auditory stimulation on the rapid eye movements of REM sleep in normal children

1. 1. The effect of continuous vestibular and auditory stimulation during sleep on the rapid eye movement activity of REM sleep was studied in normal children. 2. 2. The total amount of rapid eye movement activity, several measures of the clustering of the rapid eye movements and their distribution were quantified and compared under conditions of vestibular stimulation, auditory stimulation, and no stimulation. 3. 3. Compared to nights with no stimulation, both vestibular and auditory stimulation increased the total amount of rapid eye movement activity, the measures of rapid eye movement clustering, and the variability of these measures. 4. 4. During the nights of continuous stimulation, vestibular stimulation had a cumulative influence on the clustering of the rapid eye movements. A maximum effect followed by a compensatory negative rebound occurred during the course of the night. 5. 5. The findings were discussed in relation to the hypothesis of the vestibular mediation of the phasic sensory and motor events of REM sleep.