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Interview with Dr. Lucila Prado, who explained in detail sleep disorders care in children.

August 19, 2016


Interview with Dr. Lucila Prado, who explained in detail sleep disorders care in children.

Sleep Medicine specialist, Dr. Lucila Pardo, talked to Neurovirtual about the main disorders affecting children and the best way to diagnose and treat these patients, which entails specific care.

Neurovirtual –  Which are the most common sleep disorders in children and which are their symptoms?

Lucila Prado – When talking about children we have to think of different ages. The prevalence of sleep in children depends on their age. There is a common complaint by parents: “my kid does not sleep”. This happens at all ages, from newborns, because they have colics, because they are hungry, because they feel uncomfortable, to older children who show resistance to go to bed, who want to keep watching TV, who want to play videogames, to manipulate cellphones, etc. And teenagers, who are also in the children age range and who want to “go partying”, sleep late, and wake up later. So the lack of sleep, the disorders related to sleep hygiene are more common in children. Of all sleep conditions in children, obstructive sleep apnea is in fact one of the most prevalent ones. Children snore, do not necessarily suffer from excessive daytime sleepiness…on the contrary, school learning is difficult for them. This is a child who cannot focus, who has attention deficit, and who is not able to learn.

NV –  What are the main causes of the most common disorders in children?

LP – For obstructive sleep apnea, hypertrophy is the most common cause, or enlarged adenoid tissue. So, the enlarged adenoids or tonsils, that obviously cause an obstruction to airflow, lead to snoring and apnea in children. Among the sleep hygiene causes, not establishing an appropriate sleep, going to bed, getting up and waking up schedule is one of the main causes… This is, more or less, a child without limits. Insomnia causes in children, are, air quotes, their parents or caregivers.

NV – What are the signs parents need to pay attention to in order to identify possible sleep disorders in children?

LP – Obstructive sleep apnea is the most important, which leads to learning disorders, attention deficit. So, the most important task here is to see nocturnal signs of sleep apnea. Snoring is important…The child is tossing and turning to get to sleep, has difficulty…sleep is more restless. Concerning the respiratory signs, for obstructive sleep apnea syndrome, there are daytime and nighttime symptoms. Nighttime symptoms are linked to the child wheezing, mainly snoring and agitation during sleep. Daytime symptoms: learning deficit, hyperactivity…the child does not stop. It is a lot more than in daytime sleepiness, which is more common in adults. It is all more related to the child´s activities. Other insomnia symptoms are the child´s resistance to go to bed, the child wants to continue playing, the child changes daytime activity into nighttime activity. These are, obviously, very important complaints from parents.

NV –  In which way do sleep disorders generally affect the intellectual and physical development of children?

LP – As I was mentioning, it is important that children sleep. It is during sleep that children grow and memorize whatever they learn during the day. If their sleep is not appropriate or if they don´t sleep enough, they are going to have difficulty memorizing what they learned during the day. So we have a child who has learning difficulties because he/she has a sleep condition, and on top of that, sleep deficit. This kid will have difficulty memorizing and storing what he learned during the day.

NV –  What´s your opinion of the current sleep field?

LP – It is a relatively new field despite sleep having concerned the Earth´s population since ancient times. But it has started to evolve since the 80s and is being included in the curriculum of physicians, in the curriculum of residents. We, at Unifesp, have a resident program in Sleep Medicine. We are developing specialists, equipment, the anamnesis method, and we are including the sleep anamnesis within the medical anamnesis more and more. Asking about the sleep schedules is important, asking patients about what afflicts them during sleeptime, in order to produce a diagnosis and to make progress in sleep disorders research.

NV –   Do procedures for a correct diagnostic differ in the care of children and adults?

LP – Yes. Sleep apnea causes in children are different, sleep disorders causes in children are different. Adults have bigger head sensors, electrodes, and children, small. Different ages, different abdominal circumferences. So, sleep disorders diagnostic criteria in children, in polisomnography, are also different. This is a specialty within another specialty, children´s sleep.

NV – Do AASM protocols contribute to the procedures for this type of patients?

LP – Within the AASM, there are protocols for adults, and whithin those protocols, a whole component for kids. So it is different, yes. There are different diagnostic criteria, sleep apnea is different in children, all different. A child is not, certainly, a small version of an adult.

NV – Which are the main challenges of the sleep field in Brazil, both from the diagnostic and from the treatment point of view?

LP – Sleep Medicine should be treated at the prevention level, so this should be done in schools and through basic health programs, sleep anamnesis, both for children and for adults, in order to prevent sleep disorders instead of treating them in the future to be able to do something important for both levels. Prevent obesity, prevent hypertension… Diagnostic by polysomnography is less expensive for patients. The Sleep Medicine anamnesis encompasses more, it takes more than an hour to ask questions during a first consultation. It takes up to two hours to do so with a child, to ask about all the customs, parenting habits. Treatment, some times, takes longer because it is necessary to make parents conscious about sleep schedules…and adults, too. So, it is necessary to change people´s way of thinking in terms of schedules organization, and see sleep as a diet. You have to eat healthily and you have to sleep healthily. Because, at the end of the day, you spend one third of your life sleeping. That is 8 hours sleep. If you get to live 90 years, that is 30 years sleeping. These 30 years have to be well lived and well-followed, because this will make a difference for the rest of the day, for sure.

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