Alfred Wiater

Normative values of polysomnographic parameters in childhood and adolescence: Arousal events

OBJECTIVE This study focused on differences in arousals during sleep, using the arousal rules of the American Academy of Sleep Medicine, by gender, age, and maturity in healthy children. METHODS One-night polysomnography was performed on 209 healthy German children (age 1-18 years) at their habitual bedtimes in 16 laboratories. Subjects were grouped by gender (112 females, 97 males), age, and Tanner stage. RESULTS Normative values of arousal events in sleep are presented, including indexes of spontaneous and respiratory arousals, total electroencephalogram (EEG) arousals, phasic increase in submental electromyogram (EMG) in stage R, and leg movements. With increasing age, a decrease was seen in: EEG arousal index ≥1-2.9 s, EEG arousal index ≥3 s, index of total EEG arousals, index of respiratory arousals, chin EMG enhancement in stage R ≥1-2.9 and ≥3 s, index of total leg movements, and leg movements with EEG arousals (p<0.05). Only spontaneous arousals showed no association with age. There was a significant negative correlation between Tanner stage and arousals ≥1-2.9 s, respiratory arousals, leg movements, and leg movements with arousals (p<0.05). Only arousals ≥3 s and total leg movements showed gender differences (p<0.05). CONCLUSIONS For the diagnosis of pediatric sleep disturbances, the given arousal data enable estimation of the degree of deviation from normal findings for age and maturity. There is need for further research on, and further discussion of, the arousal rules of the American Academy of Sleep Medicine.

Sleep disorders in children beginning school: their causes and effects.

BACKGROUND Sleep disorders are a common problem among children beginning school and may be associated both with impaired school performance and with behavioral difficulties. Because these disorders manifest themselves highly variably among children of any given age, and even in an individual affected child, they need an appropriate diagnostic evaluation so that the many environmental and background factors that may be relevant to the further course of the problem can be assessed. METHODS Extensive data were obtained on approximately 1400 children who were tested before beginning school in 2005 by means of a special sleep questionnaire and another screening instrument that is used to assess behavioral strengths and difficulties (the SDQ, Strengths and Difficulties Questionnaire). RESULTS Five percent of the children were found to have difficulty falling asleep, difficulty staying asleep, or nocturnal awakening. Less frequent problems included parasomnias such as pavor nocturnus (0.5%), sleepwalking (0.1%), and frequent nightmares (1.7%). CONCLUSION Sleep disorders increase the risk of daytime fatigue and of psychological problems in general, including both hyperactivity and excessive emotional stress. These results imply that sleep problems and emotional disturbances are intimately connected and underscore the importance of diagnosing sleep problems in young children.

Prevalence of Sleep Problems and Relationship between Sleep Problems and School Refusal Behavior in School-Aged Children in Children's and Parents' Ratings

Objective: This cross-section study investigated the prevalence of sleep disorders and the relationship between sleep problems (insomnias, parasomnias, and daytime sleepiness) and school refusal behavior in school-age children (fourth grade elementary school in Cologne, Germany). Method: A sample of 1,490 children (age range: 8-11 years) and their parents each completed a sleep questionnaire and the School Refusal Assessment Scale. Results: The results indicate that sleep problems in childhood are frequent. Furthermore, the results of the study clearly indicate that there is a relationship between sleep problems and school refusal behavior. Children suffering from insomnias (sleep onset problems, difficulties maintaining sleep), parasomnias (nightmares, night terrors), and daytime sleepiness showed without exception significantly higher scores in 3 out of 4 school refusal behavior maintaining conditions compared to children without sleep problems. These three conditions are all associated with anxiety disorders (anxiety or depressive disorder, as well as separation anxiety disorder). Only in the fourth condition, which is associated with oppositional defiant or conduct disorders, truancy, or no disorder at all, were there no significant differences between children with and children without sleep problems. Conclusions: For research and clinical practice, it is important to view sleep problems and school refusal behavior in relation to each other rather than as isolated phenomena.

Schlafstörungen bei hyperkinetischen Kindern - polysomnografische Untersuchungen zur Schlafstruktur und -architektur

Zusammenfassung: Fragestellung: In der vorliegenden Untersuchung wurde der Frage nachgegangen, ob bei hyperkinetischen Kindern spezifische Auffalligkeiten in der Schlafstruktur und -architektur gefunden werden konnen und ob sie ein erhohtes Risiko fur das Auftreten einer schlafbezogenen Atmungsstorung vorweisen. Methoden: In einer Schlaflaboruntersuchung bei hyperkinetischen Kindern und schlafgestorten Kindern im Alter zwischen 6 und 12 Jahren wurde die polysomnografisch gemessene Schlafstruktur von hyperkinetischen Kindern (n = 36) verglichen mit den Ergebnissen nicht schlafgestorter Kinder (n = 87) sowie von Kindern mit Schlafstorungen (n = 15). Des Weiteren erfolgten gruppenvergleichende kardiorespirografische Analysen. Ergebnisse: Die Ergebnisse der Studie weisen aus, dass die Schlafstruktur nicht-schlafgestorter Kinder mit hyperkinetischen Storungen gegenuber unauffalligen Kindern nur geringe Abweichungen aufweist. Die festgestellten Auffalligkeiten schlafgestorter Kinder mit hyperkinetischen Storung...

Schlafstörungen bei hyperkinetischen Kindern - Zusammenhänge zu Arousalstörungen, differentialdiagnostische Abgrenzungen und Komorbiditäten

OBJECTIVES Sleep disorders are frequently observed in Attention Deficit-Hyperactivity Disorder (ADHD). At the same time, however, there is little evidence of their prevalence and their specific characteristics. Also unclear is a possible pathogenetic relationship between disturbed sleep and the core symptoms of ADHD. There are still very few findings on the role of comorbid internal and neurological disorders like sleep apnea and restless legs syndrome in the differential diagnosis of ADHD. METHODS We present an overview of the current literature, describing the most important results concerning sleep disorders in ADHD. RESULTS A principal goal of future assessments is to ascertain whether sleep problems in children with ADHD represent unspecific concurrent symptoms or whether they play a substantial role in the pathogenesis of ADHD. CONCLUSIONS Moreover a possibly increased risk of comorbid sleep-disordered breathing disorder might be an important issue in the differential diagnostic considerations with regard to ADHD.

Successful treatment of severe parasomnias with paroxetine in a 12-year-old boy

Night terrors and somnambulism are parasomnias associated with non-REM sleep. Medical treatment is only considered in severe cases with persistent and extended symptoms where there is a high risk of self-injury. We report the case of a 12-year-old boy with severe night terrors and somnambulism whose symptoms completely remitted under medication with the selective serotonin re-uptake inhibitor paroxetine. Its impact on sleep remains unclear as we were not able to show any significant changes in the polysomnographic sleep macroarchitecture. Paroxetine might be an alternative to benzodiazepines or tricyclic antidepressants because it permits subchronic medication, necessitates little dose titration and is well tolerated, with few side-effects, and, in particular, has low sedating properties.Night terrors and somnambulism are parasomnias associated with non-REM sleep. Medical treatment is only considered in severe cases with persistent and extended symptoms where there is a high risk of self-injury. We report the case of a 12-year-old boy with severe night terrors and somnambulism whose symptoms completely remitted under medication with the selective serotonin re-uptake inhibitor paroxetine. Its impact on sleep remains unclear as we were not able to show any significant changes in the polysomnographic sleep macroarchitecture. Paroxetine might be an alternative to benzodiazepines or tricyclic antidepressants because it permits subchronic medication, necessitates little dose titration and is well tolerated, with few side-effects, and, in particular, has low sedating properties.

Private Therapiegeräte in der Klinik – wer ist verantwortlich?

Immer wieder kommt es vor, dass Patienten zur stationaren Aufnahme private Gerate mitbringen, die sie dringend benotigen – z. B. einen Insulin-Pen oder ein CPAP-Gerat. Manche Kliniken gestatten den Gebrauch dieser Gerate nicht. Die Begrundung: Das Personal sei nicht eingewiesen, und zudem sei unklar, ob das Gerat uberhaupt sicher sei. Dieses Positionspapier stellt den aktuellen juristischen Hintergrund dar und kommentiert die Situation aus arztlicher Sicht.

Psychische Störungen und umschriebene Entwicklungsstörungen im Kindes- und Jugendalter

With a prevalence of 5–6 % the isolated disorder of motor development, also known as Developmental Coordination Disorder, is the most frequent motor dysfunction.