Physical Examination and Test for Sleep Disorders

Physical examination is warranted and should focus on the causes and consequences of sleep-related disorders. Significant things to look for in a physical examination are as follows:

• Level of consciousness
• Physical features
• • Head circumference
  • Weight and indicators of failure to thrive
  • Features suggestive of congenital anomalies
  • Size of the posterior pharynx
• Physical causes of airway blockage such as enlarged tonsils or adenoids
• Obesity, neck circumference
• Systemic signs of heart failure such as clubbing or cyanosis
• Signs indicative of seizure activity
• Tooth injuries on tongue
• Incontinence
• Postictal changes in sensorium

Tests For Sleep Disorder

• Sleep laboratory studies are very helpful when indicated, but most common pediatric sleep problems do not require formal sleep laboratory testing. Most sleep problems resolve with behavioral treatments. A detailed sleep history, thorough physical examination, and sleep logs provide the foundation for accurate diagnosis, treatment, and possible referral for polysomnography. Atypical presentations, snoring associated with daytime somnolence, behavioral-emotional problems, apneic or hypopneic episodes, suspicion of narcolepsy, abnormal and disruptive movements in sleep, unexplained or recalcitrant sleep difficulties, or daytime sleepiness indicate a need for sleep studies.
• Overnight polysomnography and next-day multiple sleep latency testings represent the most commonly used sleep studies. Clinical suspicion of any of the following disorders should prompt referral for sleep studies:
• • Sleep-related seizurelike activity
  • Sleep-related gastroesophageal reflux
  • Nighttime asthma or persistent cough
  • ADHD or Tourette syndrome associated with restless sleep and disrupted daytime functioning
  • RLS and PLMS – Relatively common in these patients
  • Recurrent REM sleep behaviors
  • Severe bruxism
  • Snoring and hypopnea or apnea
  • Recalcitrant or unexplained and daytime somnolence
  • Suspected narcolepsy
• Multiple sleep latency tests aid in clarifying unexplained excessive daytime sleepiness and narcolepsy symptoms.

These are the most important items for parasomnia evaluation: 

• Interview the person and his or her bed partner
• Review of medical records
• Elicit details about sleep-wake patterns
• Medical history
• Psychiatric history
• Alcohol and drug-use history
• Family history
• Past or current history of physical, sexual, and emotional abuse 
• Psychiatric and neurologic interviews and examinations

Polysomnography (sleep test)

This test is usually conducted in a sleep study center. The patient sleeps at the center, and the following parameters are monitored:

• Electrical activity of the brain (electroencephalogram)
• Electrical activity of the heart (electrocardiogram)
• Movements of the muscles (electromyogram)
• Eye movements (electrooculogram)

These parameters are monitored as the person passes through the various sleep stages. Characteristic patterns from the electrodes are recorded while the person is awake with eyes closed and

 

 

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Clinic and Editor in Chief :

Widodo Judarwanto, pediatrician

email : judarwanto@gmail.com

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