Method for assessing quality of nocturnal sleep in children

FIELD: medicine.

SUBSTANCE: polysomnography is conducted. Slow sleep phases (SSP) and fast sleep phases (FSP) are determined. A maturity index of integrative sleeping apparatuses (MIS) is calculated by formula MIS = SSP/FSP. If the MIS is less than 1.5, a physiologically optimum structure of the nocturnal sleep is stated in a healthy child.

EFFECT: method enables assessing the quality of the nocturnal sleep in the children.

1 tbl, 2 ex

 

The invention relates to medicine, in particular, neurology, and can be used to determine the quality of a night's sleep in children under the age of 5 years in normal and various neurological pathologies.

There is a method of determining integrative sleep quality index (X) obtained through mathematical analysis based on the calculation of the confidence interval 37 settings polysomnogram (Carpets, Century, staves, S. I., 1997. Insomnia: current diagnostic and therapeutic approaches. Ed. prof Levin, J. I.). - M.: publishing house Medpraktika-M, 2005. 116 C. ). The disadvantages of this method is that it does not reflect the process of ontogenesis night sleep patterns in children. The IRS does not take into account individual peculiarities of the integrative apparatus of the sleep regulating series connection of the phases and stages of sleep that is crucial to predict the maturation of children. This fact is the main drawback of the IRS for children with neurological disorders, when machines dream ripen is not optimal.

The technical result is to simplify and increase the sensitivity of the method.

The novelty of the method lies in the fact that using polysomnography in a child older than 5 years calculate the maturity index integrative AIDS sleep (SFL) by the formula

SFL = FMS/PBS, where

SFL - index Mature the particular integrative AIDS sleep in a child,

FMS - slow-wave sleep in the percentage of the total duration of sleep,

FBC - REM sleep in the percentage of the total duration of sleep,

and the value of SFL less than 1.5 is indicative of a physiologically optimal patterns of nocturnal sleep in healthy child.

The method is as follows.

Polysomnographically the night sleep study is carried out with a parallel videomonitoring (without adaptation night) for 8 hours, with forced awakening using a hardware-software complex Neurospect - 4/EP (Neurosoft, Ivanovo, Russia).

For recording the electroencephalogram use two Central leads (C3-C4), basic analysis, and two occipital (01-02), as an auxiliary for the evaluation of the alpha rhythm. The reference electrode at the same time placed on the mastoid bone of the opposite side. The movement of the eyeballs evaluate using electrooculography. The electrodes are fixed at the outer corner of the eye. Channel submental electromyography registers the muscle tone of the aperture of the mouth.

Analysis of records polysomnogram, the selection cycles of sleep, its phases and stages is carried out in accordance with the international standards proposed by the group of experts under the leadership of A. Rechtschaffen and A. Kales (A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. - US Government Printing Office, studied extensively: the provision of Public Service, Washington, DC, 1968. 59 p.).

Assess the following indicators polysomnographical studies: percentage representation of the phases of slow sleep (FMS) and REM sleep (FBS) to the total duration of sleep.

The results calculated by the formula:

SFL = FMS/PBS, where

SFL - maturity index integrative AIDS sleep in a child,

FMS - slow-wave sleep in the percentage of the total duration of sleep,

FBC - REM sleep in the percentage of the total duration of sleep.

Indicator physiologically optimal sleep patterns in healthy children 5 years of age is the value of the index maturity sleep less than 1.5.

Examples of specific performance.

Observation 1. Patient E., 8 years old, girl.

At the time of the examination of the girls complained about the impulsiveness of behavior, learning difficulties, emotional lability (often aggressive behavior), decreased memory and attention, excessive talkativeness. Headaches oppressive character in the fronto-temporal region, monotonous, mostly during the second half of the day, 2-3 times a week, without nausea and vomiting. Pain stymied by relaxing, taking shpy. Also the girl mentioned difficulties in falling asleep, increased motor activity during sleep.

The history of life: a Child from 2 pregnancies, 1 birth. In the analysis of outpatient card revealed that the pregnancy was amid the storms interrupt (rising tone of the uterus in the first trimester, toxicity in the first trimester, ARVI in 22 weeks, anemia. Delivery is urgent, at 39 weeks. It was noted the weakness of patrimonial activity, was conducted drug redistillate. The duration of delivery of about 16 hours, anhydrous period of about 6 hours. Newborn baby cried immediately applied to the breast in the delivery room. The color of the skin physiological. Estimation on Apgar scale 8-9 b. In the first year of life of motor and mental development corresponded to normal levels.

The girl was restless, active, impulsive. In addition to the decreed time neurologist to 7 years were observed, the treatment is not received. From the age of 7 was observed by a neurologist with a diagnosis of attention deficit disorder with hyperactivity disorder, combined form. Received treatment. Significant positive dynamics were observed.

Objective examination. The girl is active, to explore react adequately. Turned it understands, responds to questions willingly, in complete sentences. It is clear, not broken. Skin physiological coloring, easy hyperhidrosis of the palms and soles. Cranial innervation without pathology.

Muscle tone in the upper and lower extremities physiological equal. Muscle strength is sufficient. The tendon reflexes of the upper extremities symmetric without extension reflex zones. Tendon reflexes bottom is x extremities symmetric, moderate symptoms. Pathological reflexes are not called. Meningeal symptoms negative.

Coordinatorsee tests: Romberg sustainable, finger-nose test performs confidently and accurately. Disorders of gait not.

For verification of the diagnosis, we used the scale ICD-10. In the analysis which recorded the presence of manifestations of inattention - 6 signs of hyperactivity - 4 trait 2 trait impulsivity.

When evaluating the results of the analysis of the questionnaire for parents (SNAP-IV, we received the following indicators: hyperactivity - 1.7 points (rate of 0.27-1.59 points), impulsivity 1.7 points (rate of 0.26-1.52 points), inattention - 2.0 points (rate of 0.4 to 1.8).

To study the structure of sleep we were polysomnographically study night's sleep, without adaptation night. The results of the study:

FMS - 38,2%,

FBC - 17,9%

SFL = 38,2/17,9=2,13

Thus, the above observation is an example of attention deficit disorder and hyperactivity with impulsivity. There is a significant increase in the duration of a phase of slow wave sleep and a decrease in the representation phase of REM sleep, which is an indicator of immaturity integrative AIDS sleep. The maturity index sleep exceeds 1.5.

Observation 2. Patient M., age 9, boy.

At the time of the survey, the boy had complained about crudest is in the development of academic skills, violation letters.

The history of life: a Child from 2 pregnancies, 2 births. When analyzing the patient card is known that this pregnancy was physiological, without pathological conditions. Delivery term, 40 weeks. It was noted the weakness of patrimonial activity, was conducted drug redistillate. The duration of delivery of about 12 hours, the dry period is 3 hours. Newborn baby cried immediately applied to the breast in the delivery room. The color of the skin physiological. Estimation on Apgar scale 8-9 b. In a maternity home have spent 5 days. In the first year of life motor and psycho-speech development corresponded to normal levels. In 3 years was noted masanotti speech, the boy did not say separate sounds. The neurologist was not observed. Worked with a speech therapist, speech is normalized to 6 years.

Objective examination. The boy is active, to explore react adequately. Turned it understands, responds to questions in complete sentences. It is clear, not broken. Skin physiological painting, hyperhidrosis of the palms and soles is not marked.

Cranial innervation without pathology. Muscle tone in the upper and lower extremities physiological equal. Muscle strength is sufficient. The tendon reflexes of the upper extremities symmetric without extension reflex zones. The tendon reflexes of the lower end is awn symmetric, moderate symptoms. Pathological reflexes are not called. Meningeal symptoms negative. Coordinatorsee tests: Romberg sustainable, finger-nose test performs confidently and accurately. Disorders of gait not.

When determining dominance hemispheres - right: leading hand - right foot - right eye - right.

For verification of the diagnosis, we used the scale ICD-10. In the analysis which did not detect the presence of manifestations of inattention - 2 symptoms, hyperactivity - 1 sign, and 0 trait impulsivity.

When evaluating the results of the analysis of the questionnaire for parents (SNAP-IV, we received the following indicators: hyperactivity - 1.13 points (rate of 0.27-1.59 points), impulsivity 0.9 score (average of 0.26-1.52 points), inattention - 1.2 points (rate of 0.4 to 1.8).

To study the structure of sleep we were polysomnographically study night's sleep, without adaptation night. The results of the study:

FMS - 29,7%,

FBC - 20,4%

SFL = 29,7/20,4=1,46

Accordingly, the observation is an example of violation of academic skills, dysgraphia, without neurological deficit. Indicators of patterns of sleep are physiological for this age. The maturity index of sleep is less than 1.5.

The proposed method is simple, reliable and available for use in clinical sleep laboratories. It bases the filing data confirmed by clinical and polysomnographically research in 85 patients with neurological disorders (attention deficit disorder and hyperactivity, obstructive sleep apnea, nocturnal enuresis, somnambulism, night terrors, dysphasia development) and 20 healthy children older than 5 years (table 1).

The method of determining the quality of a night's sleep in children older than 5 years using polysomnography, including the definition phase of slow wave sleep (FMS) and the phase of REM sleep (FBS), characterized in that the child calculate the maturity index integrative AIDS sleep (SFL) by the formula SFL = FMS/PBS, where
SFL - maturity index integrative AIDS sleep in a child,
FMS - slow-wave sleep in the percentage of the total duration of sleep,
FBC - REM sleep in the percentage of the total duration of sleep,
and when the SFL is less than 1.5 determine the physiologically optimal structure of nighttime sleep in healthy child.



 

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4 dwg, 2 ex, 1 tbl

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1 tbl, 4 ex

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EFFECT: accelerated noninvasive method.

1 tbl

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