Sleep problems and sleep disordered breathing in children with cerebral palsy

Area of Science:

• Neurology
• Pediatrics
• Sleep Medicine

Background:

• Cerebral palsy (CP) affects movement and posture due to brain injury, often accompanied by comorbidities like sleep disorders.
• Sleep disorders, particularly sleep-disordered breathing (SDB), are more common in children and young people (CYP) with CP than in typically developing peers.
• SDB encompasses obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and hypoventilation, influenced by various intrinsic and extrinsic factors.

Purpose of the Study:

• To investigate the prevalence and contributing factors of sleep-disordered breathing (SDB) in children and young people (CYP) with cerebral palsy (CP).
• To outline diagnostic methods for SDB in CYP with CP.
• To discuss management strategies and the role of respiratory support in improving quality of life for CYP with CP.

Main Methods:

• Utilized sleep studies, including polysomnography and cardiorespiratory polygraphy, to detect SDB.
• Measured oxygen saturation (SpO2) and transcutaneous carbon dioxide (tcpCO2) during sleep studies.
• Reviewed conservative measures, surgical options, and respiratory support (CPAP, NIV) for SDB management.

Main Results:

• Sleep studies enable diagnosis and classification of SDB (OSA, CSA, hypoventilation) by monitoring respiratory effort, apnoea, SpO2, and tcpCO2.
• Interventions for SDB in CYP with CP range from conservative (airways, collars) to surgical (adenotonsillectomy) and respiratory support.
• Respiratory support (CPAP/NIV) is increasingly used, not only for SDB but also for airway clearance, despite potential management challenges.

Conclusions:

• SDB is a significant comorbidity in CYP with CP, requiring accurate diagnosis through sleep studies.
• Management of SDB in CYP with CP is multifactorial, involving various interventions including respiratory support.
• Effective management, including open communication and shared goal-setting, is crucial for improving the quality of life for CYP with CP.