Clinician’s Corner
Case 3: Change in personality and daytime sleepiness in a seven-year-old boy A seven-year-old boy presented to his paediatrician with his mother for learning and school difficulties. During the appointment, the boy fell asleep intermittently; therefore, a referral was made to sleep medicine. His mother described him as a completely different boy than one year before. At that time, he began to experience difficulty staying awake during the day and would fall asleep when not fully engaged or when sitting still. There were concerns from the school regarding falling asleep in class, learning difficulties, aggression and being teased. On weekends, he would play video games all day to stay awake. Implementation of a strict sleep schedule allowing for 10.5 h of sleep per night resulted in some improvement; however, he continued to be a restless sleeper with frequent singing, sleep walking and occasional snoring. He significantly decreased his activity level and his weight increased. Further history revealed that his sisters had discovered that if they made him laugh, he would fall down. His mother noted that he had previously laughed often but now suppressed it. Around the start of these symptoms, he had an infected tooth treated with penicillin. Medical history was significant for several episodes of tonsillitis and speech difficulties. He was in a modified grade 2 program and lived with his parents and two sisters, one of whom had a seizure disorder secondary to encephalitis.
Correspondence (Case 3): Dr Joanna E MacLean, Division of Respiratory Medicine, Department of Pediatrics, 4-590 Edmonton Clinic Health Academy (ECHA), 11405 87th Avenue, University of Alberta, Edmonton, Alberta T6G 1C9. Telephone 780-248-5650, fax 780-248-5627, e-mail [email protected] Case 3 accepted for publication June 4, 2015
Paediatr Child Health Vol 21 No 2 March 2016
©2016 Pulsus Group Inc. All rights reserved
71
Clinician’s Corner
Case 3 Diagnosis: Narcolepsy
An overnight polysomnogram (sleep study) and multiple sleep latency test (MSLT) were performed. The sleep study revealed short sleep and rapid eye-movement (REM) sleep latency (1 min 54 s and 4 min, respectively). Sleep was fragmented with frequent arousals, stage changes and intrusion of REM sleep into other sleep stages. Despite this, his sleep efficiency (83%) was acceptable. The MSLT revealed a mean sleep latency of 1 min 10 s across five daytime nap opportunities, with REM noted in the first and fifth naps; a mean sleep latency
Case 3: Change in personality and daytime sleepiness in a seven-year-old boy A seven-year-old boy presented to his paediatrician with his mother for learning and school difficulties. During the appointment, the boy fell asleep intermittently; therefore, a referral was made to sleep medicine. His mother described him as a completely different boy than one year before. At that time, he began to experience difficulty staying awake during the day and would fall asleep when not fully engaged or when sitting still. There were concerns from the school regarding falling asleep in class, learning difficulties, aggression and being teased. On weekends, he would play video games all day to stay awake. Implementation of a strict sleep schedule allowing for 10.5 h of sleep per night resulted in some improvement; however, he continued to be a restless sleeper with frequent singing, sleep walking and occasional snoring. He significantly decreased his activity level and his weight increased. Further history revealed that his sisters had discovered that if they made him laugh, he would fall down. His mother noted that he had previously laughed often but now suppressed it. Around the start of these symptoms, he had an infected tooth treated with penicillin. Medical history was significant for several episodes of tonsillitis and speech difficulties. He was in a modified grade 2 program and lived with his parents and two sisters, one of whom had a seizure disorder secondary to encephalitis.
Correspondence (Case 3): Dr Joanna E MacLean, Division of Respiratory Medicine, Department of Pediatrics, 4-590 Edmonton Clinic Health Academy (ECHA), 11405 87th Avenue, University of Alberta, Edmonton, Alberta T6G 1C9. Telephone 780-248-5650, fax 780-248-5627, e-mail [email protected] Case 3 accepted for publication June 4, 2015
Paediatr Child Health Vol 21 No 2 March 2016
©2016 Pulsus Group Inc. All rights reserved
71
Clinician’s Corner
Case 3 Diagnosis: Narcolepsy
An overnight polysomnogram (sleep study) and multiple sleep latency test (MSLT) were performed. The sleep study revealed short sleep and rapid eye-movement (REM) sleep latency (1 min 54 s and 4 min, respectively). Sleep was fragmented with frequent arousals, stage changes and intrusion of REM sleep into other sleep stages. Despite this, his sleep efficiency (83%) was acceptable. The MSLT revealed a mean sleep latency of 1 min 10 s across five daytime nap opportunities, with REM noted in the first and fifth naps; a mean sleep latency
