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BACKGROUND: Many pediatric patients need positive airway pressure (PAP) for treatment of obstructive sleep-disordered breathing. Adherence to PAP (defined as percent of nights with PAP use of > 4 h) is often poor and not sustained long-term. With any chronic disease, education has been shown to help with patient outcomes. Education of patients and parents regarding PAP can be provided by different healthcare professionals. There is no published literature assessing the role of respiratory therapists (RTs) in improving adherence to PAP in children. We hypothesized that the addition of RT visits to a PAP clinic would improve PAP adherence. METHODS: RT services for PAP patients were introduced in a multidisciplinary pediatric sleep clinic in May 2006. We identified children who had been followed in clinic, and had adherence download information before and after introduction of RT services. We collected demographic, polysomnography, and CPAP adherence data at clinic visits. RESULTS: Forty-six subjects met criteria for inclusion. The mean ؎ SD age was 14.9 ؎ 6 y. The mean ؎ SD apnea-hypopnea index was 26.7 ؎ 30 events/h. Other than the addition of the RT intervention, all subjects continued to receive the same clinical services as before. Subjects were divided into 3 groups, based on baseline adherence: 0% use, use for 1-50% of nights, and use for > 50% of nights. There was a statistically significant improvement in PAP adherence in the subjects with baseline use of 0% and 1-50%, but no improvement in those with > 50% use at baseline. There was no significant change in PAP use at subsequent RT visits. CONCLUSIONS: Utilization at clinic visits of an RT trained in the use of PAP improved adherence in pediatric subjects with obstructive sleep-disordered breathing when their baseline PAP adherence was < 50%.

Study Objectives: In adults with narcolepsy, periodic limb movements of sleep (PLMS) occur more frequently than in control population, and presence of increased PLMS is associated with greater sleep disruption and shorter mean sleep latency. This study was performed to determine whether PLMS are common in children with narcolepsy, and whether the presence of PLMS is associated with greater sleep disruption. Design: Demographic and polysomnographic information were collected from consecutive patients diagnosed with narcolepsy identifi ed retrospectively by diagnosis-based search. Descriptive data were compiled, and sleep characteristics of children with and without PLMS were compared. Setting: Sleep disorders center in a children's hospital. Patients: 44 patients, 6-19 years old (mean 13 years, SD 3.57), were identifi ed. Twenty-eight were African American. interventions: None. Measurements and Results: Four patients had a PLMS index (PLMI) ≥ 5/h (considered abnormal in literature). Sixteen (36%) had "any PLMS" (PLMI > 0/h). The mean PLMI was 1.3/h (SD 2.5). Sleep was signifi cantly more disrupted, and the mean sleep latency was shorter in patients with "any PLMS" as compared to those with no PLMS. There was no correlation between the PLMI and other diagnostic criteria for narcolepsy. "Any PLMS" were present equally in children of African American and Caucasian heritage, 35.7% vs. 37.5%. Conclusions: As in adults, children with PLMS and narcolepsy have more sleep disruption and shorter mean sleep latencies than those with narcolepsy but without PLMS. Our fi ndings also suggest that the use of adult criteria for diagnosis of "signifi cant" PLMS in children may not be suffi ciently sensitive. keywords: Narcolepsy, children, periodic leg movements Citation: Jambhekar SK; Com G; Jones E; Jackson R; Castro MM; Knight F; Carroll JL; Griebel ML. Periodic limb movements during sleep in children with narcolepsy. J Clin Sleep Med 2011;7(6):597-601. S C i e n t i f i C i n V e S t i g A t i O n SP eriodic limb movements during sleep were fi rst described in adults in the 1980s, however; their occurrence in children and adolescents has only been recently appreciated.1 The exact prevalence of these movements, consisting of repetitive small fl exions of the upper and/or lower extremities, in the general pediatric population is unclear. Reported prevalence rates of PLMS at a frequency > 5/h vary between 1.2% to 10% of children not referred specifi cally for PLMS or restless legs syndrome (RLS).2,3 Although the prevalence of PLMS has been reported to be increased in children with other medical comorbidities, 4 the prevalence in children with narcolepsy is largely unknown. A study of 8 children with narcolepsy has shown occurrence of PLMS in 63% of the patients with a mean PLMS index of 49/h. 5In adults, increased PLMS have been shown to be more common in patients with narcolepsy than controls without narcolepsy; the presence of increased PLMS has been shown to be associated with measures of disruption of REM sleep and daytime f...

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