睡到一半醒來大哭,有事嗎?



門診縮影

第一次看到快2歲的A小弟,坐在推車裡很有份量的感覺,果然一測體重就是個很漂亮的數值。可是爸爸媽媽帶來看診的主要原因是他一直以來都睡不好,尤其是入睡過後1,2個小時就會突然起床來大哭,怎麼抱怎麼安撫都沒有效果。 而且一個晚上可能發生個好幾次,已經嚴重影響到爸爸媽媽隔天上班的精神。 

仔細問診和身體檢查之後,心裡大概有個底,最有可能的睡眠問題應該是夜驚;此外,由於弟弟的體重太美好,加上扁桃腺尺寸都比較大,所以我也考慮到睡眠呼吸障礙(例如阻塞性呼吸中止症)造成的夜間頻繁醒來,所以就幫孩子安排睡眠生理檢查,也請父母記錄一下睡眠日誌。

夜驚部分,因為家長描述和錄影檔案都十分典型,在和爸爸媽媽討論過後,我們決定使用藥物治療。而睡眠檢查的結果也證實孩子有阻塞性呼吸中止症,於是就安排手術治療。術後弟弟的睡眠狀況的確有大幅改善,加上開始上幼兒園,作息較規律,夜驚發作次數明顯減少,就慢慢減少治療藥物的劑量。從第一次看診到目前停藥,大概花了7個月的時間。


特別之處

有時候孩子的睡眠問題同時會有兩、三種不同的診斷,所以診斷和治療花的時間就會比較久,要看到治療效果也需要家長的耐心配合。

如果單純夜驚,往往是不需要排睡眠檢查的,但是因為這個孩子在首次看診的時候就有考慮到其它的問題,而這個呼吸中止症不處理,還是會造成睡眠沒辦法改善,夜驚可能也不會進步太多;所以孩子有睡眠問題的話,還是要找有經驗的醫師評估哦。
 


------------------English Version--------------------------------------edited by ChatGPT----


During our first visit, a 2-year-old boy was sitting in his stroller with a notably chubby physique. Upon checking his weight, an astonishing number was registered. However, the primary reason his parents had brought him for a visit was his troubling sleep pattern. He had a tendency to wake up abruptly, crying vehemently 1-2 hours after falling asleep. Moreover, these awakenings occurred several times each night, with no comfort measures seeming to soothe him during these episodes. His poor sleep quality was already severely interfering with his parents' daily functioning.

After a careful examination and thorough history-taking, I formed an initial impression. Sleep terror was highly suspected. Additionally, given his substantial body weight and enlarged tonsils, sleep-disordered breathing, such as obstructive sleep apnea syndrome, was also a concern. Consequently, I recommended a polysomnographic examination for him and also requested his parents to maintain a sleep diary for 7 days.

Regarding sleep terror, the comprehensive assessment, including the history and the video provided by his parents, was so characteristic that we decided to commence medical treatment with the parents' consent. Moreover, the sleep study confirmed the presence of obstructive sleep apnea. Therefore, he underwent surgical intervention for OSA, and his sleep condition progressively improved. As he grew older and began attending kindergarten with a regular circadian schedule, the instances of sleep terror also significantly decreased. Consequently, we gradually tapered off his medication. The total duration of his medication regimen was approximately seven months.

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