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در این پنل مواجه علمی با 4 بیمار با شما به بحث گذاشته خواهد شد که شامل موارد زیر است:

Case 1: 1-A 8-year-old male referred to our clinic for mood dysregulation and sleep problems. His symptoms worsened in the past 2 years with an inability to attend school. He had difficulty waking up in time for school and would doze off during his classes He showed irritability, easy distractibility, increased impulsivity, poor concentration, restlessness, and talkativeness. His symptoms were worse during school days and absent on weekends and holidays. He was diagnosed with ADHD, and had been treated at different times with stimulants, m stabilizers without improvement of symptoms

 A 4-year-old boy, that Their parents said: from the past month, after the boy going bed to sleep, he waked up in the middle of the night with crying, screaming loudly and seemingly disoriented with rapid breathing and profuse sweating. This behavior occurs once or twice a He continues to scream and fight for several minutes, followed by spontaneous cessation. Once the child is calmed, the parents can put him back in his bed, and he sleeps through the rest of the night without incident. In the morning, he wakes up in usual happy mood and does not remember what occurred the previous evening. The parents were worried that the might be having seizures. Lab blood work-up and electroencephalogram (EEG) were normal

A girl 15 years old, referred for sleep disorder breathing With symptoms: Snoring, Witness Apnea, Cyanosis and Restless sleep,

PMH: Rapid Onset obesity since 7 years old, Central hypothyroidism, hyperprolactinemia, 

precocious puberty, frequent hospitalization for pneumonia and intubation. (ROHHAD Syndrome)

PSG report: TST 5.26 h with sleep efficiency 79.8%, AI:59.3/h, ODI:5.9

RDI:83.4/h with OSA 260, CSA 31, Mixed 34 and Hypopnea 128,

Capnography: Pco2 more than 50 mmHg in 83% TST (Maximum in NREM).

Case 2: kiana is a 9-month old previously healthy girl referred for difficulty falling asleep Her parents complain of she requires rocking and and a pacifier to go to sleep wakes up frequently during the night when her pacifier falls Out of her mouth.

Reza is a 14 year old adolescent with no Significant medical history referred for isisomne He tries TO Sleep at 11:00pm but it takes Several hours to he goes cer to bed 10:00 AM fall asleep. On weekends, at 2:00 Am and wakes up

Case 3: A 5 years old boy presents with snoring, witness apnea, mouth breathing, restless sleep, and poor
concentration during day,
What’s first step in diagnosis?
If does he need polysomnography, what should we notice in PSG report, as a pediatrician?

Case 4: A 4 years old boy with snoring, restless sleep and abnormal sleeping position and morning headache

A 5 years old child with rapid onset obesity and endocrine system abnormalities and nocturnal enuresis 

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