100+ Free ABP Sleep Medicine Practice Questions

Polysomnography (PSG, MSLT, MWT)

AASM 2007 + 2024 pediatric scoring rules, full PSG montage (EEG F4/C4/O2-M1, EOG, chin EMG, ECG, RIP thoraco-abdominal effort, nasal pressure + thermistor, SpO2, mandatory EtCO2 in peds, limb EMG, position, snore, video). Pediatric AHI severity (mild 1.5-5, moderate 5-10, severe >10/hr). Obstructive vs central vs hypopnea scoring. MSLT (5 naps q2h, mean sleep latency ≤8 min + ≥2 SOREMPs) and MWT for narcolepsy and wakefulness assessment.

Obstructive Sleep Apnea (OSA)

Pediatric OSA epidemiology (adenotonsillar hypertrophy primary in children, obesity in adolescents). Adenotonsillectomy as first-line for moderate-severe OSA in otherwise healthy children (CHAT trial 2013, AAP 2012 guidelines). CPAP/BiPAP for residual or non-T&A candidates with mask-fitting issues. Mandibular Advancement Devices for selected adolescents. Hypoglossal nerve stimulator (Inspire) FDA-approved for adolescents 13-18 with Down syndrome and severe persistent OSA. Behavioral therapy, weight management, allergic rhinitis treatment.

Pediatric Sleep Physiology and Development

Sleep architecture by age (newborn 16-18 hr, ~50% REM 'active sleep'; 4-6 mo overnight consolidation; toddler 11-14 hr with 1-2 naps; preschool 10-13 hr; school-age 9-11 hr; adolescent 8-10 hr with normal phase delay). NREM stages (N1, N2 spindles/K-complexes, N3 slow-wave) plus REM. Cycle length 60-90 min in infants, 90-120 min in adults. Slow-wave sleep concentrated first 1/3 of night, REM in last 1/3. Process S (homeostatic, adenosine) and Process C (circadian, SCN to pineal melatonin). DLMO (Dim Light Melatonin Onset).

Insomnia and Behavioral Sleep Disorders

Behavioral Insomnia of Childhood — sleep-onset association type and limit-setting type. Bedtime fading and graduated extinction (Ferber method) as evidence-based behavioral interventions. Parental education, consistent bedtime routines, sleep-conducive environment. Limited pharmacology evidence in pediatric insomnia: melatonin (1-3 mg IR 30-60 min before bedtime; PR formulation for autism/ADHD with insomnia). Off-label clonidine, hydroxyzine, mirtazapine. AAP/AASM recommend AGAINST chronic Z-drugs or benzodiazepines in children.

Parasomnias

NREM parasomnias (sleepwalking, sleep terrors, confusional arousals) — first 1/3 of night, no recall, peak 4-12 yr, usually outgrown; treat with safety precautions and scheduled awakenings. REM parasomnias: nightmare disorder (last 1/3 of night, vivid recall) and REM Sleep Behavior Disorder (acting out dreams). RBD in pediatrics is rare and warrants neurologic workup — typically narcolepsy or brainstem lesion (vs adult RBD strongly linked to synucleinopathies).

Sleep and Comorbidity

Asthma and sleep (nocturnal symptoms indicate poor control). Epilepsy and sleep — focal seizures often nocturnal, frontal lobe epilepsy can mimic sleep terrors. ADHD and sleep — 25-50% comorbidity, OSA mimics ADHD, melatonin evidence in ADHD insomnia. Autism and sleep — 50-80% sleep problems, behavioral therapy plus melatonin first-line per AASM 2024 autism sleep guidelines.

Hypersomnias

Narcolepsy Type 1 (with cataplexy, hypocretin/orexin deficiency, HLA-DQB1*06:02), Type 2 (without cataplexy), idiopathic hypersomnia, Kleine-Levin syndrome (recurrent episodic, adolescent males). MSLT confirms (mean sleep latency ≤8 min, ≥2 SOREMPs). Treatment: modafinil/armodafinil, sodium oxybate (Xyrem — FDA-approved for pediatric narcolepsy with cataplexy ages 7+ since 2018), pitolisant (Wakix), solriamfetol (Sunosi, ages 12+).

Circadian Rhythm Disorders

Delayed Sleep Phase Syndrome (DSPS) common in adolescents (preferred sleep onset 2-6 AM, wake 10 AM-1 PM). Treatment: morning bright light therapy, evening melatonin 0.5-3 mg given 4-6 hours before desired sleep onset, sleep hygiene. Advanced Sleep Phase Syndrome rare in pediatrics. Free-running disorder (blind individuals). Shift-work disorder.

Sleep-Related Movement Disorders

Restless Legs Syndrome (URGE criteria: Urge to move, Rest worsens, Gets better with movement, Evening worse). Iron supplementation if ferritin <50 ng/mL (commonly deficient in pediatric RLS). Gabapentin enacarbil/pregabalin first-line in adults but not approved in children. Periodic Limb Movement Disorder (PLMI ≥5/hr in pediatrics). Sleep-related bruxism.