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Assessment of sleep disorders in children

Authors
Merrill S Wise, MD
Daniel G Glaze, MD
Section Editor
Ronald D Chervin, MD, MS
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Identification of sleep problems in children is important because a growing body of evidence suggests that sleep disorders may interfere with physical, cognitive, emotional, and social development. Conversely, children with neurodevelopmental problems, learning differences, or behavior problems may be at heightened risk for sleep problems compared with the general pediatric population [1-4].

Pediatricians, pediatric subspecialists, and other healthcare practitioners are in an ideal position to identify sleep problems and disorders in children. Clinicians should incorporate questions about sleep into routine health assessment for children of all ages because parents may not volunteer information about their child's sleep, or may not appreciate the potential relationship between sleep problems and daytime behavior. Sleep and sleep disorders in children are strongly influenced by cultural factors, parental expectations, and parental responses. Sleep problems present most commonly in the outpatient setting, but the hospitalized child may develop sleep problems during an acute illness, or chronic sleep disorders may come to medical attention during hospitalization.

Although sleep disorders may be phenomenologically similar between adults and children, important differences exist in presentation, natural history, and response to treatment [5]. As an example, in contrast with adults, most children with obstructive sleep apnea (OSA) are not obese, and many children present with daytime attentional or behavioral problems rather than overt sleepiness [4,6]. Even within the pediatric age group, the clinical manifestations of sleep problems may vary by age and developmental level. For example, a school-aged child with excessive sleepiness may exhibit motor overactivity, inattentiveness, irritability, or oppositional behavior rather than overt sleepiness [7,8]. Sleep problems such as difficulty initiating or maintaining sleep (insomnia) may coexist with anxiety or depression in the adolescent, and may worsen certain medical or psychiatric problems.

This topic review will discuss the approach to taking a structured sleep history, provide an overview of specific sleep problems that may present during childhood, and explain indications for further diagnostic testing. Specific sleep disorders are discussed in more detail in other topic reviews:

(See "Behavioral sleep problems in children".)

                          

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Literature review current through: Jun 2016. | This topic last updated: Jun 21, 2016.
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References
Top
  1. Brown LW, Maistros P, Guilleminault C. Sleep in children with neurological problems. In: Principles and Practice of Sleep Medicine in the Child, Ferber R, Kryger M (Eds), WB Saunders, Philadelphia 1995. p.135.
  2. Okawa M, Sasaki H. Sleep disorders in mentally retarded and brain-impaired children. In: Sleep and its Disorders in Children, Guilleminault C (Ed), Raven Press, New York 1987. p.269.
  3. Picchietti DL, England SJ, Walters AS, et al. Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. J Child Neurol 1998; 13:588.
  4. Chervin RD, Dillon JE, Bassetti C, et al. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997; 20:1185.
  5. Ferber R. Introduction: Pediatric sleep disorders medicine. In: Principles and Practice of Sleep Medicine in the Child, Ferber R, Kryger M (Eds), WB Saunders, Philadelphia 1995. p.1.
  6. Owens J, Opipari L, Nobile C, Spirito A. Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders. Pediatrics 1998; 102:1178.
  7. Sheldon SH, Spire JP, Levy HB. Disorders of excessive somnolence. In: Pediatric Sleep Medicine, Sheldon SH, Spire JP, Levy HB (Eds), WB Saunders, Philadelphia 1992. p.91.
  8. Wise MS. Childhood narcolepsy. Neurology 1998; 50:S37.
  9. Owens JA, Dalzell V. Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study. Sleep Med 2005; 6:63.
  10. Naylor MW, Aldrich MS. Approach to the patient with disordered sleep. In: Principles and Practice of Sleep Medicine, 2nd ed, Kryger MH, Roth T, Dement WC (Eds), WB Saunders, 1994. p.413.
  11. Harbard E, Allen NB, Trinder J, Bei B. What's Keeping Teenagers Up? Prebedtime Behaviors and Actigraphy-Assessed Sleep Over School and Vacation. J Adolesc Health 2016; 58:426.
  12. Nixon GM, Thompson JM, Han DY, et al. Falling asleep: the determinants of sleep latency. Arch Dis Child 2009; 94:686.
  13. Owens J, Adolescent Sleep Working Group, Committee on Adolescence. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics 2014; 134:e921.
  14. Paruthi S, Brooks LJ, D'Ambrosio C, et al. Recommended Amount of Sleep for Pediatric Populations: A Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016.
  15. Guilleminault C, Pelayo R. Narcolepsy in prepubertal children. Ann Neurol 1998; 43:135.
  16. Kotagal S. Narcolepsy in children. Semin Pediatr Neurol 1996; 3:36.
  17. Carroll JL, Loughlin GM. Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology. In: Principles and Practice of Sleep Medicine in the Child, Ferber R, Kryger M (Eds), WB Saunders, Philadelphia 1995. p.163.
  18. Huang YS, Lakkis C, Guilleminault C. Kleine-Levin syndrome: current status. Med Clin North Am 2010; 94:557.
  19. Lisk DR. Kleine-Levin syndrome. Pract Neurol 2009; 9:42.
  20. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
  21. Barone JG, Hanson C, DaJusta DG, et al. Nocturnal enuresis and overweight are associated with obstructive sleep apnea. Pediatrics 2009; 124:e53.
  22. Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope 2005; 115:1101.
  23. Carroll JL, McColley SA, Marcus CL, et al. Reported symptoms of childhood obstructive sleep apnea syndrome (OSA) vs primary snoring. Am Rev Respir Dis 1992; 145:A177.
  24. Wise MS. Differential diagnosis of paroxysmal nocturnal events in infants and children. In: Sleep and Epilepsy: The Clinical Spectrum, Bazil CW, Malow BA, Sammaritano MR (Eds), Elsevier Science, Amsterdam 2002. p.339.
  25. Gastaut H, Broughton RJ. A clinical and polygraphic study of episodic phenomena during sleep. Biol Psychiatry 1965; 7:197.
  26. Keefauver SP, Guilleminault C. Sleep terrors and sleep walking. In: Principles and Practice of Sleep Medicine, 2nd ed, Kryger MH, Roth T, Dement WC (Eds), WB Saunders, Philadelphia 1994. p.567.
  27. Fisher C, Byrne J, Edwards A, Kahn E. A psychophysiological study of nightmares. J Am Psychoanal Assoc 1970; 18:747.
  28. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9:293.
  29. Sammaritano MR, Therrien M. Epilepsy and the "sleep-wake cycle". In: Sleep and Epilepsy: the Clinical Spectrum, Bazil CW, Malow BA, Sammaritano MR (Eds), Elsevier Science, Amsterdam 2002. p.145.
  30. Grigg-Damberger M, Ralls F. Treatment strategies for complex behavioral insomnia in children with neurodevelopmental disorders. Curr Opin Pulm Med 2013; 19:616.
  31. Nicholson AN. Pharmacology of sleep and wakefulness: An introduction. In: Principles and Practice of Sleep Medicine, 2nd ed, Kryger MH, Roth T, Dement WC (Eds), WB Saunders, Philadelphia 1994. p.331.
  32. Gaillard JM. Benzodiazepines and GABA-ergic transmission. In: Principles and Practice of Sleep Medicine, 2nd ed, Kryger MH, Roth T, Dement WC (Eds), WB Saunders, Philadelphia 1994. p.349.
  33. Paykel ES, Fleminger R, Watson JP. Psychiatric side effects of antihypertensive drugs other than reserpine. J Clin Psychopharmacol 1982; 2:14.
  34. Ortho-McNeal Pharmaceuticals. Topiramate package insert.
  35. Carskadon MA, Rechtschaffen A. Monitoring and staging human sleep. In: Principles and Practice of Sleep Medicine, 2nd ed, Kryger MH, Roth T, Dement WC (Eds), WB Saunders, 1994. p.943.
  36. Berry RB, Brooks R, Gamaldo CE, et al for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.2, www.aasmnet.org, American Academy of Sleep Medicine, Darien, IL 2015.
  37. Berry RB, Brooks R, Gamaldo CE, et al for the American Acade. Sleep staging rules: Rules for infants. In: The AASM Manual for the Scoring of Sleep and Associated Events: Rules, terminology and technical specifications, Version 2.2, American Academy of Sleep Medicine, Darien, Illinois 2015.
  38. Aurora RN, Lamm CI, Zak RS, et al. Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children. Sleep 2012; 35:1467.
  39. Aurora RN, Zak RS, Karippot A, et al. Practice parameters for the respiratory indications for polysomnography in children. Sleep 2011; 34:379.
  40. Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28:499.
  41. Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep 2005; 28:113.
  42. Hoban TF, Chervin RD. Assessment of sleepiness in children. Semin Pediatr Neurol 2001; 8:216.