Assessment of sleep disorders in children
- Merrill S Wise, MD
Merrill S Wise, MD
- Pediatric Sleep Medicine Specialist
- Methodist Healthcare Sleep Disorders Center
- Daniel G Glaze, MD
Daniel G Glaze, MD
- Professor of Pediatrics and Neurology
- Baylor College of Medicine
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 . 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:
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- APPROACH TO THE SLEEP HISTORY
- CHIEF SLEEP COMPLAINT
- Difficulty initiating or maintaining sleep
- - Behavioral contributors
- - Other contributors
- Excessive daytime sleepiness
- - Insufficient sleep
- - Delayed sleep-wake phase disorder
- - Other causes
- Snoring or breathing problems
- - Obstructive sleep apnea
- Movements or behaviors during sleep
- - Simple or single movements
- - Periodic or rhythmic movements
- - Complex movements or behaviors
- ADDITIONAL MEDICAL HISTORY
- Concomitant medical problems
- Medications, caffeine, and alcohol
- PHYSICAL EXAMINATION
- INDICATIONS FOR REFERRAL
- ANCILLARY TESTS
- Multiple sleep latency test
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS