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 a link between sleep disorders and physical, cognitive, emotional, and social development. 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. Parents may not volunteer information about their child's sleep, or they may not appreciate the potential relationship between sleep problems and daytime behavior. For these reasons, clinicians should incorporate questions about sleep into routine health assessment for children of all ages. 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.
This topic review will discuss the approach to taking a structured sleep history, describe specific sleep problems that may present during childhood, and explain indications for further diagnostic testing. The underlying physiology of sleep in children, polysomnography techniques in infants and children, and evaluation and management of some common sleep disorders are discussed in more detail separately. (See "Sleep physiology in children" and "Overview of polysomnography in infants and children" and "Behavioral sleep problems in children" and "Evaluation of suspected obstructive sleep apnea in children" and "Sleepwalking and other parasomnias in children".)
PEDIATRIC SLEEP MEDICINE
Pediatric sleep medicine is a multidisciplinary field that includes clinicians in general pediatrics as well as subspecialists in child neurology, psychiatry, psychology, otolaryngology, pulmonary medicine, and development.
Although sleep disorders may be phenomenologically similar between adults and children, several important differences exist . The presentation, natural history, and response to treatment may differ considerably between adults and children. As an example, obstructive sleep apnea syndrome is well recognized in adults and children. However, in contrast to adults, most pediatric patients are not obese, boys and girls are equally affected, and some children present with daytime attentional or behavioral problems rather than overt sleepiness [4,6].
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- PEDIATRIC SLEEP MEDICINE
- Classification of sleep disorders
- APPROACH TO THE SLEEP HISTORY
- Chief sleep complaint
- Concomitant medical problems
- Medication history
- DIFFICULTY INITIATING OR MAINTAINING SLEEP
- Behavioral contributors
- Other contributors
- EXCESSIVE DAYTIME SLEEPINESS
- Differential diagnosis
- Underlying medical conditions
- SNORING OR BREATHING PROBLEMS
- Obstructive sleep apnea
- ABNORMAL MOVEMENTS OR BEHAVIORS DURING SLEEP
- Nocturnal seizures
- - Seizures versus parasomnias
- Periodic limb movement disorder and restless leg syndrome
- Rhythmic movement disorder
- PHYSICAL EXAMINATION
- MULTIPLE SLEEP LATENCY TEST
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS