Table 2 Common sleep disorders in children
From: Pediatric sleep disturbances and treatment with melatonin
Sleep disorder | Epidemiology | Clinical features | Diagnostic criteria | Treatment options |
|---|---|---|---|---|
Obstructive sleep apnea | Prevalence: 1–5% Onset: 2–8 years of age M:F = 1:1 More frequent in blacks and people with craniofacial abnormalities, Down syndrome, neuromuscular diseases, or choanal atresia | Snoring Unusual sleep positions Sleep-related paradoxical breathing Bedtime enuresis or diaphoresis Morning headaches Cognitive/behavioural problems Excessive daytime sleepiness Enlarged adenoids and tonsils Pectus excavatum | PSG apnea–hypopnea index > 1.5 per hour | Adeno-tonsillecto-my CPAP, nasal steroids, rapid maxillary expansion |
Confusional arousals | Prevalence: 17.3% in 3–13-year-olds, 2.9–4.2% in children older than 15 years M:F = 1:1 Positive family history | Sleep drunkenness Unusual behaviour Slowed responsiveness Slurred speech Confused after awakening Occurs during the first half of the sleep period, no memory of the event | History | Re-assurance Increase total sleep time Scheduled awakenings Bedroom/home safety counselling |
Sleep terrors | Prevalence: 1–.5% Onset: early childhood M:F = 1:1 | Intense fear Difficulty in awakening from episode Dangerous activities Occurs during the first half of the sleep period, no memory of the event Overlap with other parasomnias | History | Re-assurance Increase total sleep time Scheduled awakenings Bedroom/home safety counselling -Benzo-diazepines |
Nightmares | Prevalence: 10–50% in 3–5-year-olds Onset: 3–6 years of age; peaks: 6–10 years of age M:F = 1:1 | Unpleasant dreams Increased sympathetic activity Occurs during the second half of the sleep period, memory of the event Reluctance to sleep increases Association with mood disorders or post-traumatic stress disorder | History | Re-assurance Increase total sleep time Scheduled awakenings Bedroom/home safety counselling Cognitive behavioural therapy, SSRI (off-label use) |
Behavioural insomnia of childhood | Prevalence: 10–30% M:F = 1:1 | Sleep-onset association type Limit-setting type | History | Prevention, parental education, and extinction techniques |
Delayed sleep phase disorder | Prevalence: 7–16% in adolescents Onset: adolescence Positive familiar history in 40% of cases | Difficulty in falling asleep and waking up at socially acceptable times Night owl | History Sleep diary and/or actigraphy for at least 1 week | Sleep hygiene education Regular sleep–wake schedule Avoid bright lights before bedtime Melatonin Bright light therapy Use of sleep logs to monitor progress |
Restless legs syndrome | Prevalence: 2% More common in F Positive familiar history | Urge to move legs with discomfort Begins in the evening, worsens with rest, eases with movement Association with iron deficiency Association with negative behaviour and mood, and decreased cognition and attention Increased prevalence in children with ADHD | History PSG Presence of two of the following: disturbed sleep; a first-degree relative with the condition; five or more periodic limb movements per hour of sleep during PSG | Avoid nicotine and caffeine Dis-continue offending medications Iron replacement in the case of deficiency Severe cases: levodopa, dopamine agonists, gabapentin |