Last reviewed: November 2017
Last updated: October  2016

Summary

Definition

History and exam

Key diagnostic factors

  • disturbed cognition during event (confusional arousals, sleep terrors, sleepwalking)
  • vigorous activity or violent behavior (confusional arousals, sleepwalking, sleep terrors, and rapid eye movement sleep behavior disorder [RBD])
  • episodes of inability to move (isolated recurrent sleep paralysis)
  • autonomic hyperactivity during event (sleep terrors)
  • amnesia
  • normal physical exam between episodes

Other diagnostic factors

  • abnormal demeanor and facial expression (confusional arousals, sleepwalking, sleep terrors)
  • evidence of injuries

Risk factors

  • FHx of NREM parasomnias (confusional arousals, sleepwalking, sleep terrors)
  • presence of HLA gene DQB1*05 and *04 alleles (sleepwalking)
  • psychiatric medications or alcohol
  • hx of psychiatric disorder
  • fever
  • acute sleep deprivation or irregular sleep-wake schedule disorder
  • emotional stress and traumatic life events
  • forced awakenings
  • untreated comorbid sleep disorders
  • premenstrual state (in adolescent girls)

Diagnostic investigations

1st investigations to order

  • clinical exam
  • polysomnography (rapid eye movement sleep behavior disorder)
Full details

Investigations to consider

  • polysomnography (confusional arousals)
  • polysomnography (sleepwalking)
  • polysomnography (sleep terrors)
  • polysomnography (nightmare disorder)
  • polysomnography (all other parasomnias)
  • polysomnography with expanded EEG video recording
  • urine drug screen
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Co-Director, Pediatric Sleep and Research Center

Cardinal Glennon Childrens Hospital

Associate Professor of Neurology

Saint Louis University School of Medicine

St Louis

MO

Disclosures

RM declares that he has no competing interests.

Co-Medical Director, Sleep Medicine and Research Center

St. Luke's Hospital

Adjunct Associate Professor

Department of Pediatrics

Saint Louis University School of Medicine

St Louis

MO

Disclosures

SP receives royalties from UpToDate for writing two topics: diagnosis and management of pediatric obstructive sleep apnea.

Dr Raman Malhotra and Dr Shalini Paruthi would like to gratefully acknowledge Dr Alon Y. Avidan, the previous contributor to this monograph. AYA has been paid honorarium speaking fees by the American Academy of Sleep Medicine, the American Academy of Neurology, the American College of Chest Physicians, Sepracor Inc, Cephalon Inc, and Pfizer Pharmaceuticals.

Peer reviewers VIEW ALL

Consultant in Paediatric Neurodisability

Evelina Children's Hospital

St Thomas' Hospital

London

UK

Disclosures

PG is lead applicant on the ongoing MENDS trial, which is concerned with the use of melatonin in children with neurodevelopmental disorders and impaired sleep.

Reader in Psycho-Social Intervention

Centre for Evidence Based Intervention

Barnett House

University of Oxford

Oxford

UK

Disclosures

PM has received funding greater than 6 figures USD from the Swedish Board of Health and Welfare, Martek Biosciences, Danish Social Research Institute, UK Department of Health, UK Health Technology Assessment Programme. PM declares that he has no competing interests.

Associate Professor of Pediatrics

Chief

Division of Pulmonary and Sleep Medicine

Department of Pediatrics

Medical College of Wisconsin

Medical Director

Pulmonary Clinic

Children's Hospital of Wisconsin

Milwaukee

WI

Disclosures

LAD declares that she has no competing interests.

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