Last reviewed: 3 Feb 2021
Last updated: 02 Sep 2020
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- snoring, gasping, choking while asleep (obstructive sleep apnoea)
- night sweats (obstructive sleep apnoea)
- breathing through an open mouth (obstructive sleep apnoea)
- sleeping with hyperextended neck (obstructive sleep apnoea)
- restless sleep and periodic limb movements (obstructive sleep apnoea)
- secondary nocturnal enuresis (obstructive sleep apnoea)
- hypertension (obstructive sleep apnoea)
- inability to fall asleep (sleep association disorder)
- cataplexy (narcolepsy)
- hypnagogic or hypnopompic hallucinations (narcolepsy)
- sleep paralysis (narcolepsy)
- erratic sleep schedule (delayed sleep phase disorder/syndrome)
Other diagnostic factors
- excessive daytime sleepiness
- difficulty awakening in the morning
- sleepwalking or talking (obstructive sleep apnoea)
- sleep attacks (narcolepsy)
- refusal to sleep in own bedroom (sleep association or limit-setting disorder)
Risk factors
- craniofacial abnormalities (obstructive sleep apnoea)
- adenotonsillar hypertrophy (obstructive sleep apnoea)
- macroglossia (obstructive sleep apnoea)
- gastro-oesophageal reflux (obstructive sleep apnoea)
- allergic rhinitis (obstructive sleep apnoea)
- environmental tobacco smoke exposure (obstructive sleep apnoea)
- obesity (obstructive sleep apnoea)
- hypotonia (obstructive sleep apnoea)
- alcohol (obstructive sleep apnoea)
- medications (obstructive sleep apnoea)
- Down's syndrome (obstructive sleep apnoea)
- evening light exposure (delayed sleep phase disorder/syndrome)
- inconsistent parenting style (limit-setting disorder)
- age <6 years (behavioural insomnia of childhood or obstructive sleep apnoea)
- adolescent age (delayed sleep phase disorder/syndrome)
- distractions in bedroom (delayed sleep phase disorder/syndrome)
Diagnostic investigations
1st investigations to order
- sleep diary
- polysomnogram (PSG)
- multiple sleep latency test (MSLT)
Investigations to consider
- lateral neck films
- nasal endoscopy
- overnight oximetry
- actigraphy
- audiovisual recording
- HLA typing
Treatment algorithm
Contributors
Authors
Associate Medical Director
Center for Pediatric Sleep Disorders
Boston Children's Hospital
Assistant Professor of Pediatrics
Harvard Medical School
Boston
MA
Disclosures
DR declares that he has no competing interests.
Peer reviewers
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.
Associate Professor of Pediatrics
Division of Pediatric Pulmonary & Sleep Medicine
University of Chicago
Chicago
IL
Disclosures
LKG is an author of a number of references cited in this topic.
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