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-wake phase disorder)
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 (chronic insomnia 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-wake phase disorder)
- inconsistent parenting style or unrealistic sleep expectations (chronic insomnia disorder)
- age <6 years (chronic insomnia disorder or obstructive sleep apnoea)
- adolescent age (delayed sleep-wake phase disorder)
- distractions in bedroom (delayed sleep-wake phase disorder)
- traumatic or stressful life events (chronic insomnia disorder)
Diagnostic investigations
1st investigations to order
- sleep diary
- polysomnogram (PSG)
- multiple sleep latency test
Investigations to consider
- lateral neck films
- nasal endoscopy
- overnight oximetry
- actigraphy
- audiovisual recording
- HLA typing
Emerging tests
- pneumogram
- cerebrospinal fluid hypocretin levels
Treatment algorithm
obstructive sleep apnoea
chronic insomnia disorder
delayed sleep-wake phase disorder
narcolepsy
Contributors
Authors
Dennis Rosen, MD
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
Paul Gringras, MB, ChB, MSc, MRCPCH
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.
Leila Kheirandish Gozal, MD
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Academy of Sleep Medicine. International Classification of Sleep Disorders – third edition, text revision (ICSD-3-TR). Westchester, IL: American Academy of Sleep Medicine; 2023.
Macias MI, Malhotra S. Behavioral insomnia of childhood. Am J Respir Crit Care Med. 2021 Apr 15;203(8):P20-P21.Full text Abstract
Ishman SL, Maturo S, Schwartz S, et al. Expert consensus statement: management of pediatric persistent obstructive sleep apnea after adenotonsillectomy. Otolaryngol Head Neck Surg. 2023 Feb;168(2):115-30.Full text Abstract
Morgenthaler TI, Owens J, Alessi C, et al. Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006 Oct;29(10):1277-81.Full text Abstract
Marcus CL, Moore RH, Rosen CL, et al; Childhood Adenotonsillectomy Trial (CHAT). A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013 Jun 20;368(25):2366-76.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Primary snoring
- Central sleep apnoea
- Anxiety
More DifferentialsDiretrizes
- Management of pediatric persistent obstructive sleep apnea after adenotonsillectomy: expert consensus statement
- Age and weight considerations for the use of continuous positive airway pressure therapy in pediatric populations: an American Academy of Sleep Medicine position statement
More DiretrizesFolhetos informativos para os pacientes
Insomnia
Adenoidectomy
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