Dyssomnias in children

Dyssomnias in children include a range of diagnoses with varying aetiologies.

Most children with sleep disorders (e.g., with behavioural insomnia of childhood) do not require pharmacological treatment, and can be managed with behavioural and environmental interventions.

Obstructive sleep apnoea affects up to 4% of children. It is specifically associated with deleterious neurocognitive, developmental, and behavioural outcomes in children. Adenotonsillectomy is generally the first line of therapy and can be associated with reversal of some of these adverse sequelae.

Relevant disorders to this topic include behavioural insomnia of childhood, obstructive sleep apnoea, narcolepsy, delayed sleep phase disorder/syndrome (DSPD/DSPS), and inadequate sleep hygiene.

Paediatric sleep disturbances are very common, with a prevalence of 25% to 37%.[1]Blader JC, Koplewicz HS, Abikoff H, et al. Sleep problems of elementary school children. A community study. Arch Pediatr Adolesc Med. 1997 May;151(5):473-80. http://www.ncbi.nlm.nih.gov/pubmed/9158439?tool=bestpractice.com Most involve difficulties initiating and maintaining sleep because of behavioural insomnia of childhood (sleep association and/or limit-setting disorder), insufficient sleep, poor sleep hygiene, delayed sleep phase disorder/syndrome, and other circadian rhythm disorders.[2]Owens JA, Spirito A, McGuinn M, et al. Sleep habits and sleep disturbance in elementary school aged children. Dev Behav Pediatr. 2000 Feb;21(1):27-36. http://www.ncbi.nlm.nih.gov/pubmed/10706346?tool=bestpractice.com Obstructive sleep apnoea is also a common and under-recognised problem that is present in 1% to 4% of children.[3]Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008 Feb 15;5(2):242-52. http://www.atsjournals.org/doi/full/10.1513/pats.200708-135MG http://www.ncbi.nlm.nih.gov/pubmed/18250218?tool=bestpractice.com Other sleep disorders bringing children to medical attention include hypersomnolence, movement disorders, and narcolepsy. Sleep disturbances in patients with cerebral palsy and neurodevelopmental delay are not covered in this topic.