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
- family history of non-rapid eye movement (NREM) parasomnias (confusional arousals, sleepwalking, sleep terrors)
- presence of HLA gene DQB1*05 and *04 alleles (sleepwalking)
- medications or alcohol
- history 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 tests
1st tests to order
- clinical exam
- polysomnography (rapid eye movement sleep behavior disorder)
Tests to consider
- polysomnography (confusional arousals)
- polysomnography (sleepwalking)
- polysomnography (sleep terrors)
- polysomnography (nightmare disorder)
- polysomnography (all other parasomnias)
- polysomnography with expanded electroencephalogram (EEG) video recording
- urine drug screen
Treatment algorithm
confusional arousals
sleepwalking
sleep terrors
nightmares
isolated recurrent sleep paralysis
rapid eye movement sleep behavior disorder
Contributors
Authors
Shalini Paruthi, MD
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. SP is a board member of the Restless Legs Syndrome Foundation.
Acknowledgements
Dr Shalini Paruthi would like to gratefully acknowledge Dr Raman Malhotra and Dr Alon Y. Avidan, previous contributors to this topic.
Disclosures
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
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.
Paul Montgomery, MSc, DipSW, DPhil
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.
Lynn A. D'Andrea, MD
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.
Differentials
- Seizures (nocturnal)
- Narcolepsy
- Periodic limb movement disorder (PLMD)
More DifferentialsGuidelines
- Consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update
- Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children
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