Dyssomnias in children

Dyssomnias (sleep disorders) in children include a range of diagnoses with varying etiologies.

Most children with sleep disorders (e.g., with chronic insomnia disorder) do not require pharmacologic treatment, and can be managed with behavioral and environmental interventions.

Obstructive sleep apnea (OSA) affects up to 4% of children. It is specifically associated with deleterious neurocognitive, developmental, and behavioral 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 chronic insomnia disorder (previously behavioral insomnia of childhood), OSA, narcolepsy, and delayed sleep-wake phase disorder.

​Pediatric sleep disturbances are very common, with a prevalence of 15% to 44%.[1]Mindell JA, Sadeh A, Kwon R, et al. Cross-cultural differences in the sleep of preschool children. Sleep Med. 2013 Dec;14(12):1283-9. http://www.ncbi.nlm.nih.gov/pubmed/24269649?tool=bestpractice.com [2]Lewien C, Genuneit J, Meigen C, et al. Sleep-related difficulties in healthy children and adolescents. BMC Pediatr. 2021 Feb 16;21(1):82. https://www.doi.org/10.1186/s12887-021-02529-y http://www.ncbi.nlm.nih.gov/pubmed/33593333?tool=bestpractice.com ​ Most involve difficulties initiating and maintaining sleep because of chronic insomnia disorder (previously known as behavioral insomnia of childhood, including sleep-onset association and limit-setting subtypes), insufficient sleep, poor sleep hygiene, delayed sleep-wake phase disorder, and other circadian rhythm disorders.[3]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 apnea is also a common and under-recognized problem that is present in 1% to 4% of children.[4]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 [5]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.​ 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.