Last reviewed: 28 Feb 2023
Last updated: 14 Mar 2023
Summary
Definition
History and exam
Key diagnostic factors
- snoring, gasping, choking while asleep (obstructive sleep apnea)
- night sweats (obstructive sleep apnea)
- breathing through an open mouth (obstructive sleep apnea)
- sleeping with hyperextended neck (obstructive sleep apnea)
- restless sleep and periodic limb movements (obstructive sleep apnea)
- secondary nocturnal enuresis (obstructive sleep apnea)
- hypertension (obstructive sleep apnea)
- 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)
More key diagnostic factors
Other diagnostic factors
- excessive daytime sleepiness
- difficulty awakening in the morning
- sleepwalking or talking (obstructive sleep apnea)
- sleep attacks (narcolepsy)
- refusal to sleep in own bedroom (sleep association or limit-setting disorder)
Other diagnostic factors
Risk factors
- craniofacial abnormalities (obstructive sleep apnea)
- adenotonsillar hypertrophy (obstructive sleep apnea)
- macroglossia (obstructive sleep apnea)
- gastroesophageal reflux (obstructive sleep apnea)
- allergic rhinitis (obstructive sleep apnea)
- environmental tobacco smoke exposure (obstructive sleep apnea)
- obesity (obstructive sleep apnea)
- hypotonia (obstructive sleep apnea)
- alcohol (obstructive sleep apnea)
- medications (obstructive sleep apnea)
- Down syndrome (obstructive sleep apnea)
- evening light exposure (delayed sleep phase disorder/syndrome)
- inconsistent parenting style (limit-setting disorder)
- age <6 years (behavioral insomnia of childhood or obstructive sleep apnea)
- adolescent age (delayed sleep phase disorder/syndrome)
- distractions in bedroom (delayed sleep phase disorder/syndrome)
More risk factors
Diagnostic investigations
1st investigations to order
- sleep diary
- polysomnogram (PSG)
- multiple sleep latency test (MSLT)
More 1st investigations to order
Investigations to consider
- lateral neck films
- nasal endoscopy
- overnight oximetry
- actigraphy
- audiovisual recording
- HLA typing
More investigations to consider
Emerging tests
- pneumogram
- cerebrospinal fluid hypocretin levels
Treatment algorithm
ONGOING
obstructive sleep apnea
behavioral insomnia of childhood: sleep-onset association disorder
behavioral insomnia of childhood: limit-setting disorder
delayed sleep phase disorder/syndrome
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.
Differentials
- Primary snoring
- Central sleep apnea
- Anxiety
More DifferentialsGuidelines
- Age and weight considerations for the use of continuous positive airway pressure therapy in pediatric populations: an American Academy of Sleep Medicine position statement
- Clinical practice guideline: tonsillectomy in children (update)
More GuidelinesPatient leaflets
Insomnia
Adenoidectomy
More Patient leaflets
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