Last reviewed: 2 Feb 2021
Last updated: 02 Sep 2020
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)
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)
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)
Diagnostic investigations
1st investigations to order
- sleep diary
- polysomnogram (PSG)
- multiple sleep latency test (MSLT)
Investigations to consider
- lateral neck films
- nasal endoscopy
- overnight oximetry
- actigraphy
- audiovisual recording
- HLA typing
Treatment algorithm
Contributors
Authors
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
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.
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.
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