Sleep disorders in children, adolescents and infants are common, affecting 1 in 4 children. Poor sleep quality or quantity in children is associated with developmental, behavioral and social difficulties, weight abnormalities and other health problems. Not only do pediatric sleep problems affect a child’s health, but it also impacts family dynamics and parental or sibling sleep. Children may suffer from problems falling or staying asleep; physiological problems such as obstructive sleep apnea, abnormal or disruptive behaviors during sleep, such as sleepwalking or other parasomnias; symptoms that occur near sleep onset such as restless legs syndrome; and daytime symptoms such as excessive sleepiness.
is the cessation of breathing during sleep. The term sleep apnea generally refers to obstructive sleep apnea (OSA), which is a sleep–related breathing problem that can occur in all ages, from premature infants to the elderly. The prevalence of obstructive sleep apnea in children and adolescents ranges from 2-6% with a peak presentation ranging from 2-8 years of age. OSA is characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts breathing (i.e., ventilation) and sleep quality. OSA can cause severe complications if left untreated.
is characterized by difficulty falling asleep or staying asleep. It is one of the most common symptoms complaints made by adults, but is much less prevalent in children and adolescents. Insomnia among children is often reported by the caretakers and characterized by bedtime resistance, frequent night awakenings and/or the inability to sleep independently. Daytime symptoms typically include fatigue, decreased mood or irritability, general malaise and cognitive impairment. Insomnia can be a short-term problem, usually related to stress, or can be a long-term, chronic issue.
is characterized by habitual sleep-wake times that are delayed, usually more than two hours, relative to conventional or socially acceptable times. Affected individuals complain of difficulty falling asleep at a socially acceptable time, but once sleep ensues, sleep is reported to be normal. This affects 7% of adolescents.
is a common, sensorimotor disorder of unknown cause characterized by a prominent ‘urge’ to move the legs associated with unpleasant sensations. Symptoms are worse at night and are relieved by movement. RLS has a demonstrable impact on cognitive function, mood, neurological status and quality of life, at least partially secondary to the negative impact of sensorimotor disturbances on sleep integrity. Primary RLS is idiopathic, whereas secondary RLS is associated with several conditions, including iron deficiency, pregnancy, end-stage renal disease, neuropathy and certain medications. Its prevalence in the pediatric population has been estimated at about 2% in 8–17-year olds. Serum ferritin level below 75 ng/ml has been associated with increased severity of RLS
is characterized by brief, periodic episodes of stereotyped limb movements lasting for 0.5–5 s, typically occurring in 20–40 s intervals; many patients with RLS have PLMS . When PLMS is associated with sleep disturbance with daytime tiredness, it is referred to as PLMD. In contrast to RLS, which is diagnosed by clinical history, patients with PLMS are usually unaware of either PLMS or associated nocturnal arousals, and diagnosis is made by polysomnogram. The cause of PLMS is unknown, but deficiency of dopaminergic signaling has been hypothesized. The prevalence of PLMS in the pediatric population is unknown.
is associated with excessive daytime sleepiness, sleep paralysis or hypnagogic hallucinations. Furthermore, excessive daytime sleepiness is usually the first sign of narcolepsy with cataplexy following later in course of the illness. Cataplexy is the sudden loss of muscle tone (usually affecting the face, neck and knees) triggered by emotionally laden events. Narcolepsy with cataplexy affects 0.2% to 0.18% the population. Both sexes are affected, with a slight predominance of males. Narcolepsy with cataplexy can be observed in patients at any age, but is rarely diagnosed before age 5.