Main Article Content
Introduction: A considerable amount of knowledge has accumulated in recent years regarding the pediatric aspects of sleep with its associated disorders being understood.
Health education for parents and prospective-parents frequently pay little attention to sleep.
In addition medical students and specialist-trainers receive little instruction about sleep disorders despite the fact that many of them have contact with children and adolescents who have sleep disturbances.
The ICSD-2 describes nearly 100 sleep-disorders many of which are seen among children and adolescents.
Aim: The aim of this Article is to review sleep-disorders in children and adolescents, in the clinical-aspect beside epidemiology and disease-burden.
Methodology: Literature retrieved through Google Scholar, EMBASE, Medline and PubMed were reviewed independently by the authors towards a consensus.
Results: Sleep-disorders treatable, yet a large proportion remains of cases remain undiagnosed. Sleep-disorders are not uncommon among children and adolescents. Factors which contribute to sleep-disorders include extensive television viewing increased social recreational activities as well as academic demands all of which may contribute to sleep deprivation and sleep problems.
Patterns of sleep behaviours and disorders differ between children and adults.
Additionally some sleep-disorders previously thought to be seen mainly or exclusively in adults are now being recognized in children.
Explanations of the causes of sleep-problems at any age, both physical and psychological possibilities should be considered whilst at the same acknowledging that parenting practices play a major role part in children's sleep-problems.
This is important because persistent sleep disturbance can have harmful outcomes which can impact on mood, behavior, performance, social-function and physical health.
The treatment of most sleep disorders in children is, in principle, straight-forward and is more likely to be effective if it is appropriate and carefully implemented.
Medication should not be the first line treatment for a sleep disorder but instead should be used as a last resort. Behavioual methods such as sleep hygiene and counselling is preferable.
There is evidence to suggest that insufficient sleep might impair motor skills and reaction time as well as decision making and general concentration levels leading to an impact on academic achievement.
Persistent sleep-loss is becoming increasingly associated with an adult’s physical health
The authors mainly discuss:
- Insomnia of childhood
- Obstructive sleep apnea
- Sleep-related movement disorders: Restless legs syndrome/periodic limb movement
disorder and rhythmic movements
- Delayed sleep phase disorder
Conclusion and Recommendations: In view of the morbidity, mortality, loss of Quality of Life, and the disease burden including the economic cost of sleep-disorders, cost-effective Prevention Programs are needed. Such Programs should educate parents, parents-to-be, teachers and healthcare professionals.
Meltzer LJ, Mindell JA. Sleep and sleep disorders in children and adolescents. Psychiatr Clin North Am. 2006;29(4):1059-76.
El Shakankiry HM. Sleep physiology and sleep disorders in childhood. Nat Sci Sleep. 2011;3:101–114.
Sleep Disorders and Sleep Deprivation; An Unmet Public Health Problem. Editors: Harvey R Colten and Bruce M Altevogt. Institute of Medicine (US) Committee on Sleep Medicine and Research. Washington (DC): National Academies Press (US); 2006.
Meer Ahmad AM. Epidemiology and disease burden of sleep-disorders. First MAHSA Symposium on Sleep Disorders and Accident. MAHSA University Malaysia; 2018.
American Academy of Sleep Medicine. International Classification of Sleep Disorders, 2nd Edition Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine; 2005.
Young E, Xiong S, Finn L, Young T. Unique sleep disorders profile of a population-based sample of 747 Hmong immigrants in Wisconsin. Soc Sci Med. 2013;79:57–65.
Dinges DF. Achieving our mission: Breadth in the best basic and clinical sleep research. Sleep. 2007;30(8):951–952.
Rong Liu, Phyllis C. Zee, Ronald D. Chervin, Lester Arguelles, Jennafer Birne, Shanchun Zhang, Katherine Kaufer Christoffel, Wendy J. Brickman, Donald Zimmerman, Binyan Wang, Guoying Wang, Xiping Xu, Xiaobin Wang. Short sleep duration is associated with insulin resistance independent of adiposity in Chinese adult twins. Sleep Med. 2011;12(9):914–919.
Chapman DP, Wheaton AG, Perry GS, Sturgis SL, Strine TW, Croft JB. Household demographics and perceived insufficient sleep among US adults. J Community Health. 2012;37(2):344-9.
Lewin DS, Wolfson AR, Bixler EO, Carskadon MA. Duration isn't everything. healthy sleep in children and teens: Duration, individual need and timing. J Clin Sleep Med. 2016;12(11):1439–1441.
Carskadon MA, Tarokh L. Developmental changes in sleep biology and potential effects on adolescent behavior and caffeine use. Nutr Rev. 2014;72(Suppl 1): 60–64.
Johnson DA, Lisabeth L, Hickson D, Johnson-Lawrence V, Samdarshi T, Taylor H, Diez Roux AV. The social patterning of sleep in African Americans: Associations of socioeconomic position and neighborhood characteristics with sleep in the Jackson heart study. Sleep. 2016;39(9):1749–1759.
Owens JA, Babcock D, Blumer J, et al. The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: Rational approaches. A consensus meeting summary. J Clin Sleep Med. 2005;1:49–59.
Engle G. The need for a new medical model: A challenge for biomedicine. Science. 1977;196:129–136.
Dunbar M, Mirpuri S, Yip T. Ethnic/Racial discrimination moderates the effect of sleep quality on school engagement across high school. Cultural Diversity & Ethnic Minority Psychology. 2017;23(4): 527-540.
Stores G, Wiggs L, Eds. Sleep disturbance in children and adolescents with disorders of development its significance and management. London, UK: MacKeith Press; 2001.
Colten HR, Altevogt BM, Eds. Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: National Academies Press; 2006.
Quine L. Severity of sleep problems in children with severe learning difficulties: Description and correlates. J Community Appl Soc. 1992;2:247–268.
Hasler G, Buysse DJ, Klaghofer R, Gamma A, Ajdacic V, Eich D, Rössler W, Angst J. The association between short sleep duration and obesity in young adults: A 13-year prospective study. Sleep. 2004;27(4):661-6.
Qureshi WT, Nasir UB, Alqalyoobi S, O'Neal WT, Mawri S, Sabbagh S, Soliman EZ, Al-Mallah MH. Meta-analysis of continuous positive airway pressure as a therapy of atrial fibrillation in obstructive sleep apnea. Am J Cardiol. 2015;116(11): 1767-73.
McGlinchey EL, Oyesiku L, Diaz KM, Ye S, Abdalla M, Schwartz JE, Davidson KW, Alcántara C. Impact of sleep duration and race on recurrent cardiovascular events following acute coronary syndrome. J Am Coll Cardiol. 2018;71(6):701-703.
Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: The sleep heart health study. Arch Intern Med. 2005;165(20):2408-13
Ayas NT, Taylor CM, Laher I. Cardiovascular consequences of obstructive sleep apnea. Curr Opin Cardiol. 2016;31(6):599-605.
Bradley TD, Floras JS. Adaptive servo-ventilation for central sleep apnea in heart failure. N Engl J Med. 2016;374(7):689.
Caples SM, Garcia-Touchard A, Somers VK. Sleep-disordered breathing and cardiovascular risk. Sleep. 2007;30(3):291-303.
Baldwin DC Jr, Daugherty SR, Ryan PM, Yaghmour NA. What do residents do when not working or sleeping? A multispecialty survey of 36 residency programs. Acad Med. 2012;87(4):395-402.
Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med. 2005;6(1):23-7.
Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: A meta-analysis. Sleep. 1996;19(4):318-26.
Carskadon MA, Acebo C. Parental reports of seasonal mood and behavior changes in children. J Am Acad Child Adolesc Psychiatry. 1993;32(2):264-9.
Lau EY, Eskes GA, Morrison DL, Rajda M, Spurr KF. The role of daytime sleepiness in psychosocial outcomes after treatment for obstructive sleep apnea. Sleep Disord. 2013;2013:140725.
Wolfson AR, Carskadon MA. Sleep schedules and daytime functioning in adolescents. Child Dev. 1998;69(4):875-87.
Liu X, Chen H, Bo QG, Fan F, Jia CX. Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents. Eur Child Adolesc Psychiatry. 2017;26(3):271-279.
Kliegman RM, Stanton BMD, St. Geme J, Schor NF. Nelson Textbook of Pediatrics, 2-Volume Set 20th Edition; 2016.
Ancoli-Israel S, Kripke DF, Mason W. Characteristics of obstructive and central sleep apnea in the elderly: An interim report. Biol Psychiatry. 1987;22(6):741-50.
Ali NJ, Davies RJ, Fleetham JA, Stradling JR. The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest. 1992;101(6):1526-32.
Rosen CL. Obstructive sleep apnea syndrome (OSAS) in children: Diagnostic challenges. Sleep. 1996;19(10 Suppl): S274-7.
Redline S, Tishler PV, Tosteson TD, Williamson J, Kump K, Browner I, Ferrette V, Krejci P. The familial aggregation of obstructive sleep apnea. Am J Respir Crit Care Med. 1995;151(3 Pt 1):682-7.
Haponik EF, Smith PL, Meyers DA, Bleecker ER. Evaluation of sleep-disordered breathing. Is polysomnography necessary? Am J Med. 1984;77(4):671- 7.
Mayo Clinic. Obstructive Sleep Apnea. 1998-2018 Mayo Foundation for Medical Education and Research (MFMER).
Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368:2366-76.
Budhiraja R, Quan SF. Outcomes from the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). Sleep Med Clin. 2009;4(1):9–18.
International Classification of Sleep Disorders-Third Edition Highlights and Modifications Michael J. Sateia. CHEST. 2014;146(5):1387–1394.
Mayo Clinic. Mayo Clinic finds restless legs syndrome in children linked to family history, iron deficiency. ScienceDaily; 2005.
Judith A. Owens. Chapter 19; Sleep Medicine. In Robert M Kliegman, Bonita MD Stanton, Joseph St Geme, F Schor: Nelson Textbook of Pediatrics. 20th Edition. Elsevier. 111-123.
Gamaldo CE, Earley CJ. Restless legs syndrome: A clinical update. Chest. 2006;130(5):1596-1604.
Daniel L. Picchietti, Oliviero Bruni, Alde Weerd, Jeffrey S. Durmer, Suresh Kotagal, Judith Owens, Narong Simakajornboon; International Restless Legs Syndrome Study Group (IRLSSG). Pediatric restless legs syndrome diagnostic criteria: An update by the International Restless Legs Syndrome Study Group. Sleep Medicine. 2013;14(12):1253-1259.
Gingras JL, Gaultney JF, Picchietti DL. Periodic limb movement disorder: sleep symptoms and polysomnographic correlates compared to obstructive sleep apnea. J Clinical Sleep Medicine. 2011;7(6):603-609.
American Academy of Sleep Medicine. International classification of sleep disorders, 2nd Ed.: Diagnostic and coding manual. Rev. Ed. Westchester, II: American Academy of Sleep Medicine; 2005.
Periodic Limb Movement Disorder (PLMD) in adults: management and treatment. Cleveland Clinic.
American Sleep Association. Periodic leg movements during sleep. PLMS/PLMD. Available:www.sleepassociation.org (Accessed 11/13/2012)
Arand D, Bonnet M, Hurwitz T, Mitler M, Rosa R, Sangal RB. The clinical use of the MSLT and MWT. Sleep. 2005;28(1):123-144.
Littner MR, Kushida C, Wise M, et al; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28(1):113-121.
Dinges DF, Pack F, Williams K, et al. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night. Sleep. 1997;20(4):267-277.
Vernet C, Arnulf I. Idiopathic hypersomnia with and without long sleep time: A controlled series of 75 patients. Sleep. 2009;32(6):753-759.
Cheryl Tierney, Alexandra Lazzara, Megan Veglia, Elizabeth Miller. Narcolepsy in children and teenagers.
Sagarika Nallu, Narcolepsy Clinical Presentation.
(Updated: Oct 22, 2018)
Bassetti C, Aldrich MS, Quint DJ. MRI findings in narcolepsy. Sleep. 1997;20(8): 630-1. [Medline]
Mignot E, Lammers GJ, Ripley B, Okun M, Nevsimalova S, Overeem S, et al. The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias. Arch Neurol. 2002;59(10):1553-62. [Medline]
Morgenthaler TI, Kapur VK, Brown T, Swick TJ, Alessi C, Aurora RN, et al. Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007;30(12):1705-11. [Medline]
Stores G. Parasomnias of childhood and adolescence. Sleep Med Clin. 2007;2:405–417.
Panayiotopoulos CP, Michael M, Sanders S, Valeta T, Koutroumanidis M. Benign childhood focal epilepsies: Assessment of established and newly recognized syndromes. Brain. 2008;131:2264–2286.
Perkins FF, Breier J, McManis MH. Benign rolandic epilepsy - perhaps not so benign: Use of magnetic source imaging as a predictor of outcome. J Child Neurol. 2008;23:389–393.
Dalla Bernadina B, Colamaria V, Chiamenti C, Capovilla G, Trevisan E, Tassinari CA. Benign partial epilepsy with affective symptoms ('benign psychomotor epilepsy'). In: Roger J, Bureau M, Dravet Ch, Dreifuss FE, Perret A, Wolf P, Eds. Epileptic Syndromes in Infancy Childhood and Adolescence. 2nd Ed. London, UK: John Libbey. 1992;219–223.
Stores G, Zaiwalla Z, Bergel N. Frontal lobe complex partial seizures in children: A form of epilepsy at particular risk of misdiagnosis. Dev Med Child Neurol. 1991;3:998–1009.
Provini F, Plazzi G, Montagna P, Lugaresi E. The wide clinical spectrum of nocturnal frontal lobe epilepsy. Sleep Med Rev. 2000;4:375–386.
Tinuper P, Provini F, Bisulli F, et al. Movement disorders in sleep: Guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep. Sleep Med Rev. 2007;11:255–267.