Common Sleep Disorders in Children



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Am Fam Physician. 2014 Mar 1;89(5):368-377.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Up to 50% of children will experience a sleep problem. Early identification of sleep problems may prevent negative consequences, such as daytime sleepiness, irritability, behavioral problems, learning difficulties, motor vehicle crashes in teenagers, and poor academic performance. Obstructive sleep apnea occurs in 1% to 5% of children. Polysomnography is needed to diagnose the condition because it may not be detected through history and physical examination alone. Adenotonsillectomy is the primary treatment for most children with obstructive sleep apnea. Parasomnias are common in childhood; sleepwalking, sleep talking, confusional arousals, and sleep terrors tend to occur in the first half of the night, whereas nightmares are more common in the second half of the night. Only 4% of parasomnias will persist past adolescence; thus, the best management is parental reassurance and proper safety measures. Behavioral insomnia of childhood is common and is characterized by a learned inability to fall and/or stay asleep. Management begins with consistent implementation of good sleep hygiene practices, and, in some cases, use of extinction techniques may be appropriate. Delayed sleep phase disorder is most common in adolescence, presenting as difficulty falling asleep and awakening at socially acceptable times. Treatment involves good sleep hygiene and a consistent sleep-wake schedule, with nighttime melatonin and/or morning bright light therapy as needed. Diagnosing restless legs syndrome in children can be difficult; management focuses on trigger avoidance and treatment of iron deficiency, if present.

Sleep is one of the most commonly discussed topics during well-child visits.1 It is important for primary care physicians to be familiar with normal childhood sleep patterns and common sleep disorders. Epidemiologic studies indicate that up to 50% of children experience a sleep problem,24 and about 4% have a formal sleep disorder diagnosis.5

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Sleep disorders should be considered in children presenting with irritability, behavioral problems, learning difficulties, and poor academic performance.

C

68, 52, 53

Adenotonsillectomy is the primary treatment for children with obstructive sleep apnea.

B

13, 5658

Sleep or sedating medications have no role in the treatment of behavioral insomnia of childhood.

C

29, 30

If restless legs syndrome is suspected in a child, management should include a workup for iron deficiency and avoidance of triggers.

C

4750


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Sleep disorders should be considered in children presenting with irritability, behavioral problems, learning difficulties, and poor academic performance.

C

68, 52, 53

Adenotonsillectomy is the primary treatment for children with obstructive sleep apnea.

B

13, 5658

Sleep or sedating medications have no role in the treatment of behavioral insomnia of childhood.

C

29, 30

If restless legs syndrome is suspected in a child, management should include a workup for iron deficiency and avoidance of triggers.

C

4750


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Normal Sleep in Infants and Children

Sleep is an opportunity for the body to conserve energy, restore its normal processes, promote physical growth, and support mental development. The most recognized consequence of inadequate sleep is daytime sleepiness. However, sleepiness in children commonly manifests as irritability, behavioral problems, learning difficulties, motor vehicle crashes in teenagers, and poor academic performance.68 Distinguishing significant sleep disruptions from normal age-related changes can be challenging and can ultimately delay treatment.

Sleep changes considerably during the first few years of life and parallels physical maturation and development. Newborns require the greatest total sleep time and have a fragmented sleep-wake pattern. Starting at five months of age, infants have the ability

The Authors

KEVIN A. CARTER, DO, is director of the Department of Sleep Medicine at Martin Army Community Hospital in Fort Benning, Ga. He is a staff physician in the Departments of Sleep Medicine and Family Medicine at Martin Army Community Hospital, and is an assistant professor of family medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md., and at Mercer University School of Medicine in Macon, Ga.

NATHANAEL E. HATHAWAY, MD, is a staff physician in the Department of Primary Care at SHAPE (Supreme Headquarters Allied Powers Europe) Healthcare Facility in Mons, Belgium. At the time this article was written, he was a family medicine resident in the Department of Family Medicine at Martin Army Community Hospital.

CHRISTINE F. LETTIERI, MD, is director of medical education at Fort Belvoir (Va.) Community Hospital and is an assistant professor of family medicine at the Uniformed Services University of the Health Sciences.

The opinions expressed herein are those of the authors and should not be construed as official or as reflecting the policies of the Department of the Army or the Department of Defense.

Address correspondence to Kevin A. Carter, DO, Martin Army Community Hospital, 7950 Martin Loop, Ft. Benning, GA 31905 (e-mail: kcarter54@yahoo.com). Reprints are not available from the authors.

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