- •
Sleep problems are common among typically developing children and more frequent among children with neurodevelopmental disabilities, like autism spectrum disorder.
- •
Sleep disorders contribute not only to problematic sleep but also to daytime challenges with cognition, behavior, and family quality of life.
- •
Screening for sleep problems, including snoring, should be performed routinely.
- •
Screening tools, such as the BEARS questionnaire, can identify sleep problems efficiently.
- •
Many sleep disorders can
Neurology of Sleep
Section snippets
Key points
Development of Sleep and Sleep Requirements
Sleep is a complex process governed by the interaction of circadian and homeostatic processes mitigated by genetic and environmental influences. Sleep cycles are established in utero with the suprachiasmatic nucleus (SCN) setting the circadian rhythm as early as 18 weeks after conception.1 After 32 weeks’ gestation, sleep is divided into active, quiet, and indeterminate sleep.2 Neonatal sleep is polyphasic, with random intervals of sleep throughout a 24-hour period as the SCN matures and the
Summary
The relationship between sleep and neurodevelopment is complex and bidirectional with neurodevelopmental differences likely contributing to dysregulated sleep and the subsequent disruptions in turn interfering with optimal development. As Pediatric Sleep Medicine grows as a field, we are beginning to better understand the importance of identifying salient disruptors of sleep, delineating their potential influence on cognitive development and behavioral health, and thereby moving closer to
Clinics care points
Insomnia:
- •
Chronic insomnia is characterized by problems initiating or maintaining sleep, early morning awakenings, bedtime resistance, and/or difficulty sleeping without parental intervention, as reported by the child or caregivers.
- •
Management of insomnia in adults and children begins with behavioral programs that have been shown to be effective.
- •
In some cases, such as children with cognitive impairment, when parents or children are experiencing significant stress, medications may be appropriate.
- •
Future directions
Given the lack of evidence-based and FDA-approved treatments for many pediatric sleep disorders, research efforts should focus on well-designed pediatric clinical trials. Melatonin is the best-studied agent for pediatric insomnia; however, long-term side effects of chronic use still need investigation. Sleep disorders are well known to cause disruptions in numerous aspects of health and well-being. However, further evaluation is still needed to understand the full impact of early-life sleep
Disclosure
The authors have nothing to disclose.
References (42)
- et al.
The development of the circadian rhythms in the fetus and neonate
Semin Perinatol
(2001) - et al.
Prevalence of insomnia symptoms in a general population of young children and preadolescents: gender effects
Sleep Med
(2014) - et al.
Insomnia symptoms and suicidality in the National Comorbidity Survey - Adolescent Supplement
J Psychiatr Res
(2016) - et al.
Insomnia as a predictor of mental disorders: a systematic review and meta-analysis
Sleep Med Rev
(2019) - et al.
Pediatric restless legs syndrome diagnostic criteria: an update by the International Restless Legs Syndrome Study Group
Sleep Med
(2013) - et al.
Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychological aetiologies
Sleep Med Rev
(2009) - et al.
Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study
Sleep Med
(2005) - et al.
Neurophysiology of circadian rhythm sleep disorders of children with neurodevelopmental disabilities
Eur J Paediatr Neurol
(2012) - et al.
Prevalence and correlates of delayed sleep phase in high school students
Sleep Med
(2012) - et al.
Circadian rhythm sleep-wake phase disorders
Neurol Clin
(2019)
Hypocretin (orexin) deficiency inhuman narcolepsy
Lancet
(2000)
Dopamine and iron in the pathophysiology of restless legs syndrome (RLS)
Sleep Med
(2004)
Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report
Sleep Med
(2018)
Overview of sleep and sleep disorders in infancy and childhood
Pediatr Ann
(2017)
Principles and practice of sleep medicine
(2011)
Sleep disorders during childhood: a practical review
Eur J Pediatr
(2018)
Consensus statement of the American Academy of Sleep Medicine on the recommended amounts of sleep for healthy children: methodology and discussion
J Cl Sleep Med
(2016)
Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study
J Child Psychol Psychiatry
(2002)
Epidemiology of DSM-IV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference
Pediatrics
(2006)
International classification of sleep disorders
(2014)
Pubertal changes in daytime sleepiness
Sleep
(1980)
Cited by (7)
Sleep problems in children with developmental disorders
2022, Revista Medica Clinica Las CondesSelf-reported quantity and quality of sleep in children and adolescents with a chronic condition compared to healthy controls
2023, European Journal of PediatricsEffects of sleep deprivation during pregnancy on the offspring
2023, Zhongguo Ertong Baojian ZazhiModulation of sleep behavior in zebrafish larvae by pharmacological targeting of the orexin receptor
2022, Frontiers in Pharmacology
© 2021 Elsevier Inc. All rights reserved.