Sleep and Its Disorders in Children

 

 Buy Article Permissions and Reprints

Although the physiological mechanisms that underlie sleep disorders in children differ little from those seen in adults, the clinical manifestations may differ considerably between the two. For example, sleep apnea in adults affects men more than women, is more prevalent in the obese, and presents with symptoms of snoring and excessive somnolence. In preadolescent children, sleep apnea affects both sexes equally, is more closely correlated with adenotonsillar enlargement than obesity, and may be more likely to present with daytime inattention and learning problems rather than frank somnolence. Likewise, the insomnia and associated bedtime struggles of a 3-year-old bear little resemblance to the insomnia of a mature adult apart from the fact that both individuals are unable to easily fall asleep. Sleep disorders in children are reviewed with particular focus on age-related changes in normal sleep and on sleep disorders that primarily or exclusively affect children. Pediatric aspects of other sleep disorders will be reviewed in more limited detail, with examination of how age, developmental level, and comorbid conditions cause clinical presentation and treatment to differ from that of adults.

REFERENCES

• 1 Anders T, Sadeh A, Appareddy V. Normal sleep in neonates and children. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 7-18
  Google Scholar
• 2 Iglowstein I, Jenni O, Molinari L, Largo R. Sleep duration from infancy to adolescence: reference values and generational trends.  Pediatrics. 2003;  111(2) 302-307
  CrossrefPubMedGoogle Scholar
• 3 Ferber R. Introduction: pediatric sleep disorders medicine. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 1-5
  Google Scholar
• 4 Anders T, Guilleminault C. The pathophysiology of sleep disorders in pediatrics.  Adv Pediatr. 1976;  22 137-150
  PubMedGoogle Scholar
• 5 Petre-Quadens O, de Lee C, Remy M. Eye movement density during sleep and brain maturation.  Brain Res. 1971;  26 49-56
  CrossrefPubMedGoogle Scholar
• 6 Parmelee A, Wenner W, Akiyama Y, Schultz M, Stern E. Sleep states in premature infants.  Dev Med Child Neurol. 1967;  9 70-77
  PubMedGoogle Scholar
• 7 Dreyfus-Brisac C. Ontogenesis of sleep in human prematures after 32 weeks of conceptional age.  Dev Psychobiol. 1970;  3 91-121
  CrossrefPubMedGoogle Scholar
• 8 Metcalf D. EEG sleep spindle ontogenesis in normal children. In: Smith W Drugs, Development, and Cerebral Function Springfield, IL; Charles C. Thomas 1972: 125-144
  Google Scholar
• 9 Metcalf D, Mondale J, Butler F. Ontogenesis of spontaneous K-complexes.  Psychophysiology. 1971;  8 340-347
  PubMedGoogle Scholar
• 10 Ferber R. Childhood sleep disorders.  Neurol Clin. 1996;  14(3) 493-511
  CrossrefPubMedGoogle Scholar
• 11 Sadeh A, Lavie P, Scher A, Tirosh E, Epstein R. Actigraphic home monitoring of sleep-disturbed and control infants and young children: a new method for pediatric assessment of sleep-wake patterns.  Pediatrics. 1991;  87 494-499
  PubMedGoogle Scholar
• 12 Ferber R. Sleeplessness in children. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 79-89
  Google Scholar
• 13 Ferber R. Solve Your Child's Sleep Problems. New York; Simon & Schuster 1985
  Google Scholar
• 14 Lozoff B. Culture and family: influences on childhood sleep practices and problems. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 69-74
  Google Scholar
• 15 Weissbluth M, Davis A T, Poncher J. Night waking in 4- to 8-month old infants.  J Pediatr. 1984;  104 477-480
  PubMedGoogle Scholar
• 16 Schaefer C. Night waking and temperament in early childhood.  Psychol Rep. 1990;  67 192-194
  PubMedGoogle Scholar
• 17 Carey W. Night waking and temperament in infancy.  J Pediatr. 1974;  84 756-758
  PubMedGoogle Scholar
• 18 Lozoff B, Askew G L, Wolf A W. Cosleeping and early childhood sleep problems: effects of ethnicity and socioeconomic status.  J Dev Behav Pediatr. 1996;  17(1) 9-15
  PubMedGoogle Scholar
• 19 Lozoff B, Wolf A W, Davis N. Cosleeping in urban families with young children in the United States.  Pediatrics. 1984;  74 171-182
  PubMedGoogle Scholar
• 20 Mosko S, Richard C, McKenna J. Infant arousal during mother-infant bed sharing: implications for infant sleep and sudden infant death syndrome.  Pediatrics. 1997;  100(5) 841-849
  CrossrefPubMedGoogle Scholar
• 21 Mosko S, Richard C, McKenna J, Drummond S. Infant sleep architecture during bedsharing and possible implications for SIDS.  Sleep. 1996;  19(9) 677-684
  PubMedGoogle Scholar
• 22 Ramchandani P, Wiggs L, Webb V, Stores G. A systematic review of treatments for settling problems and night waking in young children.  BMJ. 2000;  320 209-213
  CrossrefPubMedGoogle Scholar
• 23 Ferber R. Sleeplessness in children. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine for the Child Philadelphia; WB Saunders 1995: 79-89
  Google Scholar
• 24 Hoban T. Sleeplessness in children with neurodevelopmental disorders.  CNS Drugs. 2000;  14(1) 11-22
  PubMedGoogle Scholar
• 25 Ferber R. Circadian rhythm disorders in childhood. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 91-98
  Google Scholar
• 26 Kuhn B R, Elliott A J. Treatment efficacy in behavioral pediatric sleep medicine.  J Psychosom Res. 2003;  54(6) 587-597
  CrossrefPubMedGoogle Scholar
• 27 Douglas J, Richman N. My Child Won't Sleep. Harmondsworth, UK; Penguin Books 1984
  Google Scholar
• 28 Ounsted M, Hendrick A. The first-born child: patterns of development.  Dev Med Child Neurol. 1977;  19 446-453
  PubMedGoogle Scholar
• 29 Trott G E, Badura F, Wirth S, Friese H J, Hollmann-Wehren B, Warnke A. [Self-assessment of prescribing behavior of psychotropic drugs for children and adolescence: results of a survey of established physicians].  Psychiatr Prax. 1995;  22 235-239
  PubMedGoogle Scholar
• 30 Richman N. A double-blind drug trial of treatment in young children with waking problems.  J Child Psychol Psychiatry. 1985;  26 591-598
  PubMedGoogle Scholar
• 31 Simonoff E, Stores G. Controlled trial of trimeprazine tartrate for night waking.  Arch Dis Child. 1987;  62 253-257
  PubMedGoogle Scholar
• 32 Stores G. Medication for sleep-wake disorders.  Arch Dis Child. 2003;  88(10) 899-903
  CrossrefPubMedGoogle Scholar
• 33 Coble P, Kupfer D, Reynolds C. EEG sleep of healthy children 6 to 12 years of age. In: Guilleminault C Sleep and Its Disorders in Children New York; Raven Press 1987: 29-41
  Google Scholar
• 34 Hoban T F, Chervin R D. Assessment of sleepiness in children.  Semin Pediatr Neurol. 2001;  8(4) 216-228
  PubMedGoogle Scholar
• 35 Carskadon M A. The second decade. In: Guilleminault C Sleeping and Waking Disorders: Indications and Techniques Menlo Park, CA; Addison Wesley 1982: 99-125
  Google Scholar
• 36 Carskadon M A, Dement W C, Mitler M M, Roth T, Westbrook P R, Keenan S. Guidelines for the Multiple Sleep Latency Test (MSLT): a standard measure of sleepiness.  Sleep. 1986;  9 519-524
  PubMedGoogle Scholar
• 37 Dahl R E, Carskadon M A. Sleep and its disorders in adolescence. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 19-27
  Google Scholar
• 38 Carskadon M A, Dement W. Sleepiness in the normal adolescent. In: Guilleminault C Sleep and Its Disorders in Children New York; Raven Press 1987: 53-66
  Google Scholar
• 39 Blader J C, Koplewicz H S, Abikoff H, Foley C. Sleep problems of elementary school children.  Arch Pediatr Adolesc Med. 1997;  151 473-480
  PubMedGoogle Scholar
• 40 Saarenpaa O, Laippala P, Koivikko M. Subjective daytime sleepiness in children.  Fam Pract. 2000;  17 129-133
  PubMedGoogle Scholar
• 41 Ferber R, Boyle P. Delayed sleep phase syndrome versus motivated sleep phase delay in adolescents.  Sleep Res. 1983;  12 239
  PubMedGoogle Scholar
• 42 Thorpy M, Korman E, Spielman A, Glovinsky P B. Delayed sleep phase syndrome in adolescents.  J Adolesc Health Care. 1988;  9 22-27
  CrossrefPubMedGoogle Scholar
• 43 Czeisler C, Richardson G, Coleman R et al.. Chronotherapy: resetting the circadian clocks of patients with delayed sleep phase insomnia.  Sleep. 1981;  4(1) 1-21
  PubMedGoogle Scholar
• 44 Terman M. Light treatment. In: Kryger M, Roth T, Dement W Principles and Practice of Sleep Medicine Philadelphia; WB Saunders 1994
  Google Scholar
• 45 Owens J A, Rosen C L, Mindell J A. Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians.  Pediatrics. 2003;  111 E628-E635
  CrossrefPubMedGoogle Scholar
• 46 Ledoux S, Choquet M, Manfredi R. Self-reported use of drugs for sleep or distress among French adolescents.  J Adolesc Health. 1994;  15 495-502
  PubMedGoogle Scholar
• 47 Patois E, Valatx J, Alperovitch A. Prevalence of sleep and wakefulness disorders in high school students at the Academy of Lyon.  Rev Epidemiol Sante Publique. 1993;  41 383-388
  PubMedGoogle Scholar
• 48 Smits M, Van Stel H, Van der Heijen K, Meijer A, Coenen A, Kerkhof G. Melatonin improves health status and sleep in children with idiopathic chronic sleep-onset insomnia: a randomized, placebo-controlled trial.  J Am Acad Child Adolesc Psychiatry. 2003;  42(11) 1286-1293
  PubMedGoogle Scholar
• 49 Ivanenko A, Crabtree V M, Tauman R, Gozal D. Melatonin in children and adolescents with insomnia: a retrospective study.  Clin Pediatr (Phila). 2003;  42(1) 51-58
  PubMedGoogle Scholar
• 50 Rosen G M, Mahowald M W, Ferber R. Sleepwalking, confusional arousals, and sleep terrors in the child. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 99-106
  Google Scholar
• 51 Klackenberg G. Somnambulism in childhood-prevalence, course and behavioral correlations. A prospective longitudinal study (6-16 years).  Acta Paediatr Scand. 1982;  71(3) 495-499
  CrossrefPubMedGoogle Scholar
• 52 Laberge L, Tremblay R E, Vitaro F, Montplaisir J. Development of parasomnias from childhood to early adolescence.  Pediatrics. 2000;  106(1 Pt 1) 67-74
  Google Scholar
• 53 Mahowald M W, Rosen G M. Parasomnias in children.  Pediatrician. 1990;  17 21-31
  PubMedGoogle Scholar
• 54 Frank N C, Spirito A, Stark L, Owens-Stively J. The use of scheduled awakenings to eliminate childhood sleepwalking.  J Pediatr Psychol. 1997;  22(3) 345-353
  CrossrefPubMedGoogle Scholar
• 55 Durand V M, Mindell J A. Behavioral intervention for childhood sleep terrors.  Behavior Therapy. 1999;  30 705-715
  PubMedGoogle Scholar
• 56 Fisher C, Kahn E, Edwards A, Davis D. The psychophysiological study of nightmares and night terrors.  Arch Gen Psychiatry. 1973;  28(2) 252-259
  PubMedGoogle Scholar
• 57 Pesikoff R, Davis P. Treatment of pavor nocturnus and somnambulism in children.  Am J Psychiatry. 1971;  128(6) 778-781
  PubMedGoogle Scholar
• 58 Friman P. Nocturnal enuresis in the child. In: Ferber R, Kryger M Principles and Practice of Sleep Medicine in the Child Philadelphia; WB Saunders 1995: 107-114
  Google Scholar
• 59 D'Cruz O F, Vaughn B V. Parasomnias-an update.  Semin Pediatr Neurol. 2001;  8(4) 251-257
  PubMedGoogle Scholar
• 60 Smedje H, Broman J E, Hetta J. Parents' reports of disturbed sleep in 5-7-year-old Swedish children.  Acta Paediatr. 1999;  88(8) 858-865
  CrossrefPubMedGoogle Scholar
• 61 Hoban T F. Rhythmic movement disorder in children.  CNS Spectr. 2003;  8(2) 135-138
  PubMedGoogle Scholar
• 62 Klackenberg G. Rhythmic movements in infancy and early childhood.  Acta Paediatr Scand Suppl. 1971;  224 74-82
  PubMedGoogle Scholar
• 63 Walters A S, Hickey K, Maltzman J et al.. A questionnaire study of 138 patients with restless legs syndrome: the ‘Night-Walkers’ survey.  Neurology. 1996;  46(1) 92-95
  PubMedGoogle Scholar
• 64 Chervin R D, Archbold K H, Dillon J E et al.. Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements.  Sleep. 2002;  25(2) 213-218
  PubMedGoogle Scholar
• 65 Hoban T F. Assessment and treatment of disturbed sleep in attention deficit hyperactivity disorder.  Expert Rev Neurotherapeutics. 2004;  4 307-316
  CrossrefPubMedGoogle Scholar
• 66 Picchietti D L, Walters A S. Moderate to severe periodic limb movement disorder in childhood and adolescence.  Sleep. 1999;  22(3) 297-300
  PubMedGoogle Scholar
• 67 Picchietti D L, Underwood D J, Farris W A et al.. Further studies on periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder.  Mov Disord. 1999;  14(6) 1000-1007
  CrossrefPubMedGoogle Scholar
• 68 Guilleminault C, Eldridge F L, Simmons F B, Dement W C. Sleep apnea in eight children.  Pediatrics. 1976;  58(1) 23-30
  PubMedGoogle Scholar
• 69 Ward S L, Marcus C L. Obstructive sleep apnea in infants and young children.  J Clin Neurophysiol. 1996;  13(3) 198-207
  CrossrefPubMedGoogle Scholar
• 70 Bower C M, Gungor A. Pediatric obstructive sleep apnea syndrome.  Otolaryngol Clin North Am. 2000;  33(1) 49-75
  CrossrefPubMedGoogle Scholar
• 71 Marcus C L, Loughlin G M. Obstructive sleep apnea in children.  Semin Pediatr Neurol. 1996;  3(1) 23-28
  PubMedGoogle Scholar
• 72 Guilleminault C, Pelayo R, Leger D, Clerk A, Bocian R C. Recognition of sleep-disordered breathing in children.  Pediatrics. 1996;  98(5) 871-882
  PubMedGoogle Scholar
• 73 Ali N J, Pitson D J, Stradling J R. Snoring, sleep disturbance, and behaviour in 4-5 year olds.  Arch Dis Child. 1993;  68(3) 360-366
  CrossrefPubMedGoogle Scholar
• 74 Corbo G M, Fuciarelli F, Foresi A, De Benedetto F. Snoring in children: association with respiratory symptoms and passive smoking.  BMJ. 1989;  299(6714) 1491-1494
  PubMedGoogle Scholar
• 75 Ali N J, Pitson D, Stradling J R. Natural history of snoring and related behaviour problems between the ages of 4 and 7 years.  Arch Dis Child. 1994;  71 74-76
  PubMedGoogle Scholar
• 76 Teculescu D B, Caillier I, Perrin P, Rebstock E, Rauch A. Snoring in French preschool children.  Pediatr Pulmonol. 1992;  13(4) 239-244
  PubMedGoogle Scholar
• 77 Gislason T, Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence.  Chest. 1995;  107(4) 963-966
  CrossrefPubMedGoogle Scholar
• 78 Guilleminault C, Korobkin R, Winkle R. A review of 50 children with obstructive sleep apnea syndrome.  Lung. 1981;  159 275-287
  PubMedGoogle Scholar
• 79 Archbold K H, Pituch K J, Panahi P, Chervin R. Symptoms of sleep disturbances among children at two general pediatrics clinics.  J Pediatr. 2002;  140 97-102
  CrossrefPubMedGoogle Scholar
• 80 Marcus C L, Keens T G, Bautista D B, von Pechmann W S, Ward S L. Obstructive sleep apnea in children with Down syndrome.  Pediatrics. 1991;  88(1) 132-139
  PubMedGoogle Scholar
• 81 Stebbens V A, Dennis J, Samuels M P, Croft C B, Southall D P. Sleep related upper airway obstruction in a cohort with Down's syndrome.  Arch Dis Child. 1991;  66(11) 1333-1338
  PubMedGoogle Scholar
• 82 Brouilette R, Hanson D, David R et al.. A diagnostic approach to suspected obstructive sleep apnea in children.  J Pediatr. 1984;  105(1) 10-14
  PubMedGoogle Scholar
• 83 Frank Y, Kravath R E, Pollak C P, Weitzman E D. Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations.  Pediatrics. 1983;  71(5) 737-742
  PubMedGoogle Scholar
• 84 Chervin R D, Dillon J E, Bassetti C, Ganoczy D A, Pituch K J. Symptoms of sleep disorders, inattention, and hyperactivity in children.  Sleep. 1997;  20(12) 1185-1192
  PubMedGoogle Scholar
• 85 Gozal D. Sleep-disordered breathing and school performance in children.  Pediatrics. 1998;  102(3) 616-620
  CrossrefPubMedGoogle Scholar
• 86 Marcus C L, Greene M G, Carroll J L. Blood pressure in children with obstructive sleep apnea.  Am J Respir Crit Care Med. 1998;  157 1098-1103
  PubMedGoogle Scholar
• 87 Lamm C, Mandeli J, Kattan M. Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children.  Pediatr Pulmonol. 1999;  27(4) 267-272
  CrossrefPubMedGoogle Scholar
• 88 Brouillette R T, Morielli A, Leimanis A, Waters K A, Luciano R, Ducharme F M. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea.  Pediatrics. 2000;  105(2) 405-412
  CrossrefPubMedGoogle Scholar
• 89 Chervin R, Hedger K M, Dillon J E, Pituch K J. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems.  Sleep Med. 2000;  1 21-32
  CrossrefPubMedGoogle Scholar
• 90 Chervin R D, Aldrich M S. Effects of esophageal pressure monitoring on sleep architecture.  Am J Respir Crit Care Med. 1997;  156 881-885
  PubMedGoogle Scholar
• 91 Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. Los Angeles; UCLA Brain Information Service/Brain Research Institute 1968
  Google Scholar
• 92 Rosen C L, D'Andrea L, Haddad G G. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction.  Am Rev Respir Dis. 1992;  146(5 Pt 1) 1231-1234
  PubMedGoogle Scholar
• 93 Marcus C L, Omlin K J, Basinki D J et al.. Normal polysomnographic values for children and adolescents.  Am Rev Respir Dis. 1992;  146(5 Pt 1) 1235-1239
  PubMedGoogle Scholar
• 94 Helfaer M A, McColley S A, Pyzik P L et al.. Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea.  Crit Care Med. 1996;  24(8) 1323-1327
  CrossrefPubMedGoogle Scholar
• 95 Suen J S, Arnold J E, Brooks L J. Adenotonsillectomy for treatment of obstructive sleep apnea in children.  Arch Otolaryngol Head Neck Surg. 1995;  121(5) 525-530
  PubMedGoogle Scholar
• 96 Marcus C L, Ward S L, Mallory G B et al.. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea.  J Pediatr. 1995;  127(1) 88-94
  PubMedGoogle Scholar
• 97 Guilleminault C, Pelayo R, Clerk A, Leger D, Bocian R C. Home nasal continuous positive airway pressure in infants with sleep-disordered breathing.  J Pediatr. 1995;  127(6) 905-912
  PubMedGoogle Scholar
• 98 Waters K A, Everett F M, Bruderer J W, Sullivan C E. Obstructive sleep apnea: the use of nasal CPAP in 80 children.  Am J Respir Crit Care Med. 1995;  152(2) 780-785
  CrossrefPubMedGoogle Scholar
• 99 Kosko J R, Derkay C S. Uvulopalatopharyngoplasty: treatment of obstructive sleep apnea in neurologically impaired pediatric patients.  Int J Pediatr Otorhinolaryngol. 1995;  32(3) 241-246
  CrossrefPubMedGoogle Scholar
• 100 Wiet G J, Bower C, Seibert R, Griebel M. Surgical correction of obstructive sleep apnea in the complicated pediatric patient documented by polysomnography.  Int J Pediatr Otorhinolaryngol. 1997;  41(2) 133-143
  CrossrefPubMedGoogle Scholar
• 101 Cohen S R, Suzman K, Simms C, Burstein F D, Riski J, Montgomery G. Sleep apnea surgery versus tracheostomy in children: an exploratory study of the comparative effects on quality of life.  Plast Reconstr Surg. 1998;  102(6) 1855-1864
  PubMedGoogle Scholar

Timothy F HobanM.D. 

Department of Pediatrics, L3227 Women’s Hospital

1500 East Medical Center Drive, Ann Arbor

MI 48109-0203