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Sleep disorders in childhood: a review
1Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy. smazza@rm.unicatt.it
Insights
Childhood sleep disorders are challenging to define due to developmental changes. Frequent issues include parasomnias like sleepwalking and arousal disorders, alongside conditions such as nocturnal enuresis and narcolepsy.
Area of Science:
- Pediatric Sleep Medicine
- Neurodevelopmental Disorders
- Child Psychology
Background:
- Sleep patterns significantly change from infancy through adolescence, complicating the definition of childhood sleep disorders.
- Parasomnias are the most common childhood sleep disorders, often familial and linked to central nervous system (CNS) immaturity.
- Conditions like narcolepsy and obstructive sleep apnea (OSAS) can manifest in childhood, presenting unique challenges due to ongoing CNS development.
Purpose of the Study:
- To review and synthesize current understanding of sleep disorders in children.
- To highlight the diagnostic difficulties arising from developmental variations in sleep architecture.
- To discuss the prevalence, characteristics, and potential neurodevelopmental implications of common childhood sleep disorders.
Main Methods:
- Literature review of studies on childhood sleep disorders over the past decade.
- Analysis of developmental changes in sleep patterns from birth to adolescence.
- Categorization and description of prevalent sleep disorders including parasomnias, narcolepsy, and OSAS.
Main Results:
- Sleep patterns vary significantly with age, impacting disorder definition.
- Parasomnias (arousal disorders, somnambulism, somniloquy) are frequent and often familial.
- Nocturnal enuresis is common, and narcolepsy/OSAS symptoms can appear in childhood with CNS maturational influences.
Conclusions:
- Accurate diagnosis of childhood sleep disorders requires consideration of developmental stage.
- Parasomnias are common and often linked to CNS immaturity.
- Early identification and understanding of narcolepsy and OSAS in children are crucial for managing associated neurobehavioral complications.
Abstract:
Several studies in the last ten years have been directed towards a better understanding of sleep disorders in childhood. Defining sleep disorders in this age is difficult in dependence of relevant differences in sleep patterns at subsequent developmental stages. In new-borns total sleep time is fairly equal during night and day. Normally, day-time sleep gradually decreases over the first three years of life, such that night-time sleep progressively increases till the age of four, and similar to adult sleep-time by adolescence. The most frequent sleep disorders observed in childhood are parasomnias, that, thought to be a CNS sign of immaturity, tend to be quite predictable, recurring in the same families and not even influenced by environmental stimuli. These disorders included: a) arousal disorders, that generally emerge from delta sleep or relate to arousals occurring during NREM sleep, very common in childhood and fairly common in adulthood either; b) somnambulism and somniloquy, that have many common characteristics: first of all, they have the potential to generate a great sense of discomfort and fear in parents watching a child who suddenly sits up in bed eyes-opened but 'unseeing'; c) nocturnal enuresis, that is substantially not a problem of depth of sleep, despite many parents believe. Although narcolepsy is more common in adolescence, many studies have demonstrated that narcoleptic symptoms may begin in childhood. Narcoleptic symptoms in children are similar in their appearance to those predominant in adults, but their expression may be different because of CNS maturational factors. Historical descriptions of the OSAS evidenced since the beginning the importance of neurobehavioral complications associated with the cessation of airflow at the nose and mouth accompanied by respiratory effort, deriving from upper airway obstruction which occurs during sleep.