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Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review
Allison Beck Blackmer1,2, James A Feinstein3,4
1Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.
Insights
Sleep disturbances are common in children with neurodevelopmental disorders (NDDs). Effective management requires a combination of sleep hygiene and pharmacologic interventions, though more research is needed.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Developmental Psychology
Background:
- Neurodevelopmental disorders (NDDs) affect 1-2% of children, often causing significant sleep disruption.
- Up to 80% of children with NDDs experience disrupted sleep, impacting daytime behavior, cognition, and growth.
- Sleep disorders in NDDs are complex, heterogeneous, and disease-specific, complicating diagnosis and treatment.
Purpose of the Study:
- To review the current understanding and management of sleep disorders in children with NDDs.
- To evaluate the efficacy and safety of various pharmacologic interventions for sleep disturbances in this population.
- To highlight the need for further research and evidence-based guidelines.
Main Methods:
- Literature review of existing studies on sleep disorders in children with NDDs.
- Analysis of pharmacologic interventions, including melatonin, clonidine, and others.
- Discussion of sleep hygiene as a first-line therapy.
Main Results:
- Sleep hygiene is the recommended first-line therapy.
- Pharmacologic options reviewed include melatonin, melatonin receptor agonists, clonidine, gabapentin, hypnotics, trazodone, and atypical antipsychotics.
- Evidence for pharmacologic interventions is limited, with modest benefits expected.
Conclusions:
- Managing sleep disorders in children with NDDs is challenging but critical for overall well-being.
- Clinicians must balance limited data with clinical expertise for treatment decisions.
- Well-designed trials are urgently needed to establish effective and safe sleep pharmacotherapy for NDDs.
Abstract:
Neurodevelopmental disorders (NDDs) are defined as a group of disorders caused by changes in early brain development, resulting in behavioral and cognitive alterations in sensory and motor systems, speech, and language. NDDs affect approximately 1-2% of the general population. Up to 80% of children with NDDs are reported to have disrupted sleep; subsequent deleterious effects on daytime behaviors, cognition, growth, and overall development of the child are commonly reported. Examples of NDDs discussed in this review include autism spectrum disorder, cerebral palsy, Rett syndrome, Angelman syndrome, Williams syndrome, and Smith-Magenis syndrome. The etiology of sleep disorders in children with NDDs is largely heterogeneous and disease specific. The diagnosis and management of sleep disorders in this population are complex, and little high-quality data exist to guide a consistent approach to therapy. Managing sleep disorders in children with NDDs is critical both for the child and for the family but is often frustrating due to the refractory nature of the problem. Sleep hygiene must be implemented as first-line therapy; if sleep hygiene alone fails, it should be combined with pharmacologic management. The available evidence for the use of common pharmacologic interventions, such as iron supplementation and melatonin, as well as less common interventions, such as melatonin receptor agonists, clonidine, gabapentin, hypnotics, trazodone, and atypical antipsychotics is reviewed. Further, parents and caregivers should be provided with appropriate education on the nature of the sleep disorders and the expectation for modest pharmacologic benefit, at best. Additional data from well-designed trials in children with NDDs are desperately needed to gain a better understanding of sleep pharmacotherapy including efficacy and safety implications. Until then, clinicians must rely on the limited available data, as well as clinical expertise, when managing sleep disorders in the population of children with NDDs.
