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A 10-Year-Old with Frequent, Disruptive, and Unexplained Night Awakenings

Sameh S Morkous1,2,3

  • 1Pediatric Neurology, Lehigh Valley Reilly Children's Hospital, Allentown, USA.

Cureus
|January 8, 2021
PubMed

Insights

Confusional arousal (CoA), a sleep disorder, can be misdiagnosed as epilepsy. Treating obstructive sleep apnea (OSA) resolved the patient's nocturnal events, highlighting OSA as a treatable cause of CoA.

Area of Science:

  • Neurology
  • Sleep Medicine
  • Pediatrics

Background:

  • Epilepsy is often considered in children with nocturnal events, but parasomnias can present atypically.
  • Confusional arousal (CoA) is a parasomnia characterized by confusion and disorientation upon waking.
  • Obstructive sleep apnea (OSA) is a common sleep disorder that can have varied clinical manifestations.

Observation:

  • A 10-year-old female with persistent nocturnal events despite epilepsy treatment was evaluated.
  • Video polysomnography (PSG) captured typical events during sleep.
  • The patient exhibited confusion and nonsensical speech during nocturnal awakenings.

Findings:

  • The patient was diagnosed with confusional arousal (CoA) secondary to obstructive sleep apnea (OSA).
  • Nocturnal events resolved completely after successful treatment of OSA.
  • This case underscores an atypical presentation of CoA mimicking seizures.

Implications:

  • Obstructive sleep apnea (OSA) should be considered as a potential treatable cause of confusional arousal (CoA).
  • Video-PSG is crucial for diagnosing CoA and differentiating it from epilepsy.
  • Early diagnosis and treatment of OSA can resolve CoA symptoms in pediatric patients.

Keywords:
child neurologyepilepsy medicinesleep medicine

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