Table 2.

Common sleep disorders in children

Sleep disorder	Epidemiology	Clinical features	Diagnostic criteria	Treatment options
Obstructive sleep apnea	Prevalence: 1–5% Onset: 2–8 years of age M:F = 1:1 More frequent in blacks and people with craniofacial abnormalities, Down syndrome, neuromuscular diseases, or choanal atresia	Snoring Unusual sleep positions Sleep-related paradoxical breathing Bedtime enuresis or diaphoresis Morning headaches Cognitive/behavioural problems Excessive daytime sleepiness Enlarged adenoids and tonsils Pectus excavatum	PSG apnea–hypopnea index > 1.5 per hour	Adeno-tonsillecto-my CPAP, nasal steroids, rapid maxillary expansion
Confusional arousals	Prevalence: 17.3% in 3–13-year-olds, 2.9–4.2% in children older than 15 years M:F = 1:1 Positive family history	Sleep drunkenness Unusual behaviour Slowed responsiveness Slurred speech Confused after awakening Occurs during the first half of the sleep period, no memory of the event	History	Re-assurance Increase total sleep time Scheduled awakenings Bedroom/home safety counselling
Sleep terrors	Prevalence: 1–.5% Onset: early childhood M:F = 1:1	Intense fear Difficulty in awakening from episode Dangerous activities Occurs during the first half of the sleep period, no memory of the event Overlap with other parasomnias	History	Re-assurance Increase total sleep time Scheduled awakenings Bedroom/home safety counselling -Benzo-diazepines
Nightmares	Prevalence: 10–50% in 3–5-year-olds Onset: 3–6 years of age; peaks: 6–10 years of age M:F = 1:1	Unpleasant dreams Increased sympathetic activity Occurs during the second half of the sleep period, memory of the event Reluctance to sleep increases Association with mood disorders or post-traumatic stress disorder	History	Re-assurance Increase total sleep time Scheduled awakenings Bedroom/home safety counselling Cognitive behavioural therapy, SSRI (off-label use)
Behavioural insomnia of childhood	Prevalence: 10–30% M:F = 1:1	Sleep-onset association type Limit-setting type	History	Prevention, parental education, and extinction techniques
Delayed sleep phase disorder	Prevalence: 7–16% in adolescents Onset: adolescence Positive familiar history in 40% of cases	Difficulty in falling asleep and waking up at socially acceptable times Night owl	History Sleep diary and/or actigraphy for at least 1 week	Sleep hygiene education Regular sleep–wake schedule Avoid bright lights before bedtime Melatonin Bright light therapy Use of sleep logs to monitor progress
Restless legs syndrome	Prevalence: 2% More common in F Positive familiar history	Urge to move legs with discomfort Begins in the evening, worsens with rest, eases with movement Association with iron deficiency Association with negative behaviour and mood, and decreased cognition and attention Increased prevalence in children with ADHD	History PSG Presence of two of the following: disturbed sleep; a first-degree relative with the condition; five or more periodic limb movements per hour of sleep during PSG	Avoid nicotine and caffeine Dis-continue offending medications Iron replacement in the case of deficiency Severe cases: levodopa, dopamine agonists, gabapentin

PSG polysomnography, CPAP continuous positive airway pressure, M males, F females, SSRI selective serotonin re-uptake inhibitors, ADHD attention deficit/hyperactivity disorder