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. 2020 Sep 2;36(1):65–78. doi: 10.1177/0883073820946154

Table 3.

Recommendations for Screening, Assessment, and Management of Sleep Disturbances in Children With a Leukodystrophy.

Presymptomatic Early Symptomatic Intermediate Symptomatic Advanced Symptomatic
Screening Children’s Sleep Habits Questionnaire (CSHQ)17
Assessment
 Common etiologies to consider

  • Poor sleep hygiene18

  • Restless leg syndrome19

  • Sleep apnea18

In addition to presymptomatic etiologies:

  • Gastrointestinal dysmotility5

  • Pain and spasticity6

  • Dysautonomia5

  • Circadian rhythm disorders20

  • Exaggerated myoclonic jerks6,21

  • Environmental factors: nighttime nursing care, feedings, and suctioning22

 Tools

  • Sleep journal/diary18

  • Test ferritin levels19

  • Sleep study23

In addition to presymptomatic tools:

  • Consider gastrointestinal consult
Management

  • Sleep hygiene counseling24

  • Treat any contributing medical/environmental factors18

  • Behavioral interventions to improve sleep18

  • Consider medication/supplements: melatonin first, avoid polypharmacy when possible25,26

  • Take advantage of sedating side effects of medications indicated for other symptoms27