4 - Nonobstructive Pediatric Sleep Disorders

Abstract

Although most otolaryngologists are familiar with pediatric obstructive sleep apnea, nonobstructive sleep disorders are also common causes of morbidity in children. A dyssomnia is a primary sleep disorder characterized by an abnormality in the amount, quality, or timing of sleep that results in difficulty in initiating or maintaining sleep. Important pediatric dyssomnia conditions include insufficient sleep syndrome, narcolepsy, sleep-related movement disorders, circadian sleep-wake disorders, idiopathic hypersomnia, Kleine-Levin syndrome, and chronic insomnia disorder. A parasomnia is an undesirable event that occurs during entry into sleep, within sleep, or during arousals from sleep. Parasomnias are broadly characterized by occurrence during rapid-eye-movement (REM) sleep or non-REM sleep. Non-REM pediatric parasomnias include sleep terrors, sleepwalking, confusional arousals, and other events occurring during slow-wave sleep. Pediatric REM parasomnias occur later in the night and include nightmare disorder, recurrent isolated sleep paralysis, and REM sleep behavior disorder. Sleep disruption is commonly associated with neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), either as a primary manifestation or as a side effect of pharmacologic treatment. Providers who evaluate children with sleep problems should have a working knowledge of nonobstructive sleep disorders to complement their expertise in obstructive sleep disorders.