Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Dyssomnias and Parasomnias in Childhood

  • PEDIATRIC NEUROLOGY (HS SINGER, SECTION EDITOR)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Dyssomnias are sleep disorders associated with complaints of insomnia or hypersomnia. The daytime sleepiness of narcolepsy is treated by a combination of planned daytime naps, regular exercise medications such as modafinil, or salts of methylphenidate, or amphetamine. Cataplexy that accompanies narcolepsy is treated with anticholinergic agents, selective serotonin reuptake inhibitors, or sodium oxybate. Children with neurodevelopmental disabilities such as autism have sleep initiation and maintenance difficulties on a multifactorial basis, with favorable response to melatonin in some patients. Childhood onset restless legs syndrome is often familial, associated with systemic iron deficiency, and responsive to iron supplementation and gabapentin. Parasomnias are episodic phenomena events which occur at the sleep -- wake transition or by intrusion on to sleep. Arousal parasomnias such as confusional arousals and sleep walking can sometimes be confused with seizures. A scheme for differentiating arousal parasomnias from nocturnal seizures is provided. Since arousal parasomnias are often triggered by sleep apnea, restless legs syndrome, or acid reflux, treatment measures directed specifically at these disorders often helps in resolution. Clonazepam provided in a low dose at bedtime can also alleviate sleep walking and confusional arousals. Obstructive sleep apnea affects about 2 percent of children. Adeno-tonsillar hypertrophy, cranio-facial anomalies, and obesity are common predisposing factors. Mild obstructive sleep apnea can be treated using a combination of nasal corticosteroids and a leukotriene antagonist. Moderate to severe obstructive sleep apnea are treated with adeno-tonsillectomy, positive airway pressure breathing devices, or weight reduction as indicated. This paper provides an overview of the topic, with an emphasis on management steps. Where possible, the level of evidence for treatment recommendations is indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. American Academy of Sleep Medicine. International classification of sleep disorders, 2nd edition: Diagnostic and coding manual. Westchester: American Academy of Sleep Medicine; 2006.

    Google Scholar 

  2. Nevsimalova S. Narcolepsy in childhood. Sleep Med Rev. 2009;13:169–80.

    Article  PubMed  Google Scholar 

  3. Kotagal S, Paruthi S. Narcolepsy in childhood. In: Narcolepsy: a clinical guide. New York, Springer; 2010. p. 55–67.

  4. Lin L, Faraco J, Li R, et al. The sleep disorder, canine narcolepsy, is caused by a mutation in the hypocretin (orexin) receptor 2 gene. Cell. 1999;98:356–76.

    Article  Google Scholar 

  5. Nishino S, Ripley B, Overeem S, et al. Hypocretin (orexin) deficiency in human narcolepsy. Lancet. 2000;35:39–40.

    Article  Google Scholar 

  6. Saper CB. Staying awake for dinner: hypothalamic integration of sleep, feeding and circadian rhythms. Prog Brain Res. 2006;153:243–52.

    Article  PubMed  CAS  Google Scholar 

  7. Wu MF, John J, Maidment N, Lam HA, Siegel JM. Hypocretin release in normal and narcoleptic dogs after food and sleep deprivation, eating and movement. Am J Physiol Regul Integr Comp Physiol. 2002;283:R1079–86.

    PubMed  Google Scholar 

  8. Heier MS, Jansson TS, Gautvik KM. Cerebrospinal fluid hypocretin 1 deficiency, overweight and metabolic dysregulation in patients with narcolepsy. J Clin Sleep Med. 2011;7:653–8.

    PubMed  Google Scholar 

  9. Evenson KR, Ballard K, Lee G, Ammerman A. Implementation of a school based state policy to increase physical activity. J Sch Health. 2009;79:231–8.

    Article  PubMed  Google Scholar 

  10. Wise MS, Arand DL, Auger RR, Brooks SN, Watson NF. Treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007;30:1712–27.

    PubMed  Google Scholar 

  11. Morgenthaler TI, Kapur VK, Brown T, Swick TJ, Alessi C, et al. Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007;30:1705–11.Evidence based discussion of pharmacologic treatment measures.

    Google Scholar 

  12. Quinnell TG, Smith IE. Narcolepsy, idiopathic hypersomnolence, and related conditions. Clin Med. 2011;11:282–6.

    PubMed  Google Scholar 

  13. Frenette E, Kushida CA. Primary hypersomnias of central origin. Semin Neurol. 2009;29:354–67.

    Article  PubMed  Google Scholar 

  14. Basetti C, Aldrich MS. Idiopathic hypersomnia: a series of 42 patients. Brain. 1997;120:1423.

    Article  Google Scholar 

  15. Arnulf I, Lin L, Gadoth N, et al. Kleine Levin syndrome: a systematic study of 108 patients. Ann Neurol. 2008;63:482–93.

    Article  PubMed  CAS  Google Scholar 

  16. Dauvilliers Y, Mayer G, Lecendreux M, et al. Kleine Levin syndrome. An autoimmune hypothesis based on clinical and genetic analyses. Neurology. 2002;59:1739–45.

    Article  PubMed  CAS  Google Scholar 

  17. Poppe M, Friebel D, Reuner U, et al. The Kleine-Levin syndrome – effects of treatment with lithium. Neuropediatrics. 2003;34:113–9.

    Article  PubMed  CAS  Google Scholar 

  18. Surges R, Walker MC. A case of late onset Kleine Levin syndrome responding to lamotrigine. Sleep Med. 2009;10:394.

    Article  PubMed  Google Scholar 

  19. Huang YS, Lakkis C, Guilleminault C. Kleine Levin syndrome: current status. Med Clin N Am. 2010;94:557–62.

    Article  PubMed  Google Scholar 

  20. American Psychiatric Association. Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders. DSMIV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

  21. Smeets EE, Pelc K, Dan B. Rett syndrome. Mol Syndromol. 2012;2(3–5):113–27.

    PubMed  CAS  Google Scholar 

  22. Elsea SH, Girirajan S. Smith-Magenis syndrome. Eur J Hum Genet. 2008;16(4):412–21.

    Article  PubMed  CAS  Google Scholar 

  23. Zollino M, Murdolo M, Marangi G, et al. On the nosology and pathogenesis of Wolff-Hirschhorn syndrome: geneotype-phenotype correlation analysis of 80 patients and literature review. Am J Med Genet C Semin Med Genet. 2008;148C:257–69.

    Article  PubMed  CAS  Google Scholar 

  24. Boudreau EA, Johnson KP, Jackman AR, Blancato J, Huizing M, et al. Review of disrupted sleep patterns in Smith-Magenis syndrome and normal melatonin secretion in a patient with an atypical interstitial 17p11.2 deletion. Am J Med Genet. 2009;149A:1382–91.

    Article  PubMed  CAS  Google Scholar 

  25. Leger D, Stal V, Quera-Salva MA, Guilleminault C, Paillard M. Disorders of wakefulness and sleep in blind patients. Rev Neurol (Paris). 2001;157(11pt. 2):S135–9.

    CAS  Google Scholar 

  26. Leger D, Guilleminault C, Santos C, Paillard M. Sleep/wake cycles in the dark: sleep recorded by polysomnography in 26 totally blind subjects compared with controls. Clin Neurophysiol. 2002;113:1607–14.

    Article  PubMed  Google Scholar 

  27. Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A. Behavioral treatment of bedtime problems and night wakings in children. Sleep. 2006;29:1263–76.

    PubMed  Google Scholar 

  28. Richdale AL, Schreck KA. Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep Med Rev. 2009;13:403–11.

    Article  PubMed  Google Scholar 

  29. Stigler KA, Posey DJ, McDougle CJ. Ramelteon for insomnia in two youths with autism spectrum disorder. J Child Adolesc Psychopharmacol. 2006;16:631–6.

    Article  PubMed  Google Scholar 

  30. Golubchik P, Sever J, Weizman A. Low-dose quetiapine for adolescents with autistic spectrum disorder and aggressive behavior:open-label trial. Clin Neuropharmacol. 2011;34:216–9.

    Article  PubMed  CAS  Google Scholar 

  31. Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: Diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–19.

    Article  PubMed  Google Scholar 

  32. Picchietti DL, Allen RP, Walters AS, et al. Restless legs syndrome: prevalence and impact in childhood and adolesence–the Peds REST study. Pediatrics. 2007;120:253–66.

    Article  PubMed  Google Scholar 

  33. Stefansson H, Rye DB, Hicks A, Petursson H, Ingason A, et al. A genetic risk factor for periodic limb movements in sleep. N Engl J Med. 2007;357:639–47.

    Article  PubMed  CAS  Google Scholar 

  34. Walters AS. Is there a subpopulation of children with growing pains who really have Restless Legs Syndrome? A review of the literature. Sleep Med. 2002;3:93–8.

    Article  PubMed  Google Scholar 

  35. Kotagal S, Silber MH. Childhood-onset restless legs syndrome. Ann Neurol. 2004;56:803–7.

    Article  PubMed  Google Scholar 

  36. Simakajornboon N, Kheirandish-Gozal L, Gozal D. Diagnosis and management of restless legs syndrome in children. Sleep Med Rev. 2009;13:149–56.

    Article  PubMed  Google Scholar 

  37. Picchietti DL, Underwood DJ, Farris WA, et al. Further studies on periodic limb movement disorder and restless legs syndrome in children with attention deficit-hyperactivity disorder. Mov Disord. 1999;14:1000–7.

    Article  PubMed  CAS  Google Scholar 

  38. Chervin RD, Archbold KH, Dillon JE, et al. Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements. Sleep. 2002;25:213–18.

    PubMed  Google Scholar 

  39. Bogan RK, Cramer Borneman MA, Kushida CA, et al. Long-term maintenance treatment of restless legs syndrome with gabapentin enacarbil: a randomized controlled study. Mayo Clin Proc. 2010;85:512–21.

    Article  PubMed  Google Scholar 

  40. Hening WA, Allen RP, Earley CJ, Picchietti DL, Silber MH. Restless legs syndrome task force of the Standards of Practice Committee of the American Academy of Sleep Medicine. An update on the dopamnergic treatment of restless legs dyndrome and periodic limb movement disorder. Sleep. 2004;27:560–83.

    PubMed  Google Scholar 

  41. Kotagal S. Parasomnias in childhood. Sleep Med Rev. 2009;13:157–68.

    Article  PubMed  Google Scholar 

  42. Bisulli F, Vignatelli F, Provini F, Leta C, et al. Parasomnias and nocturnal frontal lobe epilepsy (NFLE): lights and shadows–controversial points in the differential diagnosis. Sleep Med. 2011;12 Suppl 2:S27–32.

    Article  PubMed  Google Scholar 

  43. Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them? Pediatrics. 2003;111:e17–25.

    Article  PubMed  Google Scholar 

  44. Tobin JD. Treatment of somnambulism with anticipatory awakening. J Pediatr. 1993;122:426–7.

    Article  PubMed  Google Scholar 

  45. Arnulf I. REM sleep behavior disorder: motor manifestations and pathophysiology. Mov Disord. 2012;27:677–89.

    Article  PubMed  Google Scholar 

  46. Lloyd R, Tippmann-Piekert M, Slocumb N, Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med. 2012;8:127–31.

    PubMed  Google Scholar 

  47. Kunz D, Mahlberg R. A two-part, double blind placebo controlled trial of exogenous melatonin in REM sleep behavior disorder. J Sleep Res. 2010;19:591–6.

    Article  PubMed  Google Scholar 

  48. Iber C, Ancoli-Israel S, Chesson A, Quan SF, for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st ed. Westchester: American Academy of Sleep Medicine; 2007.

    Google Scholar 

  49. Spitzer AR. Evidence-based methylxanthine use in the NICU. Clin Perinatol. 2012;39:137–48.

    Article  PubMed  Google Scholar 

  50. Spence J, Pasterkamp H, McDonald PJ. Isolated central sleep apnea in type I Chiari malformation: improvement after surgery. Pediatric Pulmunol. 2010;45:1141–4.

    Article  Google Scholar 

  51. Westwood AJ, Vendrame M, Montouris G, Auerbach SH. Pearls and oy-sters: treatment of central sleep apnea with topiramate. Neurology. 2012;78:e97–9.

    Article  PubMed  Google Scholar 

  52. Gozal D. New concepts in abnormalities of respiratory control in children. Curr Opin Pediatr. 2004;16:305–8.

    Article  PubMed  Google Scholar 

  53. Gozal D, Harper RM. Novel insights into congenital hypoventilation syndrome. Curr Opin Pulm Med. 1999;5:335–8.

    Article  PubMed  CAS  Google Scholar 

  54. Roshkow JE, Haller JO, Berdon WE, Sane SM. Hirschprung’s disease, Ondine’s curse, and neuroblastoma–manifestations of neurocristopathy. Pediatr Radiol. 1988;19:45–9.

    Article  PubMed  CAS  Google Scholar 

  55. Swaminathan S, Gilsanz V, Atkinson J, Keens TG. Congenital central hypoventilation syndrome associated with multiple ganglioneuromas. Chest. 1989;96:423–4.

    Article  PubMed  CAS  Google Scholar 

  56. Trochet D, O’brien LM, Gozal D, et al. PHOX2B genotype allows for prediction of tumor risk in congenital central hypoventilation syndrome. Am J Hum Genet. 2005;76:421–6.

    Article  PubMed  CAS  Google Scholar 

  57. Weese-Mayer DE, Berry-Kravis EM, Ceccherini I, et al. An official ATS clinical policy statement: congenital central hypoventilation syndrome: genetic basis, diagnosis, and management. Am J Res Crit Care Med. 2010;181:626–44.

    Article  CAS  Google Scholar 

  58. Brunetti L, Rana S, Losppalluti ML, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1207 children of Southern Italy. Chest. 2001;120:1930–5.

    Article  PubMed  CAS  Google Scholar 

  59. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:242–52.

    Article  PubMed  Google Scholar 

  60. Chervin RD, Archbold KH, Dillon JE, et al. Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements. Sleep. 2002;25:213–8.

    PubMed  Google Scholar 

  61. Gozal D. Obstructive sleep apnea in children: implications for the developing central nervous system. Semin Pediatr Neurol. 2008;15:100–6.

    Article  PubMed  Google Scholar 

  62. Guilleminault C, Pelayo R, Leger D, et al. Recognition of sleep-disordered breathing in children. Pediatrics. 1996;98:871–82.

    PubMed  CAS  Google Scholar 

  63. Brouillette RT, Morielli A, Leimanis A, et al. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics. 2000;105:405–12.

    Article  PubMed  CAS  Google Scholar 

  64. Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics. 2008;122:e149–55.

    Article  PubMed  Google Scholar 

  65. Brietzke SE, Gallagher D. The effectiveness of tonsillectomy and adenoidectomy in treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg. 2006;134:979–84.

    Article  PubMed  Google Scholar 

  66. Ambrosio A, Brigger MT. Pediatric supraglottoplasty. Adv Otorhinolaryngol. 2012;73:101–4.

    PubMed  Google Scholar 

  67. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, et al. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15:343–56.

    Article  PubMed  Google Scholar 

  68. Marcus CL, Beck SE, Traylor J, Cornaglia MA, Meltzer LJ, DiFeo N, et al. Randomized, double blind trial of 2 different modes of positive pressure airway therapy on adherence and efficacy in children. J Clin Sleep Med. 2012;8:37–42.

    PubMed  Google Scholar 

  69. Verhulst SL, Van Gaal L, De Backer W, Desager K. The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents. Sleep Med Rev. 2008;12:339–46.

    Article  PubMed  Google Scholar 

  70. Villa MP, Bernkopf E, Pagani J, et al. Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med. 2002;165:123–7.

    PubMed  Google Scholar 

  71. Guilleminault C, Li KK. Maxillomandibular expansion for the treatment of sleep disordered breathing: preliminary result. Laryngoscope. 2004;114:893–6.

    Article  PubMed  Google Scholar 

  72. Wise MS, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, et al. Executive summary of respiratory indications for polysomnography in children: an evidence based review. Sleep. 2011;34:389–98.

    PubMed  Google Scholar 

  73. Kotagal S, et al. Executive summary of non-respiratory indications for polysomnography in children: an evidence based review. Sleep. 2012 (in press).

  74. Winkelmann J, Lin L, Schormair B, Kornum BR, Faraco J, Plazzi G, et al. Mutations in DNMT1 cause autosomal dominant cerebellar ataxia, deafness and narcolepsy. Hum Mol Genet. 2012;21:2205–10.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Neurology, Pediatrics and the Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Suresh Kotagal M.D.

Authors
  1. Suresh Kotagal M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suresh Kotagal M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kotagal, S. Treatment of Dyssomnias and Parasomnias in Childhood. Curr Treat Options Neurol 14, 630–649 (2012). https://doi.org/10.1007/s11940-012-0199-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-012-0199-0

Keywords

Search

Navigation