Triggers and Diagnosis of Parasomnias in Children –A Review

The occurrence of parasomnias, which are most common during childhood, is one probable early sign of psychosis vulnerability. 6–8 Frequent nightmares have long been thought to play a role in the development of psychosis. In the outpatient clinics, sleep problems are one of the most common presentations. In fact, maladaptive sleep patterns are linked to up to 50% of major complaints in primary care settings. The etiology of parasomnias is unknown because no obvious cause has been identified; nonetheless, a variety of explanations have developed. The majority of childhood parasomnias (confessional arousals, sleepwalking, sleep terror, and nightmares) are harmless, and most children outgrow them. As a result, reassuring and educating the parents can be beneficial in those situations without the need for medical assistance. With that being said there’s also serval medical approaches that address such a disease. In this article we will be looking at the disease epidemiology, etiology, diagnosis and treatment.

Disorders of Arousal: A Chronobiological Perspective

Non-rapid eye movement (NREM) sleep parasomnias are characterized by motor and emotional behaviors emerging from incomplete arousals from NREM sleep and they are currently referred to as disorders of arousal (DoA). Three main clinical entities are recognized, namely confusional arousal, sleep terror and sleepwalking. DoA are largely present in pediatric populations, an age in which they are considered as transitory, unhabitual physiological events. The literature background in the last twenty years has extensively shown that DoA can persist in adulthood in predisposed individuals or even appear de novo in some cases. Even though some episodes may arise from stage 2 of sleep, most DoA occur during slow wave sleep (SWS), and particularly during the first two sleep cycles. The reasons for this timing are linked to the intrinsic structure of SWS and with the possible influence on this sleep phase of predisposing, priming and precipitating factors for DoA episodes. The objective of this paper is to review the intrinsic sleep-related features and chronobiological aspects affecting SWS, responsible for the occurrence of the majority of DoA episodes during the first part of the night.

Sleep Terrors: An Updated Review

Background: Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. Objective: : To familiarize physicians with the clinical manifestations, diagnosis, and management of children with sleep terrors. Methods: A PubMed search was completed in Clinical Queries using the key terms " sleep terrors" OR " night terrors". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Results: It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age. The exact etiology is not known. Developmental, environmental, organic, psychological, and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has a frightened expression. The child is confused and incoherent: verbalization is generally present but disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult to arouse and console and may express feelings of anxiety or doom. In the majority of cases, the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia for the attack the following morning. Attempts to interrupt a sleep terror episode should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors. Conclusion: Most children outgrow the disorder by late adolescence. In the majority of cases, there is no specific treatment other than reassurance and parental education. Underlying conditions, however, should be treated if possible and precipitating factors should be avoided.

Concealed Affair Of Allergic Rhinitis And Somnambulism Through A Middle Man

Obstructive Sleep Apnoea is common in children as well. It is strongly associated with parasomnias, including sleep terror, sleep walking etc. In this case report, we are discussing about a boy who was referred to us for the evaluation and management of sleep walking. Enlarged adenoid and tonsil, secondary to allergic disease was found to be causing Obstructive Sleep Apnoea in him, causing a trigger for the sleep walking. Here we are highlighting the importance of controlling the allergic disease in such children, which can even result in the avoidance of invasive surgical interventions like adeno-tonsillectomy.

NREM and other parasomnias

Parasomnias are a heterogeneous group of undesirable, but not always pathological, manifestations that accompany sleep. They consist in abnormal behaviors due to the inappropriate activation of cognitive processes or physiological systems such as the motor and/or autonomic nervous systems. In some cases, they can result in sleep disruption and injuries, with adverse health or psychosocial consequences for patients, bed-partners or both. According to the International Classification of Sleep Disorders, parasomnias are distinguished on the basis of the stage of sleep in which they appear: (1) parasomnias arising from NREM (non-rapid eye movement) sleep, which include arousal disorders (confusional arousal, sleep terror, sleepwalking) and sleep-related eating disorders; (2) parasomnias associated with REM (rapid eye movement) sleep; and (3) “other parasomnias” occurring in any sleep stage (eg, sleep enuresis, exploding head syndrome). This chapter describes the NREM parasomnias and the “other parasomnias,” underlining the more recent and significant advances that have provided a better understanding of their clinical features and pathophysiology.