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Bruni O. Approach to a sleepy child: Diagnosis and treatment of excessive daytime sleepiness in children and adolescents. Eur J Paediatr Neurol 2023; 42:97-109. [PMID: 36608412 DOI: 10.1016/j.ejpn.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
The aim of this review is to give updated information to pediatric neurologists on the correct diagnostic approach and treatment of excessive daytime sleepiness (EDS) in children and adolescents. Due to the change in the society habits, EDS is becoming an emerging problem for the health system. At the present there are few articles specifically devoted to the evaluation of EDS. EDS is often reported in several manuscripts as a side effect of other sleep disorders (obstructive sleep apnea, circadian disorders, etc.) or of the use of drugs or of the substance abuse or as a consequence of bad sleep habits and poor sleep hygiene. EDS, especially in children, may manifest with paradoxical symptoms like hyperactivity, inattention, and impulsiveness. However, common sign of EDS in children are the propensity to sleep longer than usual, the difficulty waking up in the morning, and falling asleep frequently during the day in monotonous situation. The diagnosis should include subjective (sleep diaries, questionnaires) and objective (polysomnography, multiple sleep latency test, etc.) instruments to avoid misdiagnosis. Narcolepsy is the most studied central disorder of hypersomnolence, and it is a predominantly pediatric disease with a peak age of onset in prepuberty but the diagnosis is often delayed especially in mild forms. The early and correct treatment of narcolepsy and of other form of EDS is extremely important since late and inappropriate treatments can affect the psychosocial development of the children and adolescents.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Via dei Marsi, 78-00185, Rome, Italy.
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2
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Hosokawa R, Tomozawa R, Fujimoto M, Anzai S, Sato M, Tazoe H, Katsura T. Association between sleep habits and behavioral problems in early adolescence: a descriptive study. BMC Psychol 2022; 10:254. [PMID: 36335370 PMCID: PMC9636702 DOI: 10.1186/s40359-022-00958-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Sleep habits are related to children's behavior, emotions, and cognitive functioning. A strong relationship exists between sleep habits and behavioral problems. However, precisely which sleep habits are associated with behavioral problems remains unclear. Therefore, the purpose of this study is to clarify the relationship between sleep habits and behavioral problems in early adolescence. Methods This study used data from a larger longitudinal research, specifically, data from the year 2021. First-year junior high school students (12–14 years) in Japan were surveyed; their parents (N = 1288) completed a parent-report questionnaire. The main survey items were subject attributes, the Pittsburgh Sleep Quality Index (PSQI), and the Strength and Difficulties Questionnaire (SDQ). Results Of the 652 valid responses received, 604 individuals who met the eligibility criteria (no developmental disability in the child and completion of all survey items) were included in the analysis. To examine the relationship between sleep habits and behavioral problems, logistic regression analysis using the inverse weighted method with propensity score was conducted with sleep habits (sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep difficulty, use of sleeping pills, difficulty waking during the day, and sleep disturbances) as explanatory variables and behavioral problems (overall difficulty in SDQ) as objective variables. The propensity score was calculated by employing the logistic regression using the inverse weighted method based on propensity scores. Propensity scores were calculated based on gender, family structure, household income, and parental educational background. The results showed that behavioral problems tended to be significantly higher in the group at risk for sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances than in the group with no risk. Conclusion The results suggest that deterioration in sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances may increase the risk of behavioral problems in adolescents.
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Affiliation(s)
- Rikuya Hosokawa
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Riho Tomozawa
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Megumi Fujimoto
- grid.444356.40000 0004 0616 2895Osaka Seikei University, Osaka, 533-0007 Japan
| | - Sumire Anzai
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Mai Sato
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Haruko Tazoe
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Toshiki Katsura
- grid.258799.80000 0004 0372 2033Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan ,grid.410780.a0000 0004 0642 4306Faculty of Nursing, Meiji University of Integrative Medicine, Kyoto, 629-0392 Japan
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Abstract
Given the limited data currently available in the literature, the aim of this study was to investigate the risk of excessive daytime sleepiness (EDS) associated with major depression in a large sample of adolescents. The clinical and polysomnographic data of 105 adolescents recruited from the database of the Erasme Hospital sleep laboratory were analysed. A score > 10 on the Epworth Sleepiness Scale was used as cut-off for the diagnosis of EDS. The status (remitted or current) and the severity (mild to moderate or severe) of major depressive episodes were determined based on the diagnostic criteria of the DSM-IV-TR during a systematic psychiatric assessment. Logistic regression analyses were performed to determine the risk of EDS associated with major depression in adolescents. The prevalence of EDS was 34.3% in our sample of adolescents. After adjusting for the main confounding factors associated with EDS, multivariate logistic regression analysis demonstrated that unlike mild to moderate major depression, remitted major depression and severe major depression were risk factors for EDS in adolescents. In our study, we have highlighted that in adolescents, the EDS could be both residual symptom and severity marker of major depression, which seems to justify a systematic psychiatric assessment in adolescents with EDS complaints in order to allow better management of this problem in this particular subpopulation.
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Abstract
Restless sleep disorder is (RSD) a condition characterized by frequent large movements during sleep associated with daytime impairment. RSD has been studied in children aged 6 to 18 years. Polysomnography is necessary for the diagnosis of RSD. The current diagnostic criteria include more than 5 large movements per hour of sleep documented by PSG. The pathophysiology is not known yet, but iron deficiency and sleep instability and increased sympathetic activation are suspected to play a role. Iron supplementation is the only treatment option studied so far.
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Affiliation(s)
- Lourdes M DelRosso
- University of Washington, Seattle Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | - Rosalia Silvestri
- Sleep Medicine Center, Department of Clinical and Experimental Medicine, University of A.O.U.G. Martino - Pad. H, 1o piano, Via Consolare Valeria, 1, 98125 Messina (ME), Italy
| | - Raffaele Ferri
- Oasi Research Institute - IRCCS, Via C Ruggero 73, 94018 Troina, Italy
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Stavinoha PL, Olsthoorn IM, Swartz MC, Nowakowski S, Wells SJ, Hicklen RS, Sheikh I, Jang HJ. Non-pharmacological sleep interventions for pediatric cancer patients and survivors: a systematic review protocol. Syst Rev 2021; 10:166. [PMID: 34088350 PMCID: PMC8176735 DOI: 10.1186/s13643-021-01724-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep disturbances constitute a common complication in pediatric cancer patients and survivors and are frequently severe enough to warrant treatment. Suboptimal sleep has been associated with decreased emotional well-being and cognitive functioning and increased behavioral problems. Standardized guidelines for non-pharmacological sleep interventions for adults with cancer exist, but no standard of care intervention or standard guidelines are available to guide such intervention in pediatric cancer patients and survivors. Therefore, effective behavioral interventions for improving sleep quality need to be identified. The objective of the review is to evaluate the effect of non-pharmacological sleep interventions on sleep quality in pediatric cancer patients and survivors. METHODS The review will consider studies that include children and adolescents between 0 and 18 years diagnosed with cancer or who have a history of cancer who have non-respiratory sleep disturbance. We will include experimental and quasi-experimental studies evaluating non-pharmacological interventions such as psychological interventions, technical/device interventions, interventions targeting physical activity, and complementary and alternative medicine interventions (e.g., yoga, massage, music). Interventions involving medications, ingestible supplements, products purported to work through absorption, and medical devices will be excluded. Primary outcome will be sleep quality as measured by methods including retrospective ratings, daily sleep diary, and validated questionnaires. Secondary outcomes will include total sleep time, sleep onset latency, wake after sleep onset, daytime sleepiness, and daytime sleep duration (naps) as measured by retrospective ratings, daily sleep diary, validated questionnaires, and/or actigraphy. Databases will include MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, CINAHL (Ebsco), and PsycINFO (Ovid) and will be queried from database inception to present. Two reviewers will independently screen all citations, full-text articles, and extract data. The study methodological quality will be assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Data will be extracted and findings pooled and synthesized using a meta-aggregation approach via the JBI System for the Unified Management, Assessment, and Review of Information (SUMARI). If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., methodological quality, study design, outcome measures). DISCUSSION This systematic review will synthesize and consolidate evidence on existing non-pharmacological interventions to improve sleep in pediatric cancer patients and survivors. Findings may help inform practitioners working with pediatric cancer patients and survivors experiencing sleep disturbances and is intended to identify gaps and opportunities to improve methodical quality of further non-pharmacological sleep intervention research in this population toward developing an eventual standard of care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020200397 .
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Affiliation(s)
- Peter L Stavinoha
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Ineke M Olsthoorn
- School of Psychology, Fielding Graduate University, 2020 De La Vina St, Santa Barbara, CA, 93105, USA
| | - Maria C Swartz
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Sara Nowakowski
- Department of Medicine, Baylor College of Medicine & VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, TMC - McGovern Campus, 2450 Holcombe Blvd, Houston, TX, 77021, USA
| | - Stephanie J Wells
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Rachel S Hicklen
- Research Medical Library, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Irtiza Sheikh
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Hannah J Jang
- University of California, San Francisco Medical Center, Institute for Nursing Excellence, 2233 Post Street, Ste. 201, San Francisco, CA, 94115, USA
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Gandhi KD, Mansukhani MP, Silber MH, Kolla BP. Excessive Daytime Sleepiness: A Clinical Review. Mayo Clin Proc 2021; 96:1288-1301. [PMID: 33840518 DOI: 10.1016/j.mayocp.2020.08.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/20/2020] [Accepted: 08/28/2020] [Indexed: 01/27/2023]
Abstract
Excessive daytime sleepiness (EDS) is a highly prevalent condition that is associated with significant morbidity. The causes of EDS are varied, and include inadequate sleep, sleep disordered breathing, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence (narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome). Additionally, EDS could represent a symptom of an underlying medical or psychiatric disorder. Assessment of EDS includes a thorough sleep, medical, and psychiatric history, targeted clinical examination, and appropriate use of actigraphy to measure sleep duration and sleep-wake patterns, polysomnography to assess for associated conditions such as sleep-related breathing disorders or other factors that might disrupt nighttime sleep, multiple sleep latency testing to ascertain objective sleepiness and diagnose central disorders of hypersomnolence, and measurement of cerebrospinal fluid hypocretin-1 concentration. Treatment of EDS secondary to central disorders of hypersomnolence is primarily pharmacologic with wakefulness-promoting agents such as modafinil, stimulants such as methylphenidate and amphetamines, and newer agents specifically designed to improve wakefulness; behavioral interventions can provide a useful adjunct to pharmacologic treatment. When excessive sleepiness is secondary to other conditions, the treatment should focus on targeting the primary disorder. This review discusses current epidemiology, provides guidance on clinical assessments and testing, and discusses the latest treatment options. For this review, we collated the latest evidence using the search terms excessive sleepiness, hypersomnia, hypersomnolence, treatment from PubMed and MEDLINE and the latest practice parameters from the American Academy of Sleep Medicine.
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Affiliation(s)
- Kriti D Gandhi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Michael H Silber
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
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von Lukowicz H, Poets CF, Peters T, Wilhelm B, Schlarb A, Urschitz MS. Validity of the Pupillographic Sleepiness Test for the diagnosis of daytime sleepiness in children and adolescents and its relationship to sleepiness-associated outcomes. Sleep Med 2021; 83:145-150. [PMID: 34015717 DOI: 10.1016/j.sleep.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To report validation data for the Pupillographic Sleepiness Test (PST) in children and adolescents, evaluate its applicability for diagnosing excessive daytime sleepiness and its relationship to sleepiness-associated outcomes. METHODS A cross-sectional diagnostic test accuracy study was performed. Patients underwent three PST at 9 a.m. (T1), 11 a.m. (T2) and 1 p.m. (T3) plus the Multiple Sleep Latency Test (MSLT) on a single day. Additionally, two neurocognitive tests were performed and three questionnaires about quality of life, sleep-related self-efficacy and behavioural aspects completed. Gender-stratified z-values of the natural logarithm of the Pupillary Unrest Index (z-lnPUI) were correlated to Sleep Latency (SL) and Mean Sleep Latency (MSL) and to variables of neurocognitive tests and questionnaires using Spearman's rank correlation. Cut-off values were determined by receiver operating characteristic (ROC) analysis. RESULTS 47 patients were recruited (median 10.6 years, range 6-18). Correlation between z-lnPUI and SL was rT1 = -0.373 (p = 0.011); rT2 = -0.320 (p = 0.028) and rT3 = -0.336 (p = 0.022). Correlation between z-lnPUI and MSL was rT1 = -0.338 (p = 0.020); rT2 = -0.202 (p = 0.173); rT3 = -0.117 (p = 0.433). ROC analysis showed an area under the curve of 90.7% and PUI cut-off values of 12.6 mm/min (boys) and 11.6 mm/min (girls). There were moderate correlations between z-lnPUIT1 and reaction time and omission errors in neurocognitive tests (r = 0.394, p = 0.007 and 0.391, p = 0.008). CONCLUSIONS We found satisfactory correlations between PST and MSLT results. The z-lnPUIT1 was related to MSL and objective measures of attention ability. Given this accuracy, the PST may be used as a screening tool for evaluating daytime sleepiness in children and adolescents. Corresponding gender-related reference values are now available.
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Affiliation(s)
| | - Christian F Poets
- Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospital, Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospital, Tuebingen, Germany
| | - Angelika Schlarb
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Michael S Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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8
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Sung M, Rhie S, Kim JH, Lee SW, Ha EK, Jee HM, Yoo EG, Chae KY, Han MY. Assessment of vitamin D, exercise, and lipid profile associated with excessive daytime sleepiness in school children. Sleep Med 2020; 77:51-57. [PMID: 33310114 DOI: 10.1016/j.sleep.2020.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
Previous research reported associations of excessive daytime sleepiness (EDS) with a low vitamin D level, obesity, and sexual maturity. The aim of this study was to identify the association and rank the importance of these with EDS. This study examined 618 children who were 10-12 year-old. The pediatric daytime sleepiness scale (PDSS) was used to evaluate EDS and sleep patterns. EDS was defined as a total PDSS score above 17. We ranked the importance of the relationship of these factors with EDS using random forest analysis. EDS (n = 111, 18%) was positively associated with more advanced pubertal stage in girls, chronic cough, urticaria, and allergic rhinitis. Multivariable analysis with adjustment for confounding indicated that children with low level of 25-hydroxyvitaminD3 (25(OH)D3 (<20 ng/mL) and high-density lipoprotein-cholesterol (HDL-C) (<40 mg/dL) levels had an increased risk of EDS (25(OH)D3:adjusted odds ratio [aOR] = 1.73; 95% confidence interval [CI]: 1.06 to 2.81; P = 0.028; HDL-C: aOR = 2.84; 95% CI: 1.05 to 7.68; P = 0.039). Random forest analysis indicated that 25(OH)D3 level, exercise, and body mass index (BMI) were over three. This study indicated high levels of 25-(OH)D3 and HDL-C and performing regular exercise decreased the risk of EDS.
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Affiliation(s)
- Myongsoon Sung
- Department of Pediatrics, Soon Chun Hyang University Gumi Hospital, Soon Chun Hyang, University College of Medicine, Gumi, South Korea
| | - Seonkyeong Rhie
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Ju Hee Kim
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hye Mi Jee
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Eun-Gyong Yoo
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Kyu Young Chae
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
| | - Man Yong Han
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
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9
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Kamara D, Beauchaine TP. A Review of Sleep Disturbances among Infants and Children with Neurodevelopmental Disorders. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020; 7:278-294. [PMID: 33344102 PMCID: PMC7747783 DOI: 10.1007/s40489-019-00193-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Sleep problems are common among children with neurodevelopmental disorders (NDDs). We review sleep disturbance in three major NDDs: autism spectrum disorder, Down syndrome, and fetal alcohol spectrum disorder (FASD). We review associations with functional impairment, discuss how patterns of sleep disturbance inform understanding of etiology, and theorize about mechanisms of impairment. Sleep disturbance is a transdiagnostic feature of NDDs. Caregivers report high rates of sleep problems, including difficulty falling or staying asleep. Polysomnography data reveal differences in sleep architecture and increased rates of sleep disorders. Sleep disturbance is associated with functional impairment and stress among families. Further research is needed to elucidate mechanisms of impairment and develop more effective interventions. Despite significant sleep disturbance in FASD, limited research is available.
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Affiliation(s)
- Dana Kamara
- The Ohio State University, Department of Psychology, 1835 Neil Ave., Columbus, OH 43210
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10
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Owens JA, Babcock D, Weiss M. Evaluation and Treatment of Children and Adolescents With Excessive Daytime Sleepiness. Clin Pediatr (Phila) 2020; 59:340-351. [PMID: 32167377 PMCID: PMC7160754 DOI: 10.1177/0009922820903434] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Judith A. Owens
- Boston Children’s Hospital, Harvard
Medical School, Waltham, MA, USA,Judith A. Owens, Division of Neurology,
Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA 02115, USA.
| | - Debra Babcock
- Packard Children’s Health Alliance,
Stanford Children’s Health, Los Altos, CA, USA
| | - Miriam Weiss
- Children’s National Health System,
Washington, DC, USA
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11
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Gandhi KD, Mansukhani MP, Kolla BP. Hypersomnolence in Children and Adolescents: Causes, Assessment, and Management. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20191105-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Ludwig B, Smith SS, Heussler H. How Well Do Children Understand the Vocabulary of Sleep? Health Lit Res Pract 2019; 3:e53-e69. [PMID: 31294308 PMCID: PMC6608919 DOI: 10.3928/24748307-20190122-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/14/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Sleep surveys, such as the Pediatric Daytime Sleepiness Scale (PDSS), are used to determine a variety of concerns associated with sleep, including excessive daytime sleepiness (hypersomnolence), bedtime sleep behaviors, night awakenings, sleep duration, and sleep-disordered breathing. However, the literacy ability of the patient may not be adequate to ensure comprehension of questions and provision of accurate responses. Objective: To assess children's understanding of the sleep-associated vocabulary included in the PDSS. Methods: A cross-sectional, open-response survey was developed for use with students age 4 to 12 years. Prior to completing the instrument, each student was asked the meaning of six key sleep-related words used in the PDSS: drowsy, sleepy, alert, awakened, tired, and awake. The parents/caregivers were requested to record their child's definitions of these key words exactly as stated. Identification of words for “suitable” definitions was undertaken through consultation of three online dictionaries. This enabled the qualitative process associated with open-response surveys to be followed: identification of common themes, chunking of information, and criteria for coding responses. The final sample consisted of word definitions from 325 students (152 boys and 173 girls) from a school enrollment of 727 (45%). Key Results: A high percentage of children provided “suitable” responses for the words sleepy (84%) and tired (75%). The percentage of “suitable” responses for the words drowsy and awakened gradually increased across the age groups. The words alert and awake were challenging for the children to define, with the sleep-associated definition for alert only being provided by 31% of children overall and awake only being provided by 48% overall. In total, 57% of children were able to provide suitable definitions for at least four words. Conclusions: Our findings suggest that the results of many sleep surveys using these terms may not yield results that accurately reflect a child's actual state of daytime sleepiness and sleep/wake behaviors. Prior to administering a sleep survey, physicians need to clearly explain the meanings of sleep-associated words used in the survey and thus gain a more accurate reflection of a child's sleep and daytime behaviors. [HLRP: Health Literacy Research and Practice. 2019;3(1):e53–e69.] Plain Language Summary: Sleep surveys are used to identify problems with sleep. Children with poor health literacy due to age may not understand the questions and may not provide adequate answers. Children's understanding of sleep-associated vocabulary was assessed using six words: drowsy, sleepy, alert, awakened, tired, and awake. Many of these words were found to be difficult for the children to define.
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Affiliation(s)
- Beris Ludwig
- Address correspondence to Beris Ludwig, MEd, BSc (Hons) (Psychology), University of Queensland, 881 Ruthven Street, Toowoomba, QLD, Australia, 4350;
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Rosenberg R, Hirshkowitz M, Rapoport DM, Kryger M. The role of home sleep testing for evaluation of patients with excessive daytime sleepiness: focus on obstructive sleep apnea and narcolepsy. Sleep Med 2019; 56:80-89. [PMID: 30803831 DOI: 10.1016/j.sleep.2019.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/13/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022]
Abstract
Excessive daytime sleepiness (EDS) is a common complaint in the general population, which may be associated with a wide range of sleep disorders and other medical conditions. Narcolepsy is a sleep disorder characterized primarily by EDS, which involves a substantial burden of illness but is often overlooked or misdiagnosed. In addition to identifying low cerebrospinal fluid (CSF) hypocretin (orexin) levels, evaluation for narcolepsy requires in-laboratory polysomnography (PSG). Polysomnography is the gold standard for diagnosis of obstructive sleep apnea (OSA) as well as other sleep disorders. However, the use of home sleep apnea testing (HSAT) to screen for OSA in adults with EDS has increased greatly based on its lower cost, lower technical complexity, and greater convenience, versus PSG. The most commonly used, types 3 and 4, portable monitors for HSAT lack capability for electroencephalogram recording, which is necessary for the diagnosis of narcolepsy and other sleep disorders and is provided by PSG. These limitations, combined with the increased use of HSAT for evaluation of EDS, may further exacerbate the under-recognition of narcolepsy and other hypersomnias, either as primary or comorbid disorders with OSA. Adherence to expert consensus guidelines for use of HSAT is essential. Differential clinical characteristics of patients with narcolepsy and OSA may help guide correct diagnosis. Continued EDS in patients diagnosed and treated for OSA may indicate comorbid narcolepsy or another sleep disorder. Although HSAT may diagnose OSA in appropriately selected patients, it cannot rule out or diagnose narcolepsy. Therefore, at present, PSG and MSLT remain the cornerstone for narcolepsy diagnosis.
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Affiliation(s)
| | | | | | - Meir Kryger
- Yale Pulmonary and Critical Care Medicine, New Haven, CT, USA.
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14
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Abstract
SummaryDisordered sleep has long been recognised as both a consequence of psychiatric illness and a contributory factor to its development. Significant sleep disturbance occurs in about 25% of children and adolescents and 80% or more of children in high-risk groups; it often continues into adulthood. All psychiatrists should therefore be familiar with the principles of sleep medicine and the impact of sleep and its disorders. In this article, the relationship between sleep disorders and the breadth of child and adolescent psychiatry in particular is explored. The classification, aetiology and implications of sleep disorders are discussed, as well as the practicalities of screening, diagnosis and management, with a view to informing readers how accurate diagnosis, prevention and successful treatment of sleep disorders can benefit patients and their families.
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Abstract
Sleepiness is not uncommon in the pediatric population. Although the etiology can be multifactorial, sleepiness due to increased sleep drive, also called central hypersomnia, is a common cause. The third edition of the International Classification of Sleep Disorders updated the diagnostic criteria for several of the central disorders of hypersomnolence, most notably narcolepsy. Although the International Classification Of Sleep Disorders-3 is not specific to pediatric patients, the peak incidence for many of the included disorders occurs during childhood or adolescence. As a result, recognition of these lifelong and potentially debilitating disorders is imperative for providers who evaluate pediatric patients. This review provides an update on recent advances in the field and highlights some of the diagnostic dilemmas, unique clinical features, and variable presentations associated with central disorders of hypersomnolence within the pediatric population.
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Affiliation(s)
- Thomas J Dye
- Division of Neurology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH.
| | - Sejal V Jain
- Division of Neurology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Sanjeev V Kothare
- Department of Neurology, NYU Langone Medical Center, New York, NY; Pediatric Sleep Program, Comprehensive Epilepsy & Sleep Center, NYU Langone Medical Center, New York, NY
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Walter LM, Nixon GM, Davey MJ, Downie PA, Horne RSC. Sleep and fatigue in pediatric oncology: A review of the literature. Sleep Med Rev 2015; 24:71-82. [PMID: 25679070 DOI: 10.1016/j.smrv.2015.01.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 02/06/2023]
Abstract
Cancer in children has detrimental effects on sleep patterns and sleep quality, which in turn impacts on the perception of, and the ability to cope with, the emotional and physical challenges associated with both the disease and its treatment. This places an added burden on their quality of life that can last many years beyond diagnosis and treatment. In addition to the effect of the cancer itself, surgery, chemotherapy and radiotherapy can all contribute both short and long term to sleep disruption. Sleep disorders have also been associated with pain, fatigue, medication and hospitalisation in children suffering from cancer. This review will explore the relationship between childhood cancer and associated sleep disorders, in the acute stage of diagnosis, during treatment and in the years following. We will discuss the possible causes and the current treatment modalities used to treat sleep disorders in children with cancer, and in childhood cancer survivors. It has been estimated that the recent advances in treatment have improved the overall five year survival rate for all childhood cancers to over 80%, with some cancers achieving a near 100% cure rate such as early stage Wilms' tumour. Thus, recognition and appropriate treatment of associated sleep disorders is essential to optimise long term quality of life.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
| | - Gillian M Nixon
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Margot J Davey
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Peter A Downie
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Children's Cancer Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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Urschitz MS, Heine K, Mendler L, Peters T, Wilhelm B, Poets CF. Pilot study on the validity of the pupillographic sleepiness test in children and adolescents. Sleep Med 2014; 15:720-3. [PMID: 24796284 DOI: 10.1016/j.sleep.2014.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/12/2014] [Accepted: 02/16/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report preliminary validation data for the pupillographic sleepiness test (PST) in children and adolescents. METHODS Twelve patients (13.1±4.4 years of age) underwent the multiple sleep latency test (MLST) and three PSTs at 09:00, 11:00, and 13:00 on one single day. Correlations were tested between mean sleep latency and gender-adjusted z-values of the natural logarithm of the pupillary unrest index (zlnPUI). RESULTS Spearman's correlation (P-value) between the zlnPUI values obtained at 09:00 and 11:00 with the MSL was rS = -0.641 (0.025) and r = -0.553 (0.062). CONCLUSION There was satisfactory agreement between PST and the MLST, which is similar to what is found in adults. The PST may be promising for the evaluation of daytime sleepiness in children and adolescents, and should be further evaluated in future studies.
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Affiliation(s)
- Michael S Urschitz
- Unit of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany.
| | - Katrin Heine
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
| | - Lea Mendler
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospital Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospital Tuebingen, Germany
| | - Christian F Poets
- Working Group on Pediatric Sleep Medicine, University Children's Hospital Tuebingen, Germany
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Langevin R, Laurent A, Sauvé Y. Évaluation préliminaire de l’efficacité de la Luminette® chez des adolescents atteints du syndrome de retard de phase du sommeil (SRPS) : essai randomisé en simple insu et contrôlé par placebo. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.msom.2014.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Urschitz MS. Assessing objective daytime sleepiness in children and adults: do we have appropriate instruments? Sleep Med 2013; 14:812-3. [DOI: 10.1016/j.sleep.2013.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 11/26/2022]
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Urschitz MS, Heine K, Brockmann PE, Peters T, Durst W, Poets CF, Wilhelm B. Subjective and objective daytime sleepiness in schoolchildren and adolescents: results of a community-based study. Sleep Med 2013; 14:1005-12. [PMID: 23993873 DOI: 10.1016/j.sleep.2013.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 05/17/2013] [Accepted: 05/25/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to assess subjective and objective sleepiness in schoolchildren and adolescents by using questionnaires and the Pupillographic Sleepiness Test (PST). METHODS An observational, cross-sectional, community-based study was performed. Participants were recruited and balanced by age and gender from schools using stratified random sampling. Sleep problems and subjective sleepiness were assessed using parent- and self-reported questionnaires. Objective sleepiness was assessed in schools under standardized conditions by using the PST and by calculating the natural logarithm of the pupillary unrest index (lnPUI). RESULTS In total 163 children (82 boys; age range, 6.6-17.8 years) were enrolled. Age and sleep problems were predictors of subjective sleepiness. Nine PST recordings (5.5%) were excluded due to artifacts (feasibility, 94%). Gender, sleep problems, and sleep duration were predictors of objective sleepiness. Compared to adults (age range, 20-60 years), the lnPUI was higher in children (mean±standard deviation [SD], 1.5±0.4 vs. 2.0±0.4; P<.001) and showed significant gender differences. There was no agreement between measures of subjective sleepiness and the lnPUI (r<0.3). After excluding children with sleep problems, preliminary reference values (mean±SD) for the lnPUI were 2.01±0.43 for boys and 1.93±0.43 for girls, respectively. CONCLUSIONS The PST is a feasible method in schoolchildren and adolescents. Sleep problems are predictors of both subjective and objective sleepiness; there is no agreement between the latter. Results of the PST are influenced by sleep duration and specific pediatric gender-stratified reference values are definitively needed.
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Affiliation(s)
- Michael S Urschitz
- Unit of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center, Mainz, Germany; Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital, Tuebingen, Germany.
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Abstract
Teens tend go to bed later, get less sleep, and report more daytime sleepiness. Medical research emphasizes biological determinants of teens' disrupted sleep (i.e., the timing of puberty and resultant drops in melatonin), rarely or inadequately considering youths' social ties as a determinant of sleep behaviors. Sociologists recognize how social ties affect health behaviors but have generally neglected sleep, especially among teens. Drawing on a sample of 974 teens from the Study of Early Child Care and Youth Development, this study controls for developmental and social relational factors to predict changes in youths' sleep patterns between 12 and 15 years of age. In general, social relational factors outperform developmental factors in determining youths' sleep patterns, particularly pointing to the importance of parental, peer, and school ties in promoting healthy sleep behaviors. The implications of these findings for further research are briefly discussed.
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Poli F, Overeem S, Lammers GJ, Plazzi G, Lecendreux M, Bassetti CL, Dauvilliers Y, Keene D, Khatami R, Li Y, Mayer G, Nohynek H, Pahud B, Paiva T, Partinen M, Scammell TE, Shimabukuro T, Sturkenboom M, van Dinther K, Wiznitzer M, Bonhoeffer J. Narcolepsy as an adverse event following immunization: Case definition and guidelines for data collection, analysis and presentation. Vaccine 2013; 31:994-1007. [PMID: 23246545 DOI: 10.1016/j.vaccine.2012.12.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 01/11/2023]
Affiliation(s)
- Francesca Poli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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23
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Abstract
Approximately three-fourths of all pediatric cancer patients will be long-term survivors; however, there can be a steep cost for cancer survivorship. Cancer treatment involves exposure to chemotherapy, surgical intervention, and radiation, which can cause lasting long-term toxicities. Children with brain tumors have the highest prevalence of long-term morbidities. These effects can be attributed to direct neurologic damage to the developing brain caused by tumor, hydrocephalus, surgical removal of the tumor, and the effects of irradiation. The late effects experienced by childhood cancer survivors involve multiple domains, one of which is sleep disorders. Sleep dysfunction has an increased prevalence in the pediatric cancer survivor population. These issues are disruptive to patients and cause a decrease in quality of life. This review focuses on sleep disorders that occur in pediatric cancer survivors and discusses the possible causes, the assessments used to determine specific sleep disorders, and treatment modalities used to ameliorate this dysfunction with the hope of improving patient's quality of life.
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Ward TM, Archbold K, Lentz M, Ringold S, Wallace CA, Landis CA. Sleep disturbance, daytime sleepiness, and neurocognitive performance in children with juvenile idiopathic arthritis. Sleep 2010; 33:252-9. [PMID: 20175409 PMCID: PMC2817912 DOI: 10.1093/sleep/33.2.252] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To compare daytime sleepiness and neurobehavioral performance in children with active and inactive juvenile idiopathic arthritis (JIA), and explore relations among measures of sleep disturbance, daytime sleepiness, and neurobehavioral performance. DESIGN Cross-sectional, comparison. SETTING A university-based research sleep laboratory. PARTICIPANTS Seventy (70) children 6-11 years of age with active or inactive JIA. MEASUREMENTS AND RESULTS Self-reported daytime sleepiness, multiple sleep latency tests (MSLTs), and computerized neurobehavioral performance test scores were obtained after 2 nights of polysomnography. Children with active disease (mean physician global rating score = 2.9 +/- 1.9 SD) showed shorter mean MSLT latency (15 +/- 6.0 min) than those with inactive disease (16.5 +/- 5.5 min, P < 0.03). Scores on neurobehavioral performance tests showed no group differences. However, number of wake bouts predicted sustained visual attention (rapid visual processing, P < 0.05) and apnea hypopnea index (AHI) predicted reaction time (P < 0.0001), after controlling for age, IQ, medication, and disease status. CONCLUSION Indices of sleep disturbance were associated with validated tests of neurobehavioral performance in JIA, regardless of disease activity. Additional research is needed about the extent of sleep disturbances in relation to neurocognitive performance in JIA and compared to healthy children.
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Affiliation(s)
- Teresa M. Ward
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA
| | - Kristen Archbold
- Practice Division, College of Nursing, University of Arizona, Tucson, AZ
| | - Martha Lentz
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA
| | - Sarah Ringold
- Seattle Children's Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Carol A. Wallace
- Seattle Children's Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Carol A. Landis
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA
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Merino-Andréu M, Martínez-Bermejo A. [Narcolepsy with and without cataplexy: an uncommon disabling and unrecognized disease]. An Pediatr (Barc) 2009; 71:524-34. [PMID: 19892609 DOI: 10.1016/j.anpedi.2009.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 11/25/2022] Open
Abstract
Although narcolepsy is a relatively uncommon condition, its impact on a child's life can be dramatic and disabling. Narcolepsy is characterized by excessive daytime sleepiness (EDS), with brief "sleep attacks" at very unusual times and usually associated with cataplexy (sudden loss of muscle control while awake, resulting in a fall, triggered by laughter). Other symptoms frequently reported are sleep paralysis (feeling of being unable to move or speak, even totally aware), hypnagogic hallucinations (vivid dreamlike experiences difficult to distinguish from reality) or disturbed night time sleep. Some children also experience depression or overweight-obesity. Although narcolepsy has been thoroughly studied, the exact cause is unknown. It appears to be a disorder of cerebral pathways that control sleep and wakefulness, involving dorsolateral hypothalamus and hypocretin. A genetic factor has been suggested, but narcolepsy in relatives is rare. Researchers have suggested that a set of genes combines with additional factors in a person's life to cause narcolepsy. The effective treatment of narcolepsy requires not only medication (usually stimulants, antidepressants and sodium oxybate), but also adjustments in life-style (scheduled naps). Management of this condition in children demands a comprehensive approach to the patient, that includes a correct diagnosis, pharmacological and non-pharmacological treatment and adjustments in the environment. These strategies can improve the child's self-esteem and ability to obtain a good education.
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Affiliation(s)
- M Merino-Andréu
- Unidad Pediátrica de Trastornos de Sueño, Hospital Universitario La Paz, Madrid, España.
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26
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Abstract
PURPOSE OF REVIEW We provide an update on the pathogenesis, diagnosis, assessment (clinical and laboratory), and treatment options for children with narcolepsy and other hypersomnias of central origin in order to raise awareness of these diseases and to highlight the clinical findings that should make the pediatrician suspect the diagnosis. RECENT FINDINGS Narcolepsy is a chronic rapid eye movement sleep disorder. Accumulating evidence indicates that signs of narcolepsy may start during childhood. Recent data suggest that a deficiency in the hypothalamic orexin/hypocretin system underlies the pathogenesis of narcolepsy with cataplexy. Confirmatory tests such as polysomnography, multiple sleep latency test, and actigraphy, along with referral to a sleep physician, maybe necessary in appropriate cases. Laboratory tests such as human leukocyte antigen typing and cerebrospinal fluid hypocretin-1 analysis are useful as adjuncts. Modafinil is now considered the first-line treatment for excessive sleepiness in adult patients with narcolepsy. Sodium oxybate is currently approved by the Food and Drug Administration for the treatment of narcolepsy with cataplexy in patients aged more than 16 years. SUMMARY Awareness of the extent of hypersomnia in children will allow physicians to effectively screen every child; once identified, further assessment should be performed in order to diagnose and treat the underlying cause. Better understanding of pathogenesis, availability of newer therapies with different mechanism of effect, and appropriately designed randomized clinical trials should allow improved management of children with narcolepsy.
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