Restless sleep disorder in children with NREM parasomnias

Abstract

Study objectives Restless sleep disorder (RSD) is a newly defined sleep disorder in the pediatric age group. Here we investigated the frequency of RSD and the sleep characteristics in children with NREM (non-rapid eye movements) parasomnias associated with RSD. Methods We analyzed all patients with NREM parasomnias for the last one year, and investigated the clinical and polysomnographic characteristics. Results Twenty-eight children with NREM parasomnias and age-and gender-matched 20 healthy children were analyzed. The diagnosis of RSD was made in 8 children with NREM parasomnias (28.6%), and none of the children had RSD in controls (p=0.008). The most common diagnosis among children with RSD was somnambulism (six children), but not significantly (p=0.308). Sleep efficiency was lower in children with RSD than those without RSD (p=0.033). In cyclic alternating pattern analysis (CAP), CAP rate, durations and the indices of phases A1, A2, and A3 were significantly higher in children with NREM parasomnias in compared to controls. CAP parameters between children with or without RSD, however, were similar, except for higher index of phase A3 in children with RSD, suggesting arousal reactions accompanying RSD. Conclusions We demonstrated that RSD was present in almost one third of the children with NREM parasomnias. Sleep quality was worse in children with NREM parasomnias and RSD. An increase in sleep instability compatible with NREM parasomnia was present, while an increased phase A3 in RSD was remarkable. RSD is associated with a worse sleep quality and increased arousals, and should be questioned in children with NREM parasomnias.

Restless sleep disorder in children with epileptic and non‐epileptic nocturnal attacks

“…Increased sleep instability has been postulated as a mechanism for sleep disruption in children with restless sleep disorder, which was confirmed by the studies with CAP analysis showing the longer duration of CAP cycle sequences (DelRosso, Hartmann et al, 2020c; Senel et al, 2021). These studies in children with restless sleep disorder have shown that LMM mostly occurred during non‐CAP periods, but if occurred within CAP, they were mostly associated with A3 subtypes (DelRosso, Hartmann et al, 2020c).…”

“…Nevertheless, there are only few studies in the literature reporting the restless sleep disorder prevalence under associated conditions. In a previous report of the authors (Senel et al, 2021), restless sleep disorder was diagnosed in eight out of 28 children with NREM parasomnias (28.6%). Here we observed that RSD was present in 25% of patients with parasomnia, and in 20% of patients with abnormal nocturnal movements – except for parasomnias or epilepsy.…”

“…In the current study, we found a high prevalence of restless sleep disorder in children with epilepsy. The prevalence of restless sleep disorder was estimated to be 7.7% in clinical sleep centre (DelRosso, Hartmann et al, 2020c;Senel et al, 2021). These studies in children with restless sleep disorder have shown that LMM mostly occurred during non-CAP periods, but if occurred within CAP, they were mostly associated with A3 subtypes (DelRosso, Hartmann et al, 2020c).…”

“…On the other hand, it can be challenging to differentiate RSD from other sleep disorders, especially from the restless legs syndrome/Willis‐Ekbom disease (RLS/WED) (DelRosso, Mogavero, & Ferri, 2022a). Also, some pathological/conditions may be comorbid to the restless sleep disorder, such as iron deficiency anaemia (DelRosso, Picchietti, Spruyt et al, 2021b), or NREM sleep parasomnia (DelRosso & Ferri, 2019; Senel et al, 2021). Restless sleep was also reported in paediatric patients with epilepsy, commonly in association with other sleep disorders (Kaleyias et al, 2008; Stores et al, 1998), while Becker et al (2003) did not find a significant difference in terms of the presence of restless sleep between the children with and without epilepsy.…”

“…On the other hand, it can be challenging to differentiate RSD from other sleep disorders, especially from the restless legs syndrome/Willis-Ekbom disease (RLS/WED) (DelRosso, Mogavero, & Ferri, 2022a). Also, some pathological/ conditions may be comorbid to the restless sleep disorder, such as iron deficiency anaemia (DelRosso, Picchietti, Spruyt et al, 2021b), or NREM sleep parasomnia Senel et al, 2021).…”