Sleepwalking and Sleep Terrors in Prepubertal Children: What Triggers Them?

Abstract

ABSTRACT. Objectives. To evaluate the clinical presentation and polysomnography of prepubertal children with repetitive sleep terrors and sleepwalking, to compare them with a control group, and to evaluate the treatment of associated sleep disorders.Methods. Patients with complaint of sleep terrors with or without sleepwalking were studied retrospectively. A control group was also recruited. Each subject received a standardized evaluation, which included the following: 1) Pediatric Sleep Questionnaire; 2) interview regarding child's medical and sociofamilial history, orthodontic history, schooling, psychological difficulties, medication intake, and family history of medical and sleep disorders; 3) general pediatric physical examination and neurologic, otolaryngological, and craniofacial examination by a specialist; 4) obtaining medical history on variables relevant to early life sleep disorders; 5) polysomnography, which included electroencephalogram (EEG; C3/A2, Fp1/T1, T1/O1, O1/C3, C4/A1, Fp2/T2, T2/ O2, O2/C4), chin and leg electromyelogram, right and left electro-oculogram, and electrocardiogram (modified V2 lead); respiration was monitored with a nasal cannula/ pressure transducer system, mouth thermistor, chest and abdominal bands, pulse oximeter, and neck microphone; respiratory effort was monitored with calibrated esophageal manometry; variables were collected on a computerized sleep system; and 6) available family members with a positive history of sleep terrors and sleepwalking received clinical evaluations similar to those used for index cases; they also underwent ambulatory monitoring with an Edentrace system, which monitors heart rate, body position, oro-nasal flow, chest impedance, breathing noises (neck microphone), and pulse oximetry. Movements are deduced from artifact, and leg movements may be recorded on one channel if the equipment is preset for such recording. Subjects used logs to record "lights out" time, "lights on" time, nocturnal awakenings, and other events that occurred during the night. All original and follow-up recordings were rescored by 2 of 4 randomly selected specialists who were blind to subject identity. Mann-Whitney U test was used for group comparison. Nonparametric 2 test was used to compare percentages of symptoms in symptomatic children versus control children.Results. Eighty-four children (5 with sleep terrors and 79 with both sleep terrors and sleepwalking) and 36 normal control children formed the studied population. All subjects were Tanner stage 1 (prepubertal). None of the control children had any parasomnias. Fifty-one (61%) of 84 children with parasomnia had a diagnosis of an additional sleep disorder: 49 with sleep-disordered breathing (SDB) and 2 with restless leg syndrome (RLS). Twenty-nine of the children with both parasomnia and SDB had a positive family history of parasomnias, and 24 of the 29 also had a positive family history of SDB. Of the 51 children with associated sleep disorders, 45 were treated. Forty-three of 49 children with SDB were treated with...

Disorders of Arousal

“…A trial of sleep extension or scheduled awakening may be considered. SBD were reported to frequently occur in children with parasomnias with SBD mimicking parasomnia episodes in some cases and triggering them in others [49]. Also, PLMS, RLS/WED, and gastroesophageal reflux can determine arousals from sleep; therefore, specific treatments will reduce the parasomnias.…”

Parasomnias

“…Prevalence of sleepwalking, which consists of a series of complex behaviours that are initiated during slow wave sleep and result in walking during sleep, varies from 10 per 1,000 to 145 per 1,000. In a population of adults prevalence of sleep walking was 20 per 1,000 (Guilleminault et al, 2003). Sleep terrors, which are characterized by sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic and behavioral manifestations of intense fear, are a common parasomnia in childhood.…”

Outros Distúrbios Do Sono Na Síndrome Da Apnéia Do Sono

“…Além destes, qualquer distúrbio do sono capaz de induzir à fragmentação do sono, favorecendo, portanto, à dissociação das variáveis fisioló-gicas, pode potencialmente provocar tais parassonias. Os distúrbios respiratórios do sono ocorrem mais freqüentemente em crianças e adultos que apresentam parassonias 23,24 .Episódios freqüentes de parassonia em pacientes roncadores devem levantar a suspeita de distúrbios respiratórios do sono, devendo ser realizada investigação apropriada com polissonografia. O tratamento da apnéia do sono muitas vezes tem cará-ter resolutivo também em relação às parassonias.…”