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Sleep Disorders in Children: Presentation, Early Identification and Treatment

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Pulmonary and Sleep Medicine".

Deadline for manuscript submissions: 15 May 2024 | Viewed by 12917

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Special Issue Editors

Dr. Manisha Witmans

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Guest Editor

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
Interests: obstructive sleep apnea; clinical sleep disorders; craniofacial development; systemic inflammation and sleep disorders
Special Issues, Collections and Topics in MDPI journals

Dr. Mary Anne Tablizo

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Guest Editor

Division of Pediatric Pulmonary and Sleep Medicine, Valley Children’s Hospital, Madera, CA 93636, USA
Interests: pediatric obstructive sleep apnea; clinical sleep disorders; sleep disordered breathing
Special Issues, Collections and Topics in MDPI journals

Dr. Rakesh Bhattacharjee

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Co-Guest Editor

Rady Children's Hospital and Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
Interests: pediatric obstructive sleep apnea; clinical sleep disorders; sleep disordered breathing

Dr. Darius A. Loghmanee

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Guest Editor Assistant

Advocate Children’s Hospital, Park Ridge, IL, USA
Interests: pediatric obstructive sleep apnea; clinical sleep disorders; sleep disordered breathing

Special Issue Information

Dear Colleagues,

Sleep disorders are common in children. Sleep deprivation, be it from poor sleep quality or insufficient sleep, can lead to long-term consequences for a child's health and quality of life. It can significantly impact their behavior and cognitive development. Obstructive sleep apnea can affect their growth and can also lead to cardiovascular and metabolic disorders. Early identification of sleep disorders can prevent these negative sequelae.

In the first Special Issue (https://www.mdpi.com/journal/children/special_issues/obstructive_sleep_apnea_syndrome_in_children), we discussed the presentation, pathophysiology, methods of diagnosis, sequelae, and management for children with OSA. In this series, we will continue with more updates in OSA and other sleep-related breathing disorders both in children who are healthy and with underlying medical disorders.

Other non-respiratory sleep disorders such as parasomnias are often observed in young children. They can present as sleep walking, night terrors, confusional arousal and nightmares. Poor sleep quality and insufficient sleep can exacerbate these sleep disorders. Parasomnias can cause sleep disruption and affect daytime behavior.

Insomnia in childhood is also common and can lead to long-term consequences including mental health issues and persistence of chronic insomnia. Difficulty initiating sleep among teenagers from delayed sleep schedules related to circadian rhythm disorder has been increasingly reported, especially in the period following the COVID-19 pandemic. Overall, an increased prevalence of insomnia has been reported following the COVID-19 pandemic. Behavioral insomnia in childhood from learned sleep onset association and behavioral problems leading to difficulty initiating sleep are commonly observed in younger children. Other medical conditions or sleep disorders can cause or worsen insomnia, such as restless leg syndrome, which are also even reported in young children. The urge to move the leg from leg discomfort commonly presents at night when sedentary and can cause difficulty initiating and maintaining sleep.

Excessive daytime sleepiness from primary sleep disorders such as narcolepsy is reported in children and can present even in young children. Hypersomnia can also be a consequence of other sleep disorders and health conditions.

Screening for any sleep problems during a child’s healthy routine maintenance visit is critical, as healthy and restorative sleep should be considered as a fundamental aspect of growth and development. This series of articles will highlight the recent trends and knowledge about sleep disorders in children.

Dr. Manisha Witmans
Dr. Mary Anne Tablizo
Dr. Rakesh Bhattacharjee
Guest Editors

Dr. Darius A. Loghmanee
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

parasomnia
insomnia in children
hypersomnia
sleep disorders
obstructive sleep apnea
sleep-related breathing disorders
children
sleep disordered breathing

Published Papers (9 papers)

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Research

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12 pages, 521 KiB

Open AccessArticle

Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED)

by Greta Carabelli, Ivan Binotto, Chiara Armano, Lorenza Bertù, Chiara Luini, Luana Nosetti, Massimo Agosti and Silvia Salvatore

Children 2024, 11(4), 450; https://doi.org/10.3390/children11040450 - 08 Apr 2024

Viewed by 470

Abstract

Background: Nocturnal infant crying is often empirically treated with acid suppressants. The aim of this study was to evaluate the prevalence and characteristics of gastroesophageal reflux (GER) in infants with unexplained persistent crying. Methods: We enrolled all infants (0–12 months) referred for suspected GER disease who underwent esophageal impedance–pH monitoring (MII-pH) for unexplained persistent crying not improved by parental reassurance, dietary modification or alginate. Gastrointestinal malformation/surgery, neurological impairment and infections were exclusion criteria. Demographic and anthropometric parameters, GER symptoms and questionnaires (I-GERQ-R) and MII-pH data were recorded and analyzed. Normal MII-pH was defined when acid exposure was <3%, symptom index was <50% and symptom association probability was <95%. Acid exposure >5% and >10% was also considered. Statistical analysis was performed using Chi-Square and univariate and multivariable regression analysis. Results: We included 50 infants (median age 3.5 months) who fulfilled the study criteria: 30 (60%) had normal MII-pH. I-GERQ-R score was abnormal in 33 (66%) infants, and 21/33 (64%) had normal MII-pH (p = 0.47). In the 26 (52%) infants with nocturnal crying, MII-pH was normal in 16 (54%) (p = 0.82). Associated regurgitation (>3 or >10 episodes/die) did not predict abnormal MII-pH (p = 0.74, p = 0.82, respectively). Univariate and multivariable regression analysis did not identify any clinical variable significantly associated with abnormal MII-pH. Conclusions: Infants with persistent unexplained and nocturnal crying should not be empirically treated with acid inhibitors. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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14 pages, 746 KiB

Open AccessArticle

Sleep Stage Transitions and Sleep-Dependent Memory Consolidation in Children with Narcolepsy–Cataplexy

by Katia Gagnon, Amandine E. Rey, Anne Guignard-Perret, Aurore Guyon, Eve Reynaud, Vania Herbillon, Jean-Marc Lina, Julie Carrier, Patricia Franco and Stéphanie Mazza

Children 2023, 10(10), 1702; https://doi.org/10.3390/children10101702 - 18 Oct 2023

Viewed by 1100

Abstract

Electroencephalographic sleep stage transitions and altered first REM sleep period transitions have been identified as biomarkers of type 1 narcolepsy in adults, but not in children. Studies on memory complaints in narcolepsy have not yet investigated sleep-dependent memory consolidation. We aimed to explore stage transitions; more specifically altered REM sleep transition and its relationship with sleep-dependent memory consolidation in children with narcolepsy. Twenty-one children with narcolepsy–cataplexy and twenty-three healthy control children completed overnight polysomnography and sleep-dependent memory consolidation tests. Overnight transition rates (number of transitions per hour), global relative transition frequencies (number of transitions between a stage and all other stages/total number of transitions × 100), overnight transitions to REM sleep (transition from a given stage to REM/total REM transitions × 100), and altered first REM sleep period transitions (transitions from wake or N1 to the first REM period) were computed. Narcoleptic children had a significantly higher overnight transition rate with a higher global relative transition frequencies to wake. A lower sleep-dependent memory consolidation score found in children with narcolepsy was associated with a higher overnight transition frequency. As observed in narcoleptic adults, 90.48% of narcoleptic children exhibited an altered first REM sleep transition. As in adults, the altered sleep stage transition is also present in children with narcolepsy–cataplexy, and a higher transition rate could have an impact on sleep-dependent memory consolidation. These potential biomarkers could help diagnose type 1 narcolepsy in children more quickly; however, further studies with larger cohorts, including of those with type 2 narcolepsy and hypersomnia, are needed. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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13 pages, 552 KiB

Open AccessArticle

Focus Groups to Inform User-Centered Development of an eHealth Sleep Intervention for Adolescents: Perspectives of Youth with Insomnia Symptoms, with and without Pain

by Michelle Tougas, Gabrielle Rigney, Christine Chambers, Isabel Smith, Joshua Mugford, Laura Keeler, Malgorzata Rajda and Penny Corkum

Children 2023, 10(10), 1692; https://doi.org/10.3390/children10101692 - 16 Oct 2023

Viewed by 1228

Abstract

Introduction: Adolescence is a developmental stage that often coincides with increasing sleep problems. Focus groups were conducted to inform development of an adolescent eHealth sleep intervention by exploring opinions about (1) healthy sleep practices, and (2) using an eHealth intervention. Methods: Adolescents 14–18 years old experiencing symptoms of insomnia based on the Insomnia Sleep Index, with and without recurrent pain, and associated stakeholders (i.e., parents, school personnel, and health care providers) were recruited. Across six online focus groups, 24 adolescents with insomnia participated (14 pain-free, 10 with recurrent pain; 10 male, 14 female). Across seven online focus groups, 22 stakeholders participated, including 8 parents, 9 school professionals, and 5 health care providers (10 male, 8 female). Using a content analysis, subthemes were induced from transcripts. Results: Most healthy sleep practices were perceived as reasonable for adolescents to implement, except avoiding technology before bed and using bedrooms only for sleep. Three primary barriers to sleep practices were identified, including a variable schedule due to lifestyle factors, technology at night, and academics interfering with sleep, and only in the pain group, the barrier related to pain was identified. Content addressing adolescent-specific barriers was considered important to include in a sleep intervention. Desirable eHealth components included interactive features, videos, audio, and pictures to present information. A common barrier to using an eHealth sleep intervention was the program feeling too academic, with accessibility of the sleep information and strategies as a common facilitator. Conclusions: This research represents the first step in a user-centered approach to developing an adolescent eHealth sleep intervention. These results provide insights from a range of perspectives on guiding adolescents to follow healthy sleep practices. Next, these findings will be integrated in the development of an eHealth intervention for adolescents with and without recurrent pain. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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13 pages, 1145 KiB

Open AccessArticle

Low Sleep Hygiene Is Associated with Less Adherence to the Mediterranean Diet in Chilean Schoolchildren from Rural Public Schools—A Cross-Sectional Study

by Rafael Zapata-Lamana, Jessica Ibarra-Mora, Fernanda Carrasco-Marín, Samuel Durán-Agüero, Jorge Cuevas-Aburto, Maria Antonia Parra-Rizo and Igor Cigarroa

Children 2023, 10(9), 1499; https://doi.org/10.3390/children10091499 - 01 Sep 2023

Cited by 1 | Viewed by 849

Abstract

The Mediterranean diet stands as a widely acknowledged and health-promoting dietary pattern, renowned for its notable linkage to the mitigation of noncommunicable chronic maladies. Nonetheless, the existing body of evidence concerning the potential interrelation between sleep hygiene and this dietary regimen remains circumscribed. The main objective was to determine the association between sleep hygiene and adherence to the Mediterranean diet in Chilean schoolchildren from rural public schools in southern Chile. A non-experimental study was carried out, with an analytical, cross-sectional design. A total of 265 students (56.6% women, mean age 13.5 ± 1.8) from a rural community in southern Chile were recruited. Sleep habits were evaluated using Section 6 of the Life Habits and Adolescence Questionnaire, Sleep and Rest, and adherence to the Mediterranean diet was assessed with the KIDMED Mediterranean Diet Adherence Questionnaire. The main results indicated that 52.8% of schoolchildren need to improve adherence to the Mediterranean diet and 16.6% have a low-quality Mediterranean diet. A high percentage of schoolchildren have behaviors related to poor sleep hygiene (going to bed late (46%), waking up tired and wanting to continue sleeping (63.8%), and having problems falling asleep (42.6%)). Schoolchildren who got up after 8:30 a.m., those who fell asleep after midnight, upon conducting a comparative analysis of the students based on their sleep patterns, those who woke up tired and those who had trouble falling asleep had a lower level of adherence to the Mediterranean diet compared to schoolchildren who got up earlier than 8:30 a.m., fell asleep before midnight, did not wake up tired, and those who did not find it difficult to fall asleep, respectively. In conclusion, having poor sleep patterns including difficulties in both awakening and falling asleep are associated with less adherence to the Mediterranean diet in schoolchildren from rural public schools in southern Chile. Monitoring these variables and promoting healthy lifestyle habits within the educational community are essential measures. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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11 pages, 512 KiB

Open AccessArticle

Low Doses of Melatonin to Improve Sleep in Children with ADHD: An Open-Label Trial

by Ana Checa-Ros, Antonio Muñoz-Hoyos, Antonio Molina-Carballo, Iris Viejo-Boyano, Maricarmen Chacín, Valmore Bermúdez and Luis D’Marco

Children 2023, 10(7), 1121; https://doi.org/10.3390/children10071121 - 28 Jun 2023

Cited by 1 | Viewed by 3602

Abstract

Objective. Only a few studies assessing the sleep effects of low doses of melatonin (aMT) have been performed in the past, most of them in adults, and only one in subjects with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to provide evidence of the changes induced by aMT doses as low as 1 mg in the sleep pattern of pediatric patients with ADHD under treatment with methylphenidate (MPH). Methods. Children and adolescents (7–15 years) with ADHD who were receiving extended-release MPH were recruited. A seven-week sleep diary was collected prior to starting a four-week treatment with 1 mg of aMT (30 min before bedtime). Seven-day actigraphic assessments of sleep were performed before and after treatment. Results. Twenty-seven patients (17 males, 62.96%) participated in the study, who had been receiving MPH for 1.57 (1.11) months. A significant increase in sleep duration (TST) was observed after one month of treatment (463 (49) min to 485 (41) min; p < 0.040), with nonsignificant improvements in sleep-onset latency (SOL), nocturnal awakenings, or sleep efficiency. Only minor adverse effects were reported. Conclusion. Low doses of melatonin (1 mg) are able to increase TST in children and adolescents with ADHD receiving treatment with psychostimulants, with an adequate tolerability profile. Further placebo-controlled trials adjusting the time of aMT administration to the individual circadian profile should explore the effects of low doses of this hormone to shorten SOL in this population of patients. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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Review

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11 pages, 521 KiB

Open AccessReview

Melatonin Use in Pediatrics: A Clinical Review on Indications, Multisystem Effects, and Toxicity

by Pranita Shenoy, Adriana Etcheverry, Jalyn Ia, Manisha Witmans and Mary Anne Tablizo

Children 2024, 11(3), 323; https://doi.org/10.3390/children11030323 - 09 Mar 2024

Viewed by 1403

Abstract

Exogenous melatonin is typically used for sleep regulation in the context of insomnia either in healthy children or those with neurodevelopmental disabilities. It is also used for the management of circadian rhythm sleep disorders in pediatric and adolescent patients. There are also many other possible indications that we will discuss in this paper beyond the role of melatonin for sleep regulation, including its potential use for various areas of medicine such as inflammatory conditions. Since melatonin is unregulated in the United States, distributed over the counter and perceived to be natural and safe, it has become available in many forms in the last two decades. With increasing sleep disturbances and mental health problems after the COVID-19 pandemic, melatonin has become even more popular and studies have shown a dramatic increase in use as well as resulting side effects, including melatonin overdose. As melatonin is generally viewed by physicians as a benign medication, we hope to increase awareness of melatonin’s properties as well as negative side effects to optimize its use in the pediatric population. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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15 pages, 789 KiB

Open AccessReview

Laryngomalacia and Obstructive Sleep Apnea in Children: From Diagnosis to Treatment

by Luca Cerritelli, Andrea Migliorelli, Alessio Larini, Andrea Catalano, Alberto Caranti, Chiara Bianchini, Andrea Ciorba, Francesco Stomeo, Claudio Vicini and Stefano Pelucchi

Children 2024, 11(3), 284; https://doi.org/10.3390/children11030284 - 25 Feb 2024

Viewed by 1094

Abstract

The aim of this review is to investigate the state of the art among the association between Obstructive sleep apnea (OSA) and laryngomalacia, analyzing the epidemiology, the diagnostic tools, and the possible treatments available to affected patients. Laryngomalacia, characterized by the malacic consistency of the epiglottis with a tendency to collapse during inspiratory acts, producing a characteristic noise known as stridor, is a common condition in infants and particularly in those affected by prematurity, genetic diseases, craniofacial anomalies, and neurological problems. Congenital laryngomalacia, presenting with stridor within the first 15 days of life, is often self-limiting and tends to resolve by 24 months. OSA is not only a consequence of laryngomalacia but also exacerbates and perpetuates the condition. Currently, the treatments reported in the literature are based (i) on medical therapies (including watchful waiting) and (ii) on surgical treatments. Among the surgical techniques, the most described is supraglottoplasty, performed with the use of cold instruments, CO₂ LASER, transoral robotic surgery, or the microdebrider. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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38 pages, 3378 KiB

Open AccessReview

Continuous Spike–Waves during Slow Sleep Today: An Update

by Annio Posar and Paola Visconti

Children 2024, 11(2), 169; https://doi.org/10.3390/children11020169 - 28 Jan 2024

Viewed by 1227

Abstract

In the context of childhood epilepsy, the concept of continuous spike–waves during slow sleep (CSWS) includes several childhood-onset heterogeneous conditions that share electroencephalograms (EEGs) characterized by a high frequency of paroxysmal abnormalities during sleep, which have negative effects on the cognitive development and behavior of the child. These negative effects may have the characteristics of a clear regression or of a slowdown in development. Seizures are very often present, but not constantly. The above makes it clear why CSWS have been included in epileptic encephalopathies, in which, by definition, frequent EEG paroxysmal abnormalities have an unfavorable impact on cognitive functions, including socio-communicative skills, causing autistic features, even regardless of the presence of clinically overt seizures. Although several decades have passed since the original descriptions of the electroclinical condition of CSWS, there are still many areas that are little-known and deserve to be further studied, including the EEG diagnostic criteria, the most effective electrophysiological parameter for monitoring the role of the thalamus in CSWS pathogenesis, its long-term evolution, the nosographic location of Landau–Kleffner syndrome, standardized neuropsychological and behavioral assessments, and pharmacological and non-pharmacological therapies. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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Other

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22 pages, 2134 KiB

Open AccessSystematic Review

Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review

by Marco Zaffanello, Refika Hamutcu Ersu, Luana Nosetti, Giulio Beretta, Massimo Agosti and Giorgio Piacentini

Children 2024, 11(2), 208; https://doi.org/10.3390/children11020208 - 06 Feb 2024

Viewed by 1027

Abstract

This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and –I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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