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T HE IMPORTANCE OF sleep is often undervalued, but for children, proper sleep helps ensure physical and mental health. By some estimates, many children are not getting enough quality sleep. In fact, up to 25–30 percent experience some type of sleep disorder, and worse, many are undiagnosed or misdiagnosed as mood or attention disorders. Symptoms that May Indicate Sleep Issues Part of the difficulty diagnosing sleep disorders is that symptoms may not immediately appear to be related. Patient families may observe their child is moody and irritable or has significant behavioral or learning problems. Families often expect these behaviors to result from something occurring during waking hours, and this may be reinforced through discussions with pediatricians. While younger children normally spend more than half the day asleep, clinical encounters often focus on problems that occur when the child is awake, so it's important to ask about sleep health, too. Some risk factors associated with sleep disorders tend to be more common in children who are obese or who have craniofacial abnormalities, neurological problems or developmental delays. They may also be caused by enlarged tonsils or adenoids, micronutrient deficiencies or medication side effects. A sleep study may be necessary if problems last longer than a few weeks and interfere with how the child feels and functions during the day. Types of Sleep Disorders Sleep disorders are divided into two broad categories: dys- somnias, which involve difficulty getting to sleep, staying asleep or excessive daytime sleepiness, and parasomnias, or disorders that include abnormal experiences or behaviors during sleep. Obstructive sleep apnea syndrome (OSAS) is a common dys- somnia, occurring in approximately 2 percent of young children. The prevalence and underdiagnosis of OSAS has prompted the American Academy of Pediatrics to recommend all children receive screening for snoring — the hallmark of OSAS. Other common disorders include: + Circadian rhythm disorders, including delayed sleep phase syndrome + Disorders associated with hypoventilation or hypoxemia + Hypersomnias, including narcolepsy + Insomnias, including childhood behavioral insomnias + Non-REM parasomnias, including sleep terrors, sleep walking and confusional arousal + Periodic limb movement disorder and restless legs syndrome REM parasomnias, including nightmares, sleep paralysis and REM sleep behavior disorder Sleep Studies While sleep studies in children mirror those of adults, the execution is significantly different. In Akron Children's Hospital's child-friendly sleep lab, for example, a parent stays with the child overnight during the study, and the presence of caring, pediatric-oriented sleep technologists is crucial. The most frequently ordered sleep study is an overnight polysom- nography (PSG). The PSG measures limited EEG, electrooculogram, nasal and oral airflow, snoring and vocalizations, nasal airway pressure, EKG, oxygen saturation, expired or transcutaneous carbon dioxide, and limb EMG, as well as chest and abdominal wall respiratory effort. Nighttime behaviors and body positions are monitored via video. If nighttime seizures are suspected, a full EEG can be piggybacked onto the standard PSG. A Multiple Sleep Latency Test is the standard tool for evaluating hypersomnia — narcolepsy, for example. It measures rapidity of sleep onset during the day following an overnight PSG. The test involves five nap opportunities offered two hours apart and requires careful planning to avoid confounders, such as prior sleep debt and certain medications. Hope for Children with Sleep Disorders When a child does not sleep well and exhibits challenging daytime behaviors, it can put tremendous strain on families. With proper diagnosis, many sleep disorders are highly treatable. Dr. Krishna is a board-certified pediatric and sleep medicine specialist. He is the director of Akron Children's Hospital's Pediatric Sleep Center and a member of the Pulmonary Medicine department. ■ By Jyoti Krishna, MD +++++++++++++++++ + +++ + +++ +++++++++++++++++ PEDIATRICS ❯ Diagnosing Sleep Disorders in Children The Importance of Zzzs: 2 0 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ J U LY/AU G U S T 2 0 1 5