STANFORD, CALIF—In children, parasomnias (including sleepwalking and sleep terrors) may be triggered by sleep-disordered breathing (SDB) and sometimes restless legs syndrome (RLS). A recent study discovered that when SDB and RLS were treated with tonsillectomy and drug therapy, respectively, parasomnias resolved in all cases.[1] The study also found a high frequency of SDB and parasomnias among the children’s family members.

Researchers from the Stanford University Sleep Disorders Clinic studied 84 children ages 2 to 11 who had parasomnias and compared them with 36 healthy children. Parents completed a pediatric sleep questionnaire, and children underwent neurological, otolaryngological, and craniofacial examinations. Medical and familial histories as they related to sleep disorders were taken. Polysomnography was performed, and respiration and respiratory effort were monitored.

All symptomatic children had had recurrent episodes of parasomnias for a minimum of four months. The reported frequency of these events was once a week in children ages 2 to 4, once every 15 days for ages 4 to 7, and variable for ages 7 and older.

A FAMILY AFFAIR

Among the children with parasomnias, 49 had symptoms that were suggestive of SDB, and two had symptoms of RLS. Twenty-nine of the children with parasomnias and SDB had a positive family history of parasomnias, and 24 also had a positive family history of SDB. Thirty-eight family members reported having a history of sleepwalking or sleep terrors. Among the 55 symptomatic children without family histories of parasomnias, 14 had family histories suggestive of SDB.

Fifty-five children with parasomnias had enlarged tonsils. In comparison, only three children in the control group did.

All children with parasomnias had evidence of sleep disruption during polysomnography. Twenty-three of the 49 children with symptoms of SDB had tachypnea and flow limitation at the nasal cannula, with sequences of sustained breathing effort. The mean apnea-hypopnea index was only 0.7 events per hour, but the mean respiratory disturbance index (RDI) was five events per hour. The mean number of arousals measured by electroencephalography (EEG) was nine per hour.

The control group had a mean apnea-hypopnea index of 0.3 events per hour and a mean RDI of 0.5 events per hour. Their mean number of EEG arousals was 2.7 per hour.

TONSILLECTOMY STOPS SDB

Children with SDB were referred to otolaryngologists for surgical assessment, and those with RLS were treated with drug therapy. Tonsillectomy was performed in 43 children with SDB, and the two children with RLS were prescribed a dopamine agonist to be taken at bedtime. All children who underwent surgery had a follow-up polysomnography three to four months later. Children receiving therapy for RLS had follow-up monitoring five to 12 weeks after starting treatment.

SDB and parasomnias resolved completely in all 43 children who underwent surgery. Analysis of nocturnal sleep showed a change from a mean of nine arousals per hour to three. In the six children who did not have surgery, abnormal SDB persisted. The two children who received drug therapy for RLS had complete cessation of arousals and parasomnias at follow-up.

According to the authors, “the clear, prompt improvement of severe parasomnias in children who were treated for SDB—as currently defined—provides important outcome-based evidence that SDB … more subtle than that commonly recognized to be abnormal can have substantial health-related significance.”

—Gale Jurasek

Reference
1. Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them? Pediatrics. 2003;111:e17-e25.

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