Review Article Sleep-Related Disorders in Neurologic Disease During Childhood Michael H. Kohrman, MD* and Paul R. Carney, MD † Sleep disorders commonly are associated with neuro- logic disorders in childhood. This review discusses primary sleep disorders that affect children with pri- mary neurologic diseases. Primary sleep disorders are discussed as they relate to the primary neurologic disease. In addition, sleep disorders secondary to neu- rologic disorders commonly seen in the practice of pediatric neurology are reviewed. A useful sleep his- tory to improve diagnostic and therapeutic interven- tions is outlined. Kohrman MH, Carney PR. Sleep-related disorders in neurologic disease during childhood. Pediatr Neurol 2000; 23:107-113. Introduction Disorders of sleep have an impact on daily living for both patients and caregivers. Sleep disturbance and lack of restful sleep can masquerade as myriad of clinical prob- lems, including inattention, depression, headache, and seizures. Although most neurologic disorders are well characterized during the waking state, descriptions of signs and disabilities are frequently poorly described during rapid eye movement (REM) and non–rapid eye movement (NREM) sleep. Physiologic changes associated with sleep can cause an alteration of signs and function during both REM and NREM sleep. These changes may include alterations in muscle tone, central control of autonomic functions, and changes in cortical neurotrans- mitter system interaction and balance. This review is limited to the topics outlined in Table 1. These topics were chosen because they represent a group of problems seen by the practicing pediatric neurologist. We have intentionally avoided a discussion of sleep pathophysiology and primary sleep disorders (narcolepsy, circadian rhythm disturbances, and sleep apnea syn- dromes), except as they relate to primary neurologic disease. Insufficient Sleep Syndrome The most common cause of excessive daytime sleepi- ness in children and adults is most likely insufficient sleep syndrome. The child does not obtain sufficient nocturnal sleep to maintain daytime alertness [1]. It is most often overlooked when assessing the child with school prob- lems. Pre-adolescents sleep approximately 9-10 hours per night [2]. Their daytime alertness, as measured by the multiple sleep latency test, yields average sleep latencies that are greater than 19 minutes [2]. During adolescence, the total sleep time remains constant, with total REM time increasing by approximately 5% [3]. Sleep latency, as measured by the multiple sleep latency test, decreases by 30%. Multiple sleep latency tests recorded from college students demonstrated mean sleep latency times of less than 6 minutes [3]. Daily sleep habits change between the pre-adolescent and adolescent period. The pre-adolescent sleeps on average 1 hour more on school nights than on non-school nights, and the adolescent tends to sleep more on non-school nights than on school nights. This behavior change produces a “sleep debt” created during the school week. The child attempts to compensate for the lack of sleep by increasing sleep on non-school nights. By late adolescence, this 2-3 hours of extra sleep each non-school/ work night is the equivalent of an extra night of sleep for the adolescent or adult each weekend. Increasing the daily nocturnal sleep improves daytime alertness and is thera- peutic. Sleep logs usually confirm less than 7 hours of sleep at night. In conjunction with increased sleep on weekends, decreased sleep latency and an absence of significant arousals are highly suggestive of insufficient sleep syndrome [3]. Intrinsic disorders of sleep, affective disorders, and psychophysiologic insomnia should be excluded if behavioral modification is not successful. From the *Department of Pediatrics; Section of Neurology; University of Chicago Pritzker School of Medicine; Chicago, Illinois and † Department of Pediatrics; Division of Neurology; University of Florida College of Medicine; Gainesville, Florida. Communications should be addressed to: Dr. Kohrman; 5841 S. Maryland Ave; MC 3055; Chicago, IL 60637. Received July 12, 1999; accepted March 13, 2000. 107 © 2000 by Elsevier Science Inc. All rights reserved. Kohrman and Carney: Sleep-Reated Disorders in Neurologic Disease PII S0887-8994(00)00174-0 ● 0887-8994/00/$20.00