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A survey from the National Sleep Foundation (NSF) shows that 69% of children under 10 years of age experience some type of sleep disturbance.1 Significant sleep problems affect 25% to 40% of children and adolescents.2 These sleep problems tend to persist to adulthood if left untreated. Despite the high prevalence of sleep problems, most pediatricians do not ask question about children’s sleep. The survey from community practice shows that pediatricians acknowledge the importance of sleep problems, but they fail to screen adequately for them, especially in older children and adolescents.3 Untreated sleep disorders can lead to long-term consequences. Several studies have demonstrated the association between sleep disorders and cardiovascular and neurocognitive complications. Therefore, it is crucial that pediatricians recognize the signs and symptoms of sleep disorders and integrate sleep issues as part of the routine health maintenance. In this chapter, normal sleep development and the common sleep problems encountered in general pediatric practices are discussed. Obstructive sleep apnea is reviewed in Chapter 508.

Knowledge of sleep regulation, normal sleep, and its change during development is essential to understand and recognize sleep disorders in children and adolescents. Certain features of sleep help in the diagnosis of sleep disorders. For example, night terror, a phenomenon that occurs in nonrapid eye movement (NREM) sleep, is more likely to occur during the first part of the night when NREM predominates, while nightmares, a rapid eye movement (REM) phenomenon, are common during the latter part of the night. Sleep is the result of complex interaction between sleep- and wake-promoting neurons. The sleep-promoting neurons are located in the ventrolateral preoptic nucleus, which contains GABA-ergic (Gamma-amino-butyric acid) and galaninergic neurons. The awake-promoting neurons are located in the posterior lateral hypothalamus, which contains orexin/hypocretin neurons. A model is proposed in which wake- and sleep-promoting neurons inhibit each other, which results in stable wakefulness and sleep.4 Sleep and alertness are regulated by 2 important factors: the homeostatic factor, which depends on prior sleep duration and quality and awakening time and the circadian rhythm or intrinsic biological clock. These 2 forces interact and allow the diurnal pattern of sleep with consolidated sleep at night and wakefulness during daytime. Two “sleepiness” periods occur in humans. The first occurs at night between midnight and 6.00 am and the second in the early afternoon.5 The circadian rhythm is affected by several environmental cues (zeitgebers), such as social interaction and timing of meals, but the most important environmental cue is light exposure, which has different effects on the biological clock depending on the time of exposure.

Normal human sleep comprises 2 major stages, NREM and REM sleep, based on the characteristic of the electroencephalogram, electromyogram, and electrooculogram.6 NREM sleep is subdivided into 4 stages. Stage 1 is defined by an attenuation of high-frequency alpha wave (8–13 Hz); the presence of low-amplitude, mixed-frequency electroencephalogram (theta wave, 4–7 Hz); a slight decrease in chin electromyogram from awake; vertex sharp waves; ...

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