In children and adolescents whose screening process reveals suspected
sleep problems, it is important to obtain a further sleep history.
The sleep habits include the bedtime and wake-up time during weekdays
and weekends, sleep onset, night awakenings, and daytime naps. In children
who snore at night, inquiries of other associated symptoms of sleep-disordered breathing
should be raised, such as respiratory pauses, gasping or choking
during sleep, mouth breathing, and morning headaches. For children with
suspected movement disorders during sleep, symptoms of leg discomfort
and abnormal movements of arms and legs should be obtained. The
presence of other parasomnias, especially nightmares, night terrors,
sleepwalking, and violent behavior during sleep should be reviewed. Children
with hypersomnia should be assessed for other accessory symptoms
of narcolepsy, including cataplexy, hypnagogic or hypnopompic hallucination,
and sleep paralysis. The degree of daytime sleepiness can be assessed
by asking about sleep propensity during various daytime activities,
such as during school class, while watching television, and while
taking a shower. It is important to evaluate the effect of sleep
disturbances on neurocognitive function, particularly school performance,
attention problems, and hyperactivity disorder. Details of sleep
environments, such as night light, level of noise, room temperature,
and television in the bedroom, should be sought. Other sleep issues,
such as cosleeping, bedtime refusal, and bedtime stalling, should
be addressed. Because several medications can affect sleep, a detailed
medical history, including current medications, caffeine, alcohol
consumption, and cigarette smoking, should be obtained. In the past
medical history, attention should be directed to risk factors for sleep-disordered
breathing (eg, history of frequent pharyngitis or tonsillitis, allergic
rhinitis, or sinusitis). Certain medical conditions can be associated
with specific sleep disorders, such as RLS and PLMD (iron deficiency
anemia, renal diseases) and secondary narcolepsy (brain tumor, Prader-Willi
syndrome, myotonic dystrophy). Psychiatric history, such as of depression, bipolar
disorder, and anxiety disorder, should be obtained. It is essential
to inquire about family history of sleep disorders, including sleep
apnea, RLS, PLMD, narcolepsy, and parasomnias.