Review of Somnambulism in Children

Allison   Chan   DO; Christian      Guilleminault

Abstract

Sleepwalking is a disorder that manifests in the pediatric population and is seen out of stages 3-4 NREM sleep during the first third of the night. This paroxysmal disorder of arousal is reproducible and associated with automatic actions and retrograde amnesia. Clinicians need to consider sleep terrors, confusional arousals, nocturnal seizures, and migraines in the differential. Overnight polysomnograms of patients with sleepwalking show an instability of NREM sleep, which may be due to the presence of other sleep-related disorders. One of the most common of these disorders is related to abnormal breathing during sleep. This abnormal breathing may be the well known obstructive sleep apnea syndrome, but often it is a more subtle form called Upper Airway Resistance Syndrome. This last presentation may be associated with chronic allergy, orthodontic problems or moderately enlarged adenotonsils. Restless Leg or Periodic Limb Movement syndromes may also lead to chronic instability of NREM sleep, on which sleepwalking will occur. Treatment of these underlying disorders eliminates the sleepwalking. Use of special recording techniques in polysomnography enables appropriate recognition of the associated and subtle sleep disorders, particularly in cases of chronic sleepwalking. Patients with sleepwalking as well as their family members should be informed of the many ways to safeguard their environment at night.

Keywords: sleepwalking, parasomnia, slow-wave sleep (sws), nrem

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