Background: Sleep terrors are common, frightening, but fortunately benign events. Familiarity
with this condition is important so that an accurate diagnosis can be made.
Objective: To familiarize physicians with the clinical manifestations, diagnosis, and management
of children with sleep terrors.
Methods: A PubMed search was completed in Clinical Queries using the key terms " sleep terrors"
OR " night terrors". The search strategy included meta-analyses, randomized controlled trials,
clinical trials, observational studies, and reviews. Only papers published in the English literature
were included in this review. The information retrieved from the above search was used in the
compilation of the present article.
Results: It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep
terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7
years of age. The exact etiology is not known. Developmental, environmental, organic, psychological,
and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend
to occur within the first three hours of the major sleep episode, during arousal from stage three or
four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from
sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has
a frightened expression. The child is confused and incoherent: verbalization is generally present but
disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis,
flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult
to arouse and console and may express feelings of anxiety or doom. In the majority of cases,
the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia
for the attack the following morning. Attempts to interrupt a sleep terror episode should be
avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good
sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary,
but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent
and severe or are associated with functional impairment, such as fatigue, daytime sleepiness,
and distress. Anticipatory awakening, performed approximately half an hour before the child is
most likely to experience a sleep terror episode, is often effective for the treatment of frequently
occurring sleep terrors.
Conclusion: Most children outgrow the disorder by late adolescence. In the majority of cases, there
is no specific treatment other than reassurance and parental education. Underlying conditions, however,
should be treated if possible and precipitating factors should be avoided.