What is the focus of the clinical history to evaluate pediatric sleep disorders?

Updated: Oct 09, 2018
  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

In evaluating a child or adolescent for a sleep disorder, the importance of a thorough sleep history cannot be overemphasized. A sleep diary, usually kept for about 2 weeks, provides information on night-to-night variability over time. An example of a sleep diary appropriate for children can be found at www.sleepforkids.org/pdf/SleepDiary.pdf.

Self-report sleep questionnaires, such as the School Sleep Habits Survey and the Children’s Sleep Habits Questionnaire (CSHQ), are specific to adolescents and school-aged children, respectively. The Sleep Disturbance Scale for Children (SDSC) is a 26-item parent questionnaire for children and adolescents to screen for primary sleep disorders such as obstructive sleep apnea.

Rating scales can help track patient compliance with behavioral interventions and response to treatment. Rating scales have been developed to quantify subjective sleepiness of patients. The Epstein Sleepiness Scale and the Stanford Sleepiness Scale are examples.

Issues to be addressed in the history include the following:

  • Temporal history

  • When the problem began

  • Predisposing, precipitating, and perpetuating factors

  • Review of evening activities and bedtime rituals

  • Sleep environment

  • Latency to sleep onset

  • Arousals - When, for how long, and how often arousal occurs; behavior during awakening; and ease with which the child returns to sleep

  • History of snoring, breathing pauses, sleepwalking, talking, enuresis, and nocturia

  • Sleep position

  • Nightmares and sleep terrors

  • Seizure symptoms - Tongue biting, chewing, blood on bedclothes, and encopresis

  • Time of morning awakening, sleep paralysis, and early-morning headache

  • Total sleep time

  • Restorative sleep

  • Daytime sleepiness, fatigue, and school performance

  • Questions about depression, anxiety, worries or concerns, hyperactivity, and irritability

  • Frequency and duration of naps

  • Existing comorbid disorders

  • Substance use

  • Use of caffeine, alcohol, drugs, medications (prescription or over-the-counter [OTC]), and herbal preparations

  • Family history of sleep disorder or metabolic disorder

  • Parents’ sleep habits [12]

  • Efforts made to control symptoms

  • Overall impact of sleep disturbance on family


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