Excessive daytime sleepiness is a common problem seen amongst children, teenagers and young adults. Excessive daytime sleepiness is usually underreported by patients and parents leading to a delayed diagnosis. This leads to many problems including a poor quality of life. In this article we discuss various causes and diagnosis of excessive daytime sleepiness in children and adolescents.
What are the causes of excessive daytime sleepiness in children?
Excessive daytime sleepiness can be caused by a wide range of sleep disorders. The commonest cause of excessive daytime sleepiness is insufficient sleep. This is usually due to unhealthy sleep habits but can also be due to insomnia secondary to sleep associations/limit setting or anxiety disorders in teenagers. The other common cause of excessive daytime sleepiness is fragmented/disturbed sleep due to obstructive sleep apnea (OSA) or restless legs syndrome (RLS). As children have a poor sleep quality at night they remain sleepy in the day. Delayed sleep wake syndrome is another cause of excessive daytime sleepiness. This happens due to the shifting of the biological clock to a later time. Primary sleep disorders that increase sleep needs like Narcolepsy, Kleine-Levin syndrome etc are rare causes of excessive daytime sleepiness.
What are the problems associated with excessive daytime sleepiness in children?
Untreated pediatric sleep problems and associated excessive daytime sleepiness leads to impaired health, behavioral problems, mood disturbances like depression, impairments in neurocognitive function and poor school performance. Sometimes, children with daytime sleepiness report to doctors when parents become concerned about behavioral, mood, and academic issues and they may not attribute this to the underlying sleep problems. Young children might develop symptoms such as hyperactivity and oppositional behavior as they are unable to verbalize the internal state of “sleepiness.”
How do we diagnose the cause of excessive daytime sleepiness in children?
The diagnosis of excessive daytime sleepiness in children requires a proper evaluation by a pediatric sleep specialist. This includes a detailed case history and examination. Detailed sleep records need to be maintained in a sleep diary to assess sleep pattern and alertness. This might be followed by investigations like an Actigraphy, Sleep Study or Polysomnography, Multiple Sleep latency test (MSLT) and Maintenance of Wakefulness Test (MWT) depending on the need. Polysomnography (PSG) is a complete in-Lab sleep study to measure breathing, nasal airflow, oxygen levels and EEG leads (measures electrical activity of your brain) to measure sleep architecture, sleep apnea and arousals. Multiple sleep latency test (MSLT) measures how long it takes for a person to fall asleep during the day and is required for a diagnosis of narcolepsy.
In case your child is having excessive daytime sleepiness you need to get in touch with the pediatric sleep specialist for proper evaluation, diagnosis, and treatment.
