Differentials
Seizures (nocturnal)
SIGNS / SYMPTOMS
Nocturnal frontal lobe seizures may be accompanied by incontinence, tongue-biting, tonic-clonic movements, and drooling. All these features are atypical in the parasomnias.
Seizures may occur when the patient is awake or asleep; parasomnias are almost always related to sleep.[44]
INVESTIGATIONS
Polysomnography (PSG) with expanded electroencephalographic (EEG) measurements: EEG demonstrates abnormal electrical activity consistent with the diagnosis of epilepsy.
Narcolepsy
SIGNS / SYMPTOMS
May present with similar features to recurrent isolated sleep paralysis.
Typically has other symptoms, including cataplexy (sudden focal or generalised loss of muscle tone in the body, brought about by strong emotional experiences), hypnagogic or hypnopompic hallucinations at sleep onset or awakening, and irresistible sleep attacks.[59]
Periodic limb movement disorder (PLMD)
SIGNS / SYMPTOMS
Parents may report that the child makes rhythmic limb movements during sleep (although not an accurate predictor of periodic limb movement disorder diagnostic index, or PLMS-I).
Obstructive sleep apnoea
SIGNS / SYMPTOMS
Snoring, gasping, choking while asleep, or breathing through an open mouth.
Night sweats.
Sleeping with neck hyperextension.
Hypertension.
INVESTIGATIONS
Polysomnography (PSG) demonstrates obstruction (apnoea-hypopnoea index >1 per hour of sleep).
Enlarged adenoids or tonsils may be found via nasal endoscopy or lateral neck films.
Overnight oximetry may show arterial oxygen desaturation.
Restless legs syndrome
SIGNS / SYMPTOMS
Dysaesthesias.
Symptoms occur in the evening.
May have relief with stretching.
INVESTIGATIONS
Diagnosis is primarily clinical.
Iron deficiency should be excluded.
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