Case history
Case history #1
A 6-year-old boy presents to clinic because of parental complaints of snoring, gasping, and choking while sleeping that has been observed on an increasing basis over the previous year, and especially during the 6 months preceding the visit. His mother reports that while he sleeps 10 hours each night, it is difficult to arouse him in the morning for school. His behaviour has deteriorated as his night-time breathing has become more laboured. He breathes through an open mouth, with his neck extended, and tosses and turns a great deal. His snoring is audible outside of the bedroom, and he has frequent breathing pauses lasting 10 to 15 seconds that terminate with a gasp. His teacher has reported poor behaviour in the classroom and deteriorating school performance. On one occasion, the teacher suggested that she have him evaluated for attention deficit hyperactivity disorder (ADHD).
Case history #2
An 8-month-old girl hardly sleeps. Her mother tries to get her to go to sleep at 7 p.m. each night. It takes 1 to 3 hours for her to fall asleep. She only falls asleep while being stroked in her mother's arms. If her mother puts her down before she is asleep, she cries and screams, sometimes to the point of vomiting. She often appears to doze off in her mother's arms, but awakens immediately when placed in her crib. She sleeps for 2 to 3 hours, wakes up, cries, and takes 5 to 60 minutes to fall asleep in her mother's arms. This occurs two to three times over the night. She settles down around 5 in the morning and remains asleep until 8 a.m., when she wakes up for the day. She takes three naps throughout the day for 30 to 60 minutes.
Other presentations
Paediatric sleep disorders are variable and include chronic insomnia disorder (previously behavioural insomnia of childhood); difficulties initiating or maintaining sleep; circadian rhythm disorders; hypersomnolence (including narcolepsy and other causes); sleep-disordered breathing; obstructive sleep apnoea; sleep-related movement disorders; restless legs syndrome; parasomnias; and nocturnal enuresis.
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