Epidemiology

In 2021, the US Centers for Disease Control and Prevention reported that 35% of children aged 4 months to 17 years sleep less than recommended for their age. One large study analysing cross-national data on adolescent sleep found that adolescents meeting the recommended 9 hours sleep/night ranged from 32% to 86% on school days and 79% to 92% on non-school days.[6][7]​​​

Chronic insomnia disorder affects 10% to 30% of children, and is estimated to be as high as 80% in children with neurodevelopmental disorders such as autism spectrum disorder.[5][8][9][10]​​​​​ The type of sleep disruption can also vary between age groups; children under 2 years more commonly display sleep-onset difficulties (e.g., needing a parent in the room to fall asleep), while children older than 2 years often display limit-setting behaviours (e.g., stalling bedtime).[9]

Delayed sleep-wake phase disorder (DSWPD) is a circadian rhythm disorder. Of the circadian rhythm disorders, DSWPD is the most common in the paediatric population, with a prevalence of 1% to 16% in adolescents.[5][11]​​​[12]​​​

Obstructive sleep apnoea (OSA) is present in 1% to 4% of the general paediatric population.[5][4][13]​​​ It is tied to numerous deleterious consequences, including cognitive, developmental, and behavioural impairment; hypertension; poor glucose metabolism; and increased cardiovascular and cerebrovascular disease.[5][14][15][16][17][18][19][20]​​​ The morbidities in children with OSA can sometimes be identified months and years prior to the diagnosis of OSA being made.[21] OSA has a higher prevalence in specific sub-groups of children such as those with craniofacial abnormalities, low muscle tone, Down's syndrome, or obesity.[22][23][24][25][26]​​​ The peak incidence of OSA in children is between ages 3 and 6 years.[27] While snoring is often a prominent symptom of OSA, not all children who snore have OSA. Studies have found that between 3% and 15% of children snore on a regular basis, especially between the ages of 3 and 6 years (13%-35%).[28]​ The only way to definitively distinguish between primary snoring and OSA in a given child is by attended polysomnogram.[29][30]

Nocturnal enuresis, parasomnias, narcolepsy, and restless legs syndrome (RLS) also present in children. Nocturnal enuresis is three times more common in boys than in girls. Prior to 5 years of age it is considered age-appropriate and thus cannot be diagnosed.[31] It is present in 15% to 25% of 5-year-olds, and prevalence is greater in boys.[31]​[32]​​​​ Primary enuresis denotes children who have never been dry, whereas secondary enuresis occurs in children who have been dry for at least 6 months. OSA is known to be a cause of secondary nocturnal enuresis.[33][34]​​​

The prevalence of narcolepsy ranges from 25 to 50/100,000. The distribution of the age of onset is bimodal, with one peak occurring around the age of 15 years and the other at the age of 35 years.[35][36][37][38]​​​​ It often takes between 5 and 10 years from the onset of symptoms until the diagnosis is made.

RLS affects 2% to 4% of school-aged children and adolescents.[39]

Recent travel across time zones may also affect circadian rhythms, and prevalence varies according to the number of people moving in any given time.

Children with ADHD have higher incidence of sleep disorders, including sleep-disordered breathing, bedtime resistance, night-time awakenings, and daytime sleepiness, than controls.[40]​ There is also a strong association between paediatric RLS and ADHD.[5]

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