Petit D, et al. Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation. JAMA Pediatr. 2015 Jul;169(7):653-8.
At a Glance:
- This large prospective cohort study examines the prevalence of sleep terrors and sleepwalking and association of these with parental history.
- The peak of prevalence was observed at age 11/2 years for sleep terrors (34.4%) and at age 10 years for sleepwalking (13.4%).
- As many as one-third of children who had early childhood sleep terrors developed sleepwalking later in childhood.
- The prevalence of childhood sleepwalking increases with parental history of sleepwalking: 22.5% for children without parental history, 47.4% for children with 1 parent with a history of sleepwalking, and 61.5% for children with both parents with a history of sleepwalking.
- These findings point to a strong genetic influence on sleepwalking and, to a lesser degree, sleep terrors.
Zadra A, et al. Somnambulism: clinical aspects and pathophysiological hypotheses. Lancet Neurol. 2013 Mar;12(3):285-94.
Somnambulism, or sleepwalking, can give rise to a wide range of adverse consequences and is one of the leading causes of sleep-related injury. Accurate diagnosis is crucial for proper management and imperative in an ever-increasing number of medicolegal cases implicating sleep-related violence. Unfortunately, several widely held views of sleepwalking are characterised by key misconceptions, and some established diagnostic criteria are inconsistent with research findings. The traditional idea of somnambulism as a disorder of arousal might be too restrictive and a comprehensive view should include the idea of simultaneous interplay between states of sleep and wakefulness. Abnormal sleep physiology, state dissociation, and genetic factors might explain the pathophysiology of the disorder.
Bhargava S. Diagnosis and management of common sleep problems in children.
Pediatr Rev. 2011 Mar;32(3):91-8; quiz 99.
Diagnostic Criteria: Sleepwalking
- Ambulation occurs during sleep.
- Persistence of sleep, an altered state of consciousness, or impaired judgment during ambulation is demonstrated by at least one of the following:
- Difficulty in arousing the person.
- Mental confusion when awakened from an episode.
- Amnesia (complete or partial) about the episode.
- Routine behaviors that occur at inappropriate times.
- Inappropriate or nonsensical behaviors.
- Dangerous or potentially dangerous behaviors.
- The disturbance is not explained by another sleep disorder, medical, or neurologic disorder, mental disorder, medication use, or substance use disorder.
Remulla A, Guilleminault C. Somnambulism (sleepwalking). Expert Opin Pharmacother. 2004 Oct;5(10):2069-74.
Somnambulism is an arousal parasomnia consisting of a series of complex behaviours that result in large movements in bed or walking during sleep. It occurs in 2-14% of children and 1.6-2.4% of adults. Occasional benign episodes are managed conservatively. However, recurrent sleepwalking with a risk of injury to self or others mandates immediate treatment with pharmacotherapy while awaiting work-up. The most commonly used medications are benzodiazepines, particularly clonazepam, with tricyclic antidepressants and serotonin selective re-uptake inhibitors also administered. Treatment of underlying causes such as obstructive sleep apnoea, upper airway resistance syndrome, restless legs syndrome and periodic limb movements, is currently the best approach and usually eliminates somnambulism in children and adults.
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