Disorders of Arousal in Children
The disorders of arousal occur when a person fails to arouse fully from non-rapid eye movement (NREM) sleep to wakefulness and instead remains in a mixed state with features of both states.2 It is hypothesized that the centers in the brain and cervical spinal cord that are responsible for movement become dissociated from the parts of the brain that mediate sleep and wakefulness. This is thought to result in the loss of inhibition of motor activity during sleep. Electroencephalographic studies show that the slow wave sleep of individuals with sleep terrors or sleepwalking tend to have small interruptions indicative of sleep instability. Failure to awaken fully from sleep, loss of motor inhibition, and unstable sleep contribute to the features common to the disorders of arousal.
The evaluation of disorders of arousal involves a careful detailed description of the episodes as well as a developmental and neurological examination. Specific information about the number of hours of sleep obtained in a 24-hour period is important to determine if the child suffers from chronic sleep deprivation. The patient should be screened for primary sleep disorders, such as sleep-disordered breathing, periodic limb movement disorder, and restless leg syndrome. Disorders of arousal are more likely if there is a positive family history of confusional arousals, sleep terrors, or sleepwalking. A thorough medication
history is also helpful. Polysomnography typically is not necessary for the diagnosis of arousal disorders. However, it is useful if sleep disordered breathing, periodic limb movement disorder, REM sleep behavior disorder, or seizures are suggested. In the latter case, the polysomnogram should be performed with an
expanded EEG montage with coverage in the frontal and temporal regions. Neuroimaging is not usually indicated unless the neurological examination is abnormal or the diagnosis of epilepsy is considered. Laboratory evaluation including a urine drug screen may be considered on a case by case basis.
The evaluation of disorders of arousal involves a careful detailed description of the episodes as well as a developmental and neurological examination. Specific information about the number of hours of sleep obtained in a 24-hour period is important to determine if the child suffers from chronic sleep deprivation. The patient should be screened for primary sleep disorders, such as sleep-disordered breathing, periodic limb movement disorder, and restless leg syndrome. Disorders of arousal are more likely if there is a positive family history of confusional arousals, sleep terrors, or sleepwalking. A thorough medication
history is also helpful. Polysomnography typically is not necessary for the diagnosis of arousal disorders. However, it is useful if sleep disordered breathing, periodic limb movement disorder, REM sleep behavior disorder, or seizures are suggested. In the latter case, the polysomnogram should be performed with an
expanded EEG montage with coverage in the frontal and temporal regions. Neuroimaging is not usually indicated unless the neurological examination is abnormal or the diagnosis of epilepsy is considered. Laboratory evaluation including a urine drug screen may be considered on a case by case basis.
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