Case of head banging that continued to adolescence

Sleep-Related Rhythmic Movement Disorder

Sleep-related rhythmic movements disorder (SRRMD), typically considered a benign pediatric sleep disorder, comprise a group of movement disorders that occur predominantly early in childhood with an average age of onset of 9 months of age. Although it usually resolves spontaneously as the child ages, it can persist into adulthood. In this article, the authors review the identification, diagnosis, and management of SRRMD in children and adults.

Disturbed nighttime sleep in children and adults with rhythmic movement disorder

Study Objectives

Rhythmic movements (RMs) during sleep are frequent and often considered as benign in children. Disabling forms are diagnosed as RM disorder and may persist in adulthood. Whether RMs severely impact sleep architecture in patients with RM disorder remain unclear. We performed a case–control study to characterize the clinical and polysomnographic patterns of children and adults with a diagnosis of RM disorder in comparison to controls, and to assess the associations between the RMs and the sleep architecture.

Methods

All consecutive patients (n = 50; 27 children, 35 males) with RM disorder from a single sleep clinic (from 2006 to 2019) underwent a comprehensive clinical evaluation and a polysomnographic recording in comparison to 75 controls (42 children and 53 males).

Results

About 82% of children and adult patients had a complaint of disturbed nighttime sleep. Comorbid neurodevelopmental, affective or sleep disorders were found in 92% of patients. While RM sequences defined by video polysomnographic criteria were observed in 82% of patients (in wakefulness and in all sleep stages), no similar sequences were observed in controls. Patients had altered sleep continuity, with low sleep efficiency, increased wake time after sleep onset, and frequent periodic leg movements and apnea events. The severity of RMs was associated with disrupted nighttime sleep, even after controlling for comorbid motor and respiratory events.

Conclusions

RM disorder is a rare, highly comorbid and disabling condition both in children and adults with frequent disturbed nighttime sleep that may contribute to the burden of the disease.

Objectively confirmed prevalence of sleep-related rhythmic movement disorder in pre-school children

OBJECTIVE

Childhood sleep-related rhythmic movement disorder (RMD) (ie, sleep-related repetitive movements involving large muscle groups) can impair sleep quality, cause local injury, and disturb household members. Previous parental reports indicate prevalence rates in children under three years of age between 5.5 and 67%. We studied the prevalence of RMD with objective home videosomnography.

METHODS

Parents of 707 children having their one-year routine health check (357 male), 740 children having their two-year health check (395 male), and 17 children of unknown age (nine male), were asked if their child showed sleep-related rhythmic movements. If telephone interview confirmed likely RMD, parents completed a standardised clinical questionnaire and three nights of home videosomnography.

RESULTS

At the one-year health check, 31/707 possible cases of RMD were identified [maximal prevalence: 4.38%; 95% CI (2.81, 5.89)] compared to 11/740 at the two-year check [maximal prevalence: 1.49%, 95% CI (0.61, 2.36)]. Of 42 possible cases, nine had resolved; 14 were uncontactable, or did not wish to participate, and four did not complete the study protocol. In four of 10 remaining one-year olds and four of five remaining two-year olds parental report was objectively confirmed by videosomnography. Minimal prevalence based on objective observation was therefore 0.28% [95% CI (0.08, 1.30)] at one-year check and 0.41% [95% CI (0.08, 1.24)] at two-year check.

CONCLUSIONS

Prevalence of RMD in a large population of infants and toddlers was lower than previously reported (maximum prevalence 2.87%, minimum prevalence 0.34%). It is important to confirm parental report using objective measures.

A Review of Pediatric Nonrespiratory Sleep Disorders

Sleep problems are extremely common during childhood, from infancy to adolescence. Despite the prevalence of sleep problems, childhood sleep disorders are often underrecognized and undiagnosed, despite being either preventable or treatable. Sleep impacts almost all aspects of a child's functioning, and thus the increased recognition and treatment of sleep disorders will positively affect a child's well-being. Children experience the same broad range of sleep disturbances encountered in adults, including sleep apnea, insomnia, parasomnia, delayed sleep phase, narcolepsy, and restless legs, but their clinical presentation, evaluation, and management may differ. Although snoring and sleep apnea may be the most common indication for an overnight sleep study in a child, one quarter of children presenting to a sleep clinic for evaluation will have a second sleep diagnosis, which is often nonrespiratory in nature. Especially in children, ruling out sleep apnea is rarely the end point of the sleep evaluation. Clinicians involved in sleep medicine must be prepared to recognize, evaluate, and manage plans for sleep disorders across the lifespan of the patient. This article will provide an updated review of nonrespiratory pediatric sleep disorders within a developmental framework.

Non-rapid eye movement sleep parasomnias

Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur during sleep. Once believed unitary phenomena related to psychiatric disorders, it is now clear that parasomnias result from several different phenomena and usually are not related to psychiatric conditions. Parasomnias are categorized as primary (disorders of the sleep states) and secondary (disorders of other organ systems that manifest themselves during sleep). Primary sleep parasomnias can be classified according to the sleep state of origin: rapid eye movement sleep, non-rapid eye movement sleep, and miscellaneous (those not respecting sleep state). Secondary sleep parasomnias are classified by the organ system involved.