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Parasomnias in Children

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Abstract

Parasomnias are undesirable physical events or experiences that occur during sleep. They are classified on the basis of the sleep stage during which each of the parasomnias tends to occur: NREM-related parasomnias also defined as disorders of arousal (confusional arousals, sleepwalking, sleep terrors, and sleep-related eating disorder), REM-related parasomnias (REM sleep behavior disorder, recurrent isolated sleep paralysis, and nightmare disorder), and other parasomnias (exploding head syndrome, sleep-related hallucinations, and sleep enuresis). Parasomnias include several clinical features, with different complexity of behaviors, usually associated with autonomic nervous system changes and skeletal muscle activity.

The current pathophysiological theories consider parasomnias as state dissociation, characterized by the coexistence of wake- and sleeplike activity within cortical and subcortical areas of the brain. Although parasomnias are not usually associated with a primary complaint of insomnia or excessive sleepiness, they are considered clinical disorders because of possible resulting injuries, adverse health, and psychosocial effects.

Most of the parasomnias can be diagnosed based on history alone. Only the REM sleep behavior disorder requires video-polysomnographic documentation as one of the essential diagnostic criteria. However, polysomnographic recordings can be useful also in other parasomnias especially when the differential diagnosis is difficult or in the case of suspected comorbidities with other sleep disorders. Patient education and behavioral management represent the main treatment approaches to the patient with parasomnias. A pharmacological treatment may be useful when episodes are frequent and persist despite resolution of possible inducing factors, are associated with a high risk of injury, or cause secondary consequences.

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Proserpio, P., Nobili, L. (2017). Parasomnias in Children. In: Nevšímalová, S., Bruni, O. (eds) Sleep Disorders in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-28640-2_14

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