Background
Sleep disruption in childhood is a common and frequently upsetting occurrence. Sleep terrors are a specific sleep disruption most remarkable for their intensity and anxiety-inducing nature. Most episodes begin within the first 1-2 hours of sleep, during stages 3 and 4 of non–rapid eye movement (REM) sleep and may occur during naps as well. Affected individuals typically appear to wake from sleep with a sudden intense distress, followed by poorly controlled panic and lack of responsiveness or normal interaction with other individuals. The episode generally last for 1-10 minutes, at which point the agitation abruptly ends, and the individual seems to resume normal sleep. The affected individual usually has no memory or only vague recall of the event the following day.
Alternate names for sleep terrors include night terrors and pavor nocturnus.
Pathophysiology
Sleep studies demonstrate that sleep terrors occur during stage 3 and 4 non-REM sleep. Occurrence is increased in some families, suggesting a genetic predilection; however, to date, no genetic marker has been clearly identified.[1] A strong correlation between sleep terrors and sleepwalking is noted, with a high frequency of either process in first-degree family members of individuals who experience sleep terrors.[2] Sleepwalking has been associated with HLADQB1.[3] An association of sleep terrors and sleepwalking in family members of individuals with nocturnal frontal lobe epilepsy has also been reported.[4]
Several precipitating factors have been suggested for sleep terrors, but no consistent structural or biochemical abnormality has been identified to account for all cases of sleep terrors.
Epidemiology
Frequency
United States
Between 1-6% of children experience sleep terrors. Frequency in adults is much less common, occurring in less than 1% of adults. Peak frequency in children younger than 3.5 years is at least one episode per week; among older children, peak frequency is 1-2 episodes per month.[5] The course in adults is more chronic, with significant variability in both the frequency and severity of episodes among affected individuals.[6]
Mortality/Morbidity
Sleep terrors are fundamentally benign but some affected individuals may experience trauma from interactions with their surroundings or injure others attending them. Attempts to wake an affected individual during an episode are generally unsuccessful and increase the potential of harm to persons offering support.[7]
Race
Sleep terrors are experienced equally across racial distinctions.
Sex
Most sources indicate that both genders experience sleep terrors at an equal frequency; however, the American Psychiatric Association (DSM-IV-TR) states an increased incidence in male children.[6]
Age
Night terrors can occur from infancy through adulthood. The peak frequency is age 4-12 years for children and age 20-30 years for adults. Most childhood onset sleep terrors resolve by adolescence.
Nguyen BH, Perusse D, Paquet J, et al. Sleep terrors in children: a prospective study of twins. Pediatrics. 2008;122(6):e1164-e1167.
Hublin C, Kaprio J. Genetic aspects and genetic epidemiology of parasomnias. Sleep Medicine Reviews. 2003;7(5):413-421.
Lecendreux M, Mayer G, Bassetti C, et al. HLA association in sleepwalking. Mol Psychiatry. 2003;8:114-7.
Bisulli F, Vignatelli L, Naldi I, et al. Increased frequency of arousal parasomnias in families with nocturnal frontal lobe epilepsy: A common mechanism?. Epilepsia. 2010;51(9):1852-1860.
DiMario FJ Jr, Emery ES 3rd. The natural history of night terrors. Clin Pediatr (Phila). Oct 1987;26(10):505-11. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
Pressman MR. Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity. SLEEP. 2007;30(8):1039-1047.
Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them?. Pediatrics. Jan 2003;111(1):e17-25. [Medline].
Mindell JA & Owens JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management ofSleep Problems. Philadelphia: Lippincott Williams & Wilkins; 2003.
Pressman, M. Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med. Rev. 2007;11:5-30.
Moore M, Allison A, and Rosen CL. A review of pediatric nonrespiratory sleep disorders. Chest. 2006;130(4):1252-1262.
Frank NC, Spirito A, Stark L, and Owens-Stively A. The use of scheduled awakenings to eliminate childhood sleep walking. Journal of Pediatric Psychology. 1997;22:345-353.
Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry. Apr 1999;60(4):268-76.
Dahl RE. The pharmacologic treatment of sleep disorders. Psychiatr Clin North Am. Mar 1992;15(1):161-78. [Medline].
Mason TB 2nd, Pack AI. Sleep terrors in childhood. J Pediatr. Sep 2005;147(3):388-92. [Medline].
Siegel JM. Why we sleep. Sci Am. Nov 2003;289(5):92-7. [Medline].
Stores G. Aspects of parasomnias in childhood and adolescence. Arch Dis Child. Jan 2009;94(1):63-9. [Medline].
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