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Table 1. Diagnostic criteria for sleep terrors

Features	DSM-5	ICSD-3
Frequency	Recurrent episodes	Recurrent episodes
Awakening	Abrupt arousal from sleep	Incomplete awakening from sleep
Responsiveness	Relative unresponsiveness	Inappropriate or absent responsiveness
Recall	Little or no recall of dream imagery	Little or no associated cognition or dream imagery
Amnesia	Amnesia of the episode	Partial or complete amnesia of the episode
Functional Impact	Significant distress or impairment in social, occupational, or other areas of functioning
Differential	Symptoms cannot be explained by another mental disorder, medical condition, or the effects of drugs of abuse or medication	Symptoms cannot be explained by another mental disorder, medical condition, or the effects of drugs of abuse or medication
Initial Expression of Fear	Panicked scream	Alarming vocalization, such as a frightened scream
Autonomic Symptoms	Autonomic arousal	Mydriasis, tachycardia, tachypnea, diaphoresis during an episode

Table 2. Comparison of sleep terrors and nightmares.

Feature	Sleep Terror	Nightmare
Categorization	Disorder of arousal	REM parasomnia
Timing	Usually occurs during the first half of the night and typically out of stage N3 slow-wave sleep	Begins out of REM sleep and typically occurs in the last third of the night
Family history	Frequently positive	May be positive
Behavior semiology	Sudden arousal with intense screaming, inconsolable crying, agitation, heightened autonomic discharge	Paroxysmal awakenings with anxiety dream recall
Event duration	Few seconds to minutes	Few seconds to minutes
Age at onset	Typically < 10 years old	Typically < 10 years old
Triggers	Sleep deprivation, febrile illness, anxiety, stress, sleep apnea, motor disorders of sleep	Sleep deprivation, febrile illness
Frequency	Few times per month/week; very rarely >1 episode in a single night	Few times per month/week; very rarely >1 episode in a single night
Post-spell	Limited to no recall of the events with confusion	Recall is typical at times with vivid detail
PSG changes	Abrupt arousal from slow-wave sleep (stage N3) with expression of confusion/ambulation/intense fright in all three arousal types, followed by return to sleep; increased cyclic alternating pattern	Dense eye(phasic) movements during REM sleep

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Author

Eve G Spratt, MD, MSc Professor of Pediatrics and Psychiatry, Division of Developmental Pediatrics, Medical University of South Carolina; Director, Pediatric Consultation Liaison Psychiatry, Medical University of South Carolina Children's Hospital at Charleston

Eve G Spratt, MD, MSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Coauthor(s)

Rishi Malla, MD, MSc Pediatric Neurologist, Pediatric Epileptologist, Cortica

Rishi Malla, MD, MSc is a member of the following medical societies: American Academy of Neurology, Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Martha Karlstad, MD Chief Resident, Child and Adolescent Psychiatry, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.

Katherine Harris, MD Medical University of South Carolina College of Medicine

Katherine Harris, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Mark Anderson, MD Lt Col, United States Air Force, 75th Medical Squadron

Disclosure: Nothing to disclose.

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chet Johnson, MD Professor and Chair of Pediatrics, Associate Director, Developmental Pediatrician, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas School of Medicine; LEND Director, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose

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