Investigation of Clinical Features and Comorbid Psychopathologies of Children with Sleep Terrors

Yıl 2024, Cilt: 11 Sayı: 3, 421 - 433, 30.09.2024

Özlem Şireli , Ayla Uzun Çiçek , Elif Abanoz , İlknur Ucuz , Yüksel Sümeyra Naralan

https://doi.org/10.34087/cbusbed.1479121

Öz

Giriş ve Amaç: Bu çalışmada, uyku terörü tanısı konulan çocukların uyku ortamı ve uyku alışkanlıkları, eşlik eden psikiyatrik bozukluklar, diğer parasomnialar ve tedavi geçmişi dahil klinik özelliklerinin incelenmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya, 2020-2024 yılları arasında 3 farklı Çocuk ve Ergen Psikiyatri polikliniğinde DSM-5 tanı kriterlerine göre uyku terörü tanısı konulmuş 51 çocuk dahil edilmiştir. Olguların sosyodemografik ve klinik özellikleri geriye dönük olarak dosya üzerinden incelenmiştir.
Bulgular: Of the 51 participants, 30 (58.8%) were male, 21 (41.2%) were female and the mean age at the time of admission was 6.76±1.45 years (min-max: 3-10 years). Olguların15’inin (%29.4) gürültülü bir ortamda uyduğu, 41’inin (%80,4) uyku terörü atağı dışında uykularının kesintiye uğradığı belirlenmiştir. 17’sinde (%33,3) en az bir psikiyatrik bozukluk saptanmış olup, en sık [n=5 (%9,8)] komorbid psikiyatrik bozukluk dikkat eksikliği hiperaktivite bozukluğudur. 14’ünde (%27,5) diğer parasomnilerin eşlik ettiği belirlenmiştir. Olguların klinik özellikleri yaş grubuna göre karşılaştırıldığında, okul öncesi dönemdekilerde tam retrograd amnezinin, okul çağındakilerinde ise atak sırasındaki motor aktivitenin, bedensel yaralanma ve/veya maddi hasarın, atak esnasında tam uyanmanın anlamlı olarak yüksek olduğu saptanmıştır. Ebeveynlerin %64,7’sinin atak esansında yanlış müdahalede bulunduğu, olguların %29,4’ünde, tedavi geçmişinde yanlış ilaç uygulandığı belirlenmiştir.
Sonuç: Çocukluk dönemi uyku teröründe, tanısal değerlendirme sürecinde olası tetikleyici etmenlerin tespiti, eşlik eden psikiyatrik bozuklukların saptanması, tedavide ebeveynlerin psikoeğitimi, gerekli olduğu durumlarda medikasyonda uygun ilaç seçimi oldukça önemlidir.

Anahtar Kelimeler

Uyku terörü, parasomnia, psikiyatrik komorbidite

Investigation of Clinical Features and Comorbid Psychopathologies of Children with Sleep Terrors

Öz

Aim: In this study, it was aimed to investigate the clinical characteristics of children diagnosed with sleep terrors, including sleep environment and sleep habits, clinical features and comorbid psychiatric disorders.
Method: Between 2020 and 2024, 51 children who were diagnosed with sleep terror according to DSM-5 diagnostic criteria in 3 different Child and Adolescent Psychiatry clinics were included in the study. The sociodemographic and clinical characteristics of the cases were examined retrospectively through the files.
Results: Of the 51 participants, 30 (58.8%) were male, 21 (41.2%) were female and the mean age at the time of admission was 6.76±1.45 years. It was determined that 15 (29.4%) of the cases slept in a noisy environment and 41 (80.4%) of the cases had their sleep interrupted except for sleep terror attacks. At least one psychiatric disorder was detected in 17 (33.3%) patients, and the most common (9.8%) comorbid psychiatric disorder was attention deficit hyperactivity disorder. It was found that complete retrograde amnesia was significantly higher in preschoolers, and motor activity during the attack, physical injury and/or material damage, and full awakening during the attack were significantly higher in school-age children. It was determined that 64.7% of the parents intervened incorrectly during the episode, and in 29.4% of the cases, the wrong medication was applied in the treatment history.
Conclusion: In sleep terrors, identification of triggering factors and comorbid psychiatric disorders during the diagnostic evaluation process, psychoeducation of parents in treatment, and selection of appropriate medication for medication are very important.

Anahtar Kelimeler

Sleep terrors, parasomnia, comorbid psychiatric disorder

Etik Beyan

All procedures were performed in accordance with the Good Clinical Practice procedures and the current revision of the Declaration of Helsinki and the study protocol was approved by the local institutional Ethics Committee.

Kaynakça

• 1. American Psychiatric Association. Parasomnia. Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (pp 399–410). VA: American Psychiatric Association, 2013.
• 2. Mason TB, Pack AI. Sleep terrors in childhood. J Pediatr 2005;147(3):388–392. https://doi.org/10.1016/j.jpeds.2005.06.042
• 3. Agargun MY, Cilli AS, Sener S, Bilici M, Ozer OA, Selvi Y, Karacan E. The prevalence of parasomnias in preadolescent school-aged children: A Turkish sample. Sleep 2004; 27: 701–705. https://doi.org/10.1093/sleep/27.4.701.
• 4. Avidan AY, Kaplish N. The parasomnias: epidemiology, clinical features, and diagnostic approach. Clin Chest Med 2010; 31(2): 353–70. https://doi.org/10.1016/j.ccm.2010.02.015.
• 5. Van Horn NL, Street M. Night Terrors, 2019.
• 6. Leung AK, Leung A., Wong AH, Hon KL. Sleep terrors: an updated review. Curr Pediatr Rev 2020; 16(3):176–182. https://doi.org/10.2174/1573396315666191014152136.
• 7. Kales A, Soldatos CR, Bixler EO, Ladda RL, Charney DS, Weber G, Schweitzeret PK. Hereditary factors in sleepwalking and night terrors. BJPsych 1980; 137:111–118. http://dx.doi.org/10.1192/bjp.137.2.111.
• 8. Nguyen BH, Pérusse D, Paquet J, Petit D, Boivin M, Tremblay RE, Montplaisir J. Sleep terrors in children: a prospective study of twins. Pediatrics 2008; 122(6): e1164‐e1167. https://doi.org/10.1542/peds.2008-1303.
• 9. Nevsimalova S, Prihodova I, Kemlink D, Skibova J. Childhood parasomnia—a disorder of sleep maturation? Eur J Paediatr Neuro 2013; 17(6):615–619. https://doi.org/10.1016/j.ejpn.2013.05.004.
• 10. Gigliotti F, Esposito D, Basile C, Cesario S, Bruni O. Sleep terrors—A parental nightmare. Pediatr Pulmonol 2022; 57(8):1869–1878. https://doi.org/10.1002/ppul.25304.
• 11. Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them? Pediatrics 2003;111(1): e1725. https://doi.org/10.1542/peds.111.1.e17.
• 12. Petit D, Pennestri MH, Paquet J, Desautels A, Zadra A, Vitaro F, Tremblay RE, Boivin M, Montplaisir J. Childhood sleepwalking and sleep terrors: A longitudinal study of prevalence and familial aggregation. JAMA Pediatr 2015; 169(7): 653–8. http://dx.doi.org/10.1001/jamapediatrics.2015.127.
• 13. Irfan M. Sleep terrors. Sleep Med Clin 2024; 19(1):63–70. https://doi.org/10.1016/j.jsmc.2023.12.004.
• 14. Waters F, Moretto U, Dang-Vu TT. Psychiatric illness and parasomnias: a systematic review. Curr Psychiatry Rep 2017; 19:1–11.
• 15. Oudiette D, Leu S, Pottier M, Buzare MA, Brion A, Arnulf I. Dreamlike mentations during sleepwalking and sleep terrors in adults. Sleep 2009; 32(12): 1621–1627. https://doi.org/10.1093/sleep/32.12.1621.
• 16. Castelnovo A, Loddo G, Provini F, Miano S, Manconi M. Mental activity during episodes of sleepwalking, night terrors or confusional arousals: differences between children and adults. Nat Sci Sleep 2021; 13: 829-840. https://doi.org/10.2147/NSS.S309868.
• 17. Ming X, Sun YM, Nachajon RV, Brimacombe M, Walters AS. Prevalence of parasomnia in autistic children with sleep disorders. Clin Med Insights Pediatr 2009; 3: CMPed-S1139. https://doi.org/10.4137/CMPed.S1139
• 18. Wiggs LD. Epidemiology and etiology of behavioral insomnias, circadian rhythm disorders, and parasomnias in ADHD. Sleep and ADHD (pp 63–93). Academic Press, 2019.
• 19. Gau SF, Suen Soong WT. Psychiatric comorbidity of adolescents with sleep terrors or sleepwalking: a case-control study. Aust N Z J Psychiatry 1999; 33(5):734–739. https://doi.org/10.1111/j.1365-2869.2006.00552.x.
• 20. Petit D, Touchette E, Tremblay RE, Boivin M, Montplaisir J. Dyssomnias and parasomnias in early childhood. Pediatrics 2007; 119(5): e1016–e1025. https://doi.org/10.1542/peds.2006-2132.
• 21. Laganière C, Gaudreau H, Pokhvisneva I, Kenny S, Bouvette-Turcot AA, Meaney M, Pennestri MH. Sleep terrors in early childhood and associated emotional–behavioral problems. J Clin Sleep Med 2022; 18(9):2253–2260. https://doi.org/10.5664/jcsm.10080.
• 22. Ozgun N, Sonmez FM, Topbas M, Can G, Goker Z. Insomnia, parasomnia, and predisposing factors in Turkish school children. Pediatr Int 2016; 58(10):1014–1022. https://doi.org/10.1111/ped.12954.
• 23. Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised. US Department of Health, Education and Welfare publication (ADM) (pp 76-338), MD: National Institute of Mental Health, 1976.
• 24. Owens JA, Millman RP, Spirito A. Sleep terrors in a 5-year-old girl. Arch Pediatr Adolesc Med 1999; 153: 309–312.
• 25. Lu R, Li R, Chen Y, Zhang Y, Kang W, Zhao A, Lin X, Hu Y, Liu S, Xu Z, Lu Z, Li S. A population-based study exploring association of parasomnia symptoms with sleep onset delay among school-aged children. Sleep Med 2024; 117:1-8. https://doi.org/10.1016/j.sleep.2024.02.010.
• 26. Allen SL, Howlett MD, Coulombe JA, Corkum PV. ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations. Sleep Med Rev 2016; 29:1–14. https://doi.org/10.1016/j.smrv.2015.08.006.
• 27. Gau SSF. Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6–15 in Taiwan. J Sleep Res 2006; 15(4):403–414. https://doi.org/10.1111/j.1365-2869.2006.00552.x.
• 28. Chiang HL, GAU SSF, Ni HC, Chiu YN, Shang CY, Wu YY, Lin LY, Tai YM, Soong WT. Association between symptoms and subtypes of attention‐deficit hyperactivity disorder and sleep problems/disorders. J Sleep Res 2010; 19(4):535–545. https://doi.org/10.1111/j.1365-2869.2010.00832.x.
• 29. Khalajmehri M, Yousefichaijan P, Rezagholizamenjany M, Salehi B, Sadeghi-Sedeh B, Taherahmadi H. Primary monosymptomatic nocturnal enuresis in children and correlation with sleep disorders in Arak, Iran. Ann Mil Health Sci Res 2021; 19(3): e111806. https://doi.org/10.5812/amh.111806.
• 30. Idir Y, Oudiette D, Arnulf I. Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new. J Sleep Res 2022; 31(4): e13596. https://doi.org/10.1111/jsr.13596.
• 31. Hublin C, Kaprio J, Partinen M, Koskenvu M. Parasomnias: Co-occurrence and genetics. Psychiatr Genet 2001; 11:65–70.
• 32. Bjorvatn B, Grønli J, Pallesen S. Prevalence of different parasomnias in the general population. Sleep Med 2010; 11:1031–1034.
• 33. Laberge L, Tremblay RE, Vitaro F, Montplaisir J. Development of parasomnias from childhood to early adolescence. Pediatrics 2000; 106(1): 67–74. https://doi.org/10.1542/peds.106.1.67.
• 34. Kilincaslan A, Yilmaz K, Batmaz Oflaz S, Aydin N. Epidemiological study of self‐reported sleep problems in T urkish high school adolescents. Pediatr Int 2014; 56(4): 594–600. https://doi.org/10.1111/ped.12287.
• 35. Pinheiro KAT, Pinheiro RT, da Silva RA, da Cunha Coelho FM, de Ávila Quevedo L, Godoy RV, Jansen K, Horta BL, Oses JP. Chronicity and severity of maternal postpartum depression and infant sleep disorders: a population-based cohort study in southern Brazil. Infant Behav Dev 2011; 34(2):371–373. https://doi.org/10.1016/j.infbeh.2010.12.006
• 36. Guttier MC, Halal CS, Matijasevich A, Del‐Ponte B, Tovo‐Rodrigues L, Barros F, Bassani DG, Santos IS. Trajectory of maternal depression and parasomnias. J Sleep Res 2024; 33(1): e13870. https://doi.org/10.1111/jsr.13870.
• 37. Castelnovo A, Turner K, Rossi A, Galbiati A, Gagliardi A, Proserpio P, Nobili L, Terzaghi M, Manni R, Strambi LF, Manconi M, Miano S, Zambrelli E, Canevini PM. Behavioural and emotional profiles of children and adolescents with disorders of arousal. J Sleep Res 2021; 30(1): e13188. https://doi.org/10.1111/jsr.13188.
• 38. Kurth S, Jenni OG, Riedner BA, Tononi G, Carskadon MA, Huber R. Characteristics of sleep slow waves in children and adolescents. Sleep 2010; 33(4):475–480. https://doi.org/10.1093/sleep/33.4.475.
• 39. Irfan M, Schenck CH, Howell MJ. Non-rapid eye movement sleep and overlap parasomnias. Continuum (Minneap Minn) 2017; 23(4):1035–50. https://doi.org/10.1212/CON.0000000000000503.
• 40. Ozcan O, Donmez YE. Melatonin treatment for childhood sleep terror. J Child Adolesc Psychopharmacol 2014; 24(9): 528–529. http://dx.doi.org/10.1089/cap.2014.0061.