Sleepwalking in Kids Breathing-Related

Breathing Problems Linked to Frequent Sleep Disturbances, Tonsil Removal Brings Relief

From the WebMD Archives

Jan. 8, 2003 -- Frequent episodes of sleepwalking and sleep terrors in children may result from allergies, swollen tonsils, and other factors that interfere with nighttime breathing -- and may be cured with surgery to remove the tonsils and adenoids.

So conclude Stanford University researchers in a breakthrough study that offers new insight into these two puzzling sleep disturbances, which some experts say may occur at least once in up to 50% of children during their lifetime. Although often attributed to stress or anxiety, it's not really clear what triggers these nocturnal nuisances, how to treat them, or why they can persist for months or years.

In their study, published in the January issue of Pediatrics, the researchers found that nearly all of the 84 children with recurring sleepwalking and/or sleep terrors suffered problems that affected sleep-time breathing -- such as habitual snoring, a history of upper respiratory infection, earaches, or mouth breathing. Meanwhile, virtually none of 36 other "control" children without sleep disturbances experienced such so-called "sleep-disordered breathing."

Most of the children with sleep-disordered breathing were then treated with tonsillectomy or adenoidectomy, procedures to remove enlarged tonsils and adenoids and help improve airflow.

"They were all cured of their sleep disturbances," says Christian Guilleminault, MD, BiolD, director of clinical research at the Stanford University Sleep Disorders Clinic. "Now, it's a matter of convincing the pediatricians and [ear nose and throat] surgeons that persistent sleepwalking and sleep terrors may be related to breathing problems -- and not just anxiety. In fact, six of the children could not get surgery because surgeons had never heard of the relationship and refused to operate on them."

While it's well documented how breathing difficulties can affect adult sleep patterns and quality, this study marks the impact they may have on children.

"To bring this into the pediatric arena, where there is less awareness of some of these relationships, is really important," says Carl E. Hunt, MD, pediatrician and director of the National Center on Sleep Disorders Research, part of the federal National Institutes of Health. "It's also a call for parents to know that it's not normal for children to snore loudly and frequently. If your child is developing or already having recurring problems with sleepwalking or night terrors and he or she frequently snores, it certainly increases the need to be evaluated."

Guilleminault tells WebMD that he first noticed a relationship between breathing problems and the baffling sleep disturbances in 1996, while conducting another study. "We did a very large survey on sleep disturbances and we noticed that frequent, recurrent sleepwalking and sleep terrors were much more common in those with abnormal breathing," he says. "But when we published the paper in Pediatrics, we didn't emphasize that finding enough. It was nagging at us, so we wanted to test it."

The new finding might not only bring answers to medical experts, but relief to parents. Sleep terrors can be particularly frightening, since these episodes often include screaming and crying, yet children are unresponsive to efforts to comfort them. Unlike nightmares, terrors are usually not remembered. Both sleep terrors and sleepwalking occur in the deepest stage or "slow-wave" sleep - usually within three hours after falling asleep; nightmares typically happen closer to waking.

"It certainly makes sense," says J. Catesby Ware, PhD, director of the Sleep Disorders Center at Eastern Virginia Medical School. "The thing that we do know about sleep terrors in children is that there must be something to produce a partial arousal from sleep. If someone placed a pillow on your face while you were sleeping, you would wake up because a cessation of breathing -- even partial -- produces an arousal."

These "arousals" prevent children from transitioning from slow-wave sleep to a lighter sleep stage. External factors like noise and light also cause arousals, along with physiologic conditions such as being "overtired" from lack of sleep and anxiety. "Normally, when we sleep, there's a very sharp distinction between awake and the different stages of sleep. With some of these disorders, the boundaries between those states are blurred," explains Hunt. "That is why with these conditions there are some behaviors that are typically awake-related occurring during sleep."

Guilleminault isn't suggesting that surgery be done to prevent these sleep disturbances in all children. "When they occur once in great while, or even in occasional bursts and then they disappear, that is perfectly normal and probably not because of breathing difficulties," he says. "The children in our study had persistent sleepwalking and terrors - occurring once or several times a week, every few weeks or so. And parents of children who have frequent episodes like that should probably have their breathing patterns evaluated."

Show Sources

SOURCES: Pediatrics, January 2003 • Christian Guilleminault, MD, BiolD, director of clinical research, Stanford University Sleep Disorders Clinic; professor of psychiatry and behavior science, Stanford University School of Medicine, Palo Alto, Calif. • Carl E. Hunt, MD, director, National Center on Sleep Disorders Research, Bethesda, Md. • J. Catesby Ware, PhD, chief, division of Sleep Medicine and director Sleep Disorders Center, Eastern Virginia Medical School, Norfolk.
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