You are in: eMedicine Specialties > Pediatrics: Developmental and Behavioral > MEDICAL TOPICS Sleep Disorder: Night TerrorsArticle Last Updated: Feb 25, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program Kevin P Connelly is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association Editors: Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School; Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine Author and Editor Disclosure Synonyms and related keywords: night terrors, night-terrors, sleep terrors, night frights, parasomnia, pavor nocturnus, autonomic arousal, sleep disruption, rapid eye movement, REM, nonrapid eye movement, non-REM, tachycardia, diaphoresis, disrupted sleep pattern, night terror disorder, sleep deprivation INTRODUCTIONSection 2 of 10
  BackgroundSleep disruption is a frequent concern among parents of children aged 2 years or younger. Half of all infants develop a disrupted sleep pattern serious enough to seek physician evaluation. PathophysiologySleep is divided into 2 categories: rapid eye movement (REM) and nonrapid eye movement (non-REM). Non-REM sleep is further divided into 4 stages, progressing from stages 1-4. Night terrors occur during the transition from stage 3 non-REM sleep to stage 4 non-REM sleep. Approximately 30-90 minutes after falling asleep, the child enters this light sleep stage and suddenly arises with symptoms of autonomic discharge. FrequencyUnited StatesAn estimated 1-6% of children experience night terror episodes. Recurrent night terror episodes accompanied by significant distress and impairment are less frequent. Mortality/MorbidityMost children outgrow night terrors as they mature neurophysiologically. RaceChildren of all races and cultures are affected. SexMales and females are equally affected. AgeNight terrors are most common among children aged 3-12 years. The median age of onset is 3.5 years. 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.1 CLINICALSection 3 of 10
HistoryThe most important step toward diagnosing this disorder is to obtain a detailed history.
PhysicalA complete physical examination is important to exclude other disorders. In general, however, physical examination adds little to information obtained from a complete history. Causes
DIFFERENTIALSSection 4 of 10
Sleep Disorder: Nightmares
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| Drug Name | Imipramine (Janimine, Tofranil, Tofranil-PM) |
|---|---|
| Description | Stopped disorder in limited studies when administered at bedtime for 8 wk. |
| Pediatric Dose | <6 years: Not established >6 years: 25-50 mg PO qhs; not to exceed 8 wk |
| Contraindications | Documented hypersensitivity; ECG changes reported in children receiving twice recommended maximum daily dose; hypersensitivity to sulfites, in formulations containing sulfites; do not use in patients taking MAOIs or fluoxetine or in patients who used these drugs in the previous 2 wk |
| Interactions | Possible added effects when coadministered with other CNS depressants; not for concomitant use with MAOIs; increases toxicity of sympathomimetic agents such as isoproterenol and epinephrine by potentiating effects and inhibiting antihypertensive effects of clonidine |
| Pregnancy | D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus |
| Precautions | May mask symptoms rather than treat disease; tolerance occurs frequently; possible rebound effect upon discontinuation, with worsening of episodes; reports of sudden death in small number of children; possible stomach upset; administer with food Caution with urinary retention, angle-closure glaucoma, hyperthyroidism, or other conditions in which anticholinergic activity aggravates condition; caution with seizure disorders; eliminate possibility of underlying cardiac disease based on ECG and physician's judgment |
Sleep Disorder: Night Terrors excerpt
Article Last Updated: Feb 25, 2008
