CHILDHOOD SLEEP DISORDERS - 11/09/11

Doi : 10.1016/S0733-8619(05)70271-1

Richard Ferber, MD ^{^{*
From the Center for Pediatric Sleep Disorders and the Department of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts}}

Resumen

From the start of life, pediatric and adult sleep patterns are quite similar, at least when they are viewed simply as a series of alternations between rapid eye movement (REM) and non–rapid eye movement (NREM) sleep patterns. The general physiologic correlates of these states are also fairly well established at the time of birth, and electrophysiologic patterns come to resemble their adult counterparts fairly quickly. REM and NREM show characteristic electrical rhythms from the start. Within a few weeks, the tracé alternant pattern of quiet sleep is replaced by the more continuous rhythms of NREM. By 6 weeks, spindles are well developed, and by 6 months, spontaneous K complexes clearly are present and NREM already is divisible into substages.^{8 Anders T.F., Sadeh A., Appareddy V. Normal sleep in neonates and children Principles and Practice of Sleep Medicine in the Child Philadelphia: WB Saunders (1995).
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Haga clic aquí para ir a la sección de Referencias, 21 Ferber R. Introduction: Pediatric sleep disorders medicine Principles and Practice of Sleep Medicine in the Child Philadelphia: WB Saunders (1995).
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Haga clic aquí para ir a la sección de Referencias, 55 Metcalf D.R., Mondale J., Butler F.K. Ontogenesis of spontaneous K-complexes Psychophysiology 1971 ; 8 : 340

Haga clic aquí para ir a la sección de Referencias, 62 Parmelee A. The ontogeny of sleep patterns and associated periodicities in infants Modern Problems in Pediatrics, vol 13: Prenatal and Postnatal Development of the Human Brain Basel: S. Karger (1974).
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Haga clic aquí para ir a la sección de Referencias, 63 Parmelee A., Akiyama Y., Shultz M. , y al. Analysis of electroencephalograms of sleeping infants Activitas Nervosa Superior 1969 ; 11 (suppl) : 111

Haga clic aquí para ir a la sección de Referencias, 64 Parmelee A.H., Schulte F.J., Akiyama Y. , y al. Maturation of EEG activity during sleep in premature infants Electroencephalogr Clin Neurophysiol 1968 ; 24 : 319

Haga clic aquí para ir a la sección de Referencias, 77 Samson-Dollfus D., Forthomme J., Capron E. EEG of the human infant during sleep and wakefulness during the first year of life Neurological and Electroencephalographic Correlative Studies in Infancy New York: Grune & Stratton (1964).
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Haga clic aquí para ir a la sección de Referencias, 84 Tanguay P.E., Ornitz E.M., Kaplan A. , y al. Evolution of sleep spindles in childhood Electroencephalogr Clin Neurophysiol 1975 ; 38 : 175 [cross-ref]

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Circadian rhythms are established in early life as well. The central pacemaker is functional at birth with an inherent rate close to 24 hours, although competing physiologic pressures such as hunger obscure its function for several months.^{27 Ferber R., Boyle M.P. Persistence of a free-running sleep–wake rhythm in a one-year-old girl Sleep Res 1983 ; 12 : 364

Haga clic aquí para ir a la sección de Referencias, 47 Kleitman N., Engelmann T.G. Sleep characteristics in infants J Appl Physiol 1953 ; 6 : 269

Haga clic aquí para ir a la sección de Referencias} In the newborn, REM occurs at sleep onset, and periods of sleep and waking seem randomly distributed across the 24-hour day. By 3 months of age, infants enter NREM when they fall asleep, and there is a clear differentiation between day and night, with most sleep consolidated during the night hours.^{8 Anders T.F., Sadeh A., Appareddy V. Normal sleep in neonates and children Principles and Practice of Sleep Medicine in the Child Philadelphia: WB Saunders (1995).
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Haga clic aquí para ir a la sección de Referencias, 17 Coons S. Development of sleep and wakefulness during the first 6 months of life Sleep and Its Disorders in Children New York: Raven Press (1987).
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Haga clic aquí para ir a la sección de Referencias, 39 Hoppenbrouwers T. Sleep in infants Sleep and Its Disorders in Children New York: Raven Press (1987).
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Haga clic aquí para ir a la sección de Referencias} At about the same time, nighttime wakings decrease markedly, with settling (i.e., sleeping through the night) usually appearing by 5 to 6 months.^{41 Jenkins S., Owen C.M., Bax M. , y al. Continuities of common behavior problems in pre-school children J Child Psychol Psychiatry 1984 ; 25 : 75 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 56 Moore T., Ucko L.E. Nightwaking in early infancy: Part I Arch Dis Child 1957 ; 32 : 333 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 69 Ragins N., Schachter S. A study of sleep behavior in two-year-old children J Am Acad Child Adolesc Psychiatry 1971 ; 10 : 464 [cross-ref]

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From 6 months on, sleep patterns and sleep rhythms among children and adults differ surprisingly little. Deep NREM sleep (stage IV) continues to show higher voltages and a greater percentage of delta activity in children than it does in adults, and sleep spindles are more prominent from 3 to 12 months than at any age thereafter.^{21 Ferber R. Introduction: Pediatric sleep disorders medicine Principles and Practice of Sleep Medicine in the Child Philadelphia: WB Saunders (1995).
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Haga clic aquí para ir a la sección de Referencias, 51 Lenard H. The development of sleep spindles in the EEG during the first two years of life Neuropediatrie 1970 ; 1 : 264

Haga clic aquí para ir a la sección de Referencias, 55 Metcalf D.R., Mondale J., Butler F.K. Ontogenesis of spontaneous K-complexes Psychophysiology 1971 ; 8 : 340

Haga clic aquí para ir a la sección de Referencias, 64 Parmelee A.H., Schulte F.J., Akiyama Y. , y al. Maturation of EEG activity during sleep in premature infants Electroencephalogr Clin Neurophysiol 1968 ; 24 : 319

Haga clic aquí para ir a la sección de Referencias, 66 Petre-Quadens O., deLee C., Remy M. Eye movement density during sleep and brain maturation Brain Res 1971 ; 26 : 49

Haga clic aquí para ir a la sección de Referencias, 84 Tanguay P.E., Ornitz E.M., Kaplan A. , y al. Evolution of sleep spindles in childhood Electroencephalogr Clin Neurophysiol 1975 ; 38 : 175 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} The 1-hour ultradian rhythm of REM/NREM alternation in the newborn only gradually lengthens to its adult value of 90 minutes by adolescence.^{74 Roffwarg H.P., Muzio J.N., Dement W.C. Ontogenetic development of the human sleep–dream cycle Science 1966 ; 152 : 604

Haga clic aquí para ir a la sección de Referencias} Young children still nap, but by 1 year of age, this is usually just once a day, and after age 3 to 4, naps usually cease.

Given the early maturation of sleep systems in children, it should not be that surprising to learn that pediatric and adult sleep disorders are essentially the same, at least phenomenologically. There is only a limited number of things that can go wrong with sleep, regardless of age. Possibilities include difficulty establishing and maintaining sleep (at night or at naptime), excessive daytime sleepiness, interruptions of sleep, things that go wrong during sleep, and variable disturbances reflecting circadian dysfunction. The differences between pediatric and adult conditions have to do with the distinction between a sleep disorder and a sleep problem and with the age-related variations in presentation, significance, cause, and treatment of these disorders and problems.^{19 Ferber R. Assessment of sleep disorders in the child Principles and Practice of Sleep Medicine in the Child Philadelphia: WB Saunders (1995).
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Haga clic aquí para ir a la sección de Referencias, 28 Ferber R.A. Assessment procedures for diagnosis of sleep disorders in children New York: Basic Books (1987).
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Haga clic aquí para ir a la sección de Referencias} These differences are greatest in the young child and progressively come to resemble the adult by adolescence.