Sleep disorders in children are among the most common parental complaints to health
care professionals and frequently occur in children with neurological and developmental
disorders. Thus, I am grateful to the editors of Neuropediatrics for the opportunity to assemble in one place several papers that outline the contemporary
knowledge about sleep disorders in patients with neurodevelopmental disabilities.
Major advances in children's sleep research and pediatric sleep disorders medicine
have occurred in recent years, and it is perfect timing to bring together perspectives
of such a distinguished group of clinicians and scientists.
In this issue, Mouthon and Huber[1] describe recent developments in the methodology to assess sleep and its disorders
in children. While sleep questionnaires, actigraphy, and polysomnography are established
techniques in pediatric sleep research and medicine since many decades, latest scientific
advances in electroencephalography (EEG) and EEG signal analysis have provided new
opportunities in understanding the regulation of children's sleep and its disorders
and have offered an undisturbed window into the developing brain. For instance, the
topography of EEG sleep slow wave activity—a marker of sleep regulatory mechanisms,
sleep homeostasis, and synaptic processes—was shown to parallel cortical maturation
during development.[2]
[3]
Advanced EEG analyses have also led to new insights into the mechanisms of specific
epilepsy syndromes as outlined in the review article by Schmitt[4] in this special issue. His review describes in detail the close and reciprocal association
between sleep and seizure disorders. In fact, more than half of all seizure episodes
occur at night and patients with epilepsy frequently suffer from poor sleep and tiredness.
Recent studies have shown that altered slow wave sleep in young patients with seizures
may cause the sleep problems and also contribute to the underlying mechanisms of the
developmental regression of these children.[5]
[6]
Over the past years, the awareness that narcolepsy is as disorder which also occurs
during childhood has been increased. In fact, more and more colleagues see growing
numbers of young patients with narcolepsy and, thus, comprehensive and up-to-date
knowledge about this devastating disorder during childhood is strongly needed. Rocca
and co-authors[7] have contributed to this special issue with the latest update on childhood narcolepsy.
I do believe that this overview from one of the leading European centers will improve
the clinical care of these patients.
Finally, Angriman and colleagues[8] summarize the diverse sleep problems that often occur in children with developmental
disabilities such as Angelman, Rett, Fragile-X syndromes, and others. They present
clinical and therapeutic approaches to help these children and their families. An
important role in the management of these patients lies in the pharmacological treatment.
However, behavioral approaches in these children are as important as medication. Our
group has recently presented a well-structured intervention concept (the Zurich 3-step
concept[9]) which focuses on basic physiological models of sleep regulation (i.e., introducing
a regular rhythm and adjusting bedtime to sleep need), and uses behavioral strategies
to handle elements of maladaptive learned sleep behavior, in both healthy children
and those with neurological and developmental disorders.
I understand that this special issue of Neuropediatrics is focusing on selected disorders of neurologically impaired children. However, I
also believe that, as the 21st century continues to unfold, there is a great need
for understanding the general role of sleep as a foundation for the children's development
across many different domains. Thus, I eagerly await the further developments in this
area of sleep research over the next years.
