or their children.
Parents may also be becoming more aware of preexisting sleep issues that their children are facing since adults are now staying at home more and are able to witness their child’s daytime sleepiness.
While many teenagers are sleepy for reasons other than any underlying medical conditions, including early school start times and poor bedtime habits, Owens says it’s important for clinicians to take the time to weed out cases that are clinically significant.
“The consequences are even more concerning in adolescents because we know that daytime sleepiness is linked to cognitive changes, particularly executive functions and problem solving. That part of the brain, the prefrontal cortex, is undergoing very rapid development during the adolescent years, so it is highly vulnerable to the effects of insufficient sleep and daytime sleepiness,” says Owens.
Is It Fatigue or Excessive Sleepiness?
It’s not always easy to see the difference between fatigue and EDS, but there are a number of screening tools to guide clinicians to make the distinction. Well-validated questionnaires for pediatric sleep problems include the BEARS 5-item questionnaire and the Children’s Sleep Habits Questionnaire, among others.
The literature review also recommends other tools used specifically to screen for EDS in the pediatric population, including the Pediatric Daytime Sleepiness Scale and Modified Epworth Sleepiness Scale for Children and Adolescents.
A parent-recorded sleep diary can also help in pinning down exactly why a child is experiencing drowsiness. The article suggests that parents should be advised to document their child’s sleep and wake times over a two-week period, which can avoid potentially inaccurate histories recalled during visits in the physician’s office.
Presentation of Daytime Sleepiness in Pediatrics
According to the article, EDS looks different in younger children than it does in adolescents. While adolescents may complain that they are tired or sleepy or doze off, EDS in prepubescent children can manifest with behavioral problems.
A hallmark of daytime sleepiness in young children is hyperactivity and impulsivity. Children may also exhibit oppositional or aggressive behaviors. For young children and adolescents, EDS can lead to the decline of many daily functions, including a poor academic performance as well as mood disturbances.
“Daytime sleepiness cuts across many different domains that really determine the quality of life for children,” says Owens.
Difficulty waking up in the morning and falling asleep during the day in inappropriate circumstances may be attributed to EDS. The propensity to sleep longer than usual when given the opportunity, including on weekends, is also an important sign of chronic insufficient sleep, the review says.
“I tell families, ‘If your child has difficulty waking up at the time that they need to get up in the morning either for school or for anything else, that is a bit of a red flag,’” says Owens.
Young children with EDS may also present as inattentive and unfocused, or withdrawn and isolated because they skip social gatherings because of their sleepiness. Since alertness in school-aged children is normally high, clinicians should have a low threshold for investigating concerns of sleepiness in this age group, the review says.
Long-term Health Outcomes and Treatment
After daytime sleepiness is confirmed, the review suggests that providers start with behavioral and nonpharmacologic approaches by advising the patients and their families on good sleep hygiene practices. Pharmacotherapy options can be explored as an adjunct if behavioral interventions are not successful.
Children with obstructive sleep apnea may see improvements from adenotonsillectomy, weight reduction, and continuous positive airway pressure.
If EDS is not treated and properly managed, a child may also experience permanent negative health outcomes. An inflammatory response can impact the cardiovascular system. Insufficient sleep is also linked to an increase risk of obesity and hypertension, says Owens.
“There’s no