t 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Young children with EDS may also present as inattentive and unfocused, or withdrawn and isolated because they skip social gatherings because of their sleepiness.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 not only a short-term effect, but potentially a longer effect as well.”
Lisa Spear is the associate editor of Sleep Review.
Owens J, Babcock D, Weiss M. Evaluation and treatment of children and adolescents with excessive daytime sleepiness. Clinical Pediatrics. 2020 March. 59 (4-5): 340-51.