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Approach to a child with excessive daytime sleepiness
  1. Keshavamurthy Kallambella,
  2. Nahin Hussain
  1. Department of Paediatric Neurology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Dr Keshavamurthy Kallambella, Department of Paediatric Neurology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary square, Leicester LE1 5WW, UK; kallambella{at}yahoo.com

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Introduction

Being alert when awake is an essential requisite for a child's overall development. Sleepiness affects a child's learning, behaviour, mood and physical health and has larger implications for the whole family.1 It is often an overlooked symptom in the paediatric practice, especially when present with other comorbidities and disabilities which increase its prevalence. A comprehensive exploration of this symptom and an accurate diagnosis of the underlying cause are very important as many of the conditions are treatable or remediable, though some of them will require specialist input.

Why is it important?

A child who is sleepy is more likely to:

  • be bullied by his/her peers at school

  • be labelled as lazy

  • have low self-esteem

  • have poor academic performance

  • have concerns raised over parenting skills

A detailed history and physical examination will guide the clinician when to extend the assessment and when to refer for more specialist review.

What causes sleepiness?

Conditions causing excessive daytime sleepiness (EDS) can be categorised into three broad groups (see figure 1); conditions that

  • lead to insufficient sleep

  • decrease quality of sleep

  • increase sleep-drive

The first two groups with overlapping aetiologies will eventually lead to chronic sleep deprivation and account for the majority of cases. Insufficient duration of sleep among adolescents and young adults resulting in daytime sleepiness and impairment is becoming increasingly recognised internationally.2

Figure 1

Causes of excessive daytime sleepiness. ADHD, attention deficit hyperactivity disorder; OSA, obstructive sleep apnoea.

What to ask for in the history?

Sleepiness is defined as inability to stay awake and alert during the major waking episodes of the day, resulting in unintended lapses into drowsiness and sleep.3 It is not uncommon for parents to confuse fatigue or excessive tiredness on activity for sleepiness though both can coexist.4 If latter is the main symptom associated with sleep disturbances, then chronic fatigue syndrome and its differentials should be considered. Furthermore, the use of …

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