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Case study A severely obese 15-year-old patient presented with enuresis, which resolved after treatment of her obstructive sleep apnoea; direct questioning about snoring allowed identification of the underlying issue. She was delighted that through non-invasive ventilation her enuresis was 'treated'.
Introduction
Sleep is a vital function of life that we cannot survive without; it is therefore unsurprising that sleep-related presentations to healthcare professionals are common. 1 Sleep-related issues are interesting, in that they may be a primary reason for seeking medical advice, but may also prove to be the underlying cause of other presenting problems. Additionally, many common health problems impact on sleep quality, including asthma, cough, gastro-oesophageal reflux, constipation, eczema, anxiety and seizures.
Poor sleep quality in children has been associated with hyperactivity, externalising behaviours, poor academic progress, symptoms of depression, daytime somnolence, bed-wetting, obesity and accidental injury. 2-4 It is sometimes only by asking specifically that sleep issues are identified and appropriate management interventions suggested.
Box 1 Targeted sleep history The first three questions provide a quick screen; if concerns are apparent more specific history can be gathered:
Does your child have any difficulty getting to sleep or staying asleep?
Does your child do anything unusual in the night?
Is your child unusually sleepy in the daytime?
When is bedtime?
What do you do in the hour leading up to bedtime?
How long does your child take to fall asleep after 'lights out'?
Where does your child fall asleep?
Does anybody need to be with the child while he/she is falling asleep?
Does your child sleep through, once asleep?
Does your child snore, have you noticed pauses in breathing when asleep?
Is your child restless in sleep?
What time does your child wake in the morning?
Is your child tired in the daytime? Does he/she fall asleep during activities?
What effect is this having on your family?
Range of normality
Parents may overestimate or underestimate the degree to which their child's sleep is disturbed. 5 As objective monitoring is not always practical, it is important we acknowledge that we are managing parents' experience of their child's sleep as well as objectively identified problems.
So what is 'normal' when it comes to sleep patterns; when should health professionals be concerned, and when can...