The clinical features of basically the same sleep disorder can be very different in children compared with adults. The overall behavioural effects of excessive sleepiness in adults is a reduction of physical and mental activity. In contrast, its effect in young children can be increased activity with irritability, tantrums, or other behavioural difficulties. Some types of attention-deficit hyperactivity disorder ( ADHD) are thought to be the result of sleep disorders (OSA, periodic limb movements in sleep, circadian sleep-wake rhythm disorder) with improvement in the difficult behaviour following treatment of the sleep disorder. (15)
Upper airway obstruction (including OSA) illustrates important differences between children and adults not only in the clinical manifestation of a particular sleep disorder but also in the underlying cause and treatment needs. Similarly, the early manifestation of narcolepsy in childhood may be very far removed from the classical narcolepsy syndrome in adults, at least in its fully developed form. (11
The same sleep disorder may also show different physiological features according to age. Diagnostic criteria (e.g. for OSA and narcolepsy) derived from polysomnographic studies in adults do not necessarily apply in children and may well need modification.
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