Response to Melatonin Treatment in Children With Autism spectrum Disorder and Relationship to Sleep Parameters and Melatonin Levels.

Melatonin is one of the most used pharmacologic treatments for sleep problems in autism spectrum disorder, though its relationship with circadian and sleep parameters is still not well stablished. A naturalistic study was conducted in children with autism spectrum disorder, previously drug-naïve, before and after treatment with immediate-release melatonin. Circadian rhythms and sleep parameters were studied using an ambulatory circadian-monitoring device, and saliva samples were collected enabling determination of dim light melatonin onset. Twenty-six children with autism spectrum disorder (age 10.50 ± 2.91) were included. Immediate-release melatonin modified circadian rhythm as indicated by wrist skin temperature, showing an increase at night. A positive correlation was found between time of peak melatonin and sleep efficiency improvement values. Sleep-onset latency and efficiency improved with immediate-release melatonin. Immediate-release melatonin could be an effective treatment to improve sleep onset and restore a typical pattern of wrist temperature, which appears to be lost in autism spectrum disorder.

Melatonin Rhythm and Its Relation to Sleep and Circadian Parameters in Children and Adolescents With Autism Spectrum Disorder.

Introduction: Sleep problems are prevalent among individuals with autism spectrum disorder (ASD), and a role has been attributed to melatonin in this multifactorial comorbidity. Methods: A cross-sectional study was conducted on 41 autistic children and adolescents (9.9 ± 3.02) and 24 children and adolescents with a normal intellectual function (8.42 ± 2.43) were used as controls. Subjects were matched for sex, body mass index, and pubertal stage, and all were drug-naive. Circadian and sleep parameters were studied using an ambulatory circadian monitoring (ACM) device, and saliva samples were collected around the onset of sleep to determine dim light melatonin onset (DLMO). Results: Prepubertal individuals with ASD presented later DLMO and an earlier decline in melatonin during adolescence. A relationship was found between melatonin and both sleep and circadian parameters. Participants and controls with later DLMOs were more likely to have delayed sleep onset times. In the ASD group, subjects with the later daytime midpoint of temperature had a later DLMO. Later melatonin peak time and DLMO time were related to lower general motor activity and lower stability of its rhythms. Conclusion: The melatonin secretion pattern was different in individuals with ASD, and it showed a relationship with sleep and circadian parameters. Alterations in DLMO have not been previously reported in ASD with the exception of more variable DLMO timing; however, high variability in the study design and sample characteristics prevents direct comparison. The ACM device enabled the measurement of circadian rhythm, a scarcely described parameter in autistic children. When studied in combination with other measures such as melatonin, ACM can offer further knowledge on sleep problems in ASD.

Sleep Problems and Circadian Functioning in Children and Adolescents With Autism Spectrum Disorder.

BACKGROUND: Sleep problems are a prevalent comorbidity in autism spectrum disorder (ASD) with a multifactorial basis in which circadian misalignment has been described. METHODS: A cross-sectional study was conducted including 52 children and adolescents with ASD (9.85 ± 3.07) and 27 children and adolescent controls with normal intellectual functioning (8.81 ± 2.14). They were matched for age, sex, and body mass index, and all were drug-naïve. An ambulatory circadian monitoring device was used to record temperature and motor, body position, sleep, and light intensity. RESULTS: Individuals with ASD presented longer sleep-onset latency, lower sleep efficiency, and decreased total sleep time and tended to be more sedentary and have less exposure to light. They also showed lower amplitude, low interdaily stability, and a different pattern of wrist temperature across the day, with a midpoint of sleep that did not concur with sleep midpoint indicated by the rest of circadian parameters. CONCLUSIONS: The sleep problems observed in this sample resemble those reported previously, with the exception of nocturnal awakenings which did not show differences. The ambulatory circadian monitoring device enabled measurement of circadian parameters such as temperature which, until now, were scarcely described in children with ASD and could be used to better understand sleep and circadian system in ASD.

Trastornos del movimiento y de la conducta durante el sueño en el adulto / Sleep-related movement and behavioural disorders in adults

Los trastornos del movimiento y de la conducta durante el sueño pueden tener un impacto en la calidad del sueño del paciente y dar lugar a síntomas diurnos. En estos grupos de enfermedades se incluyen entidades como el síndrome de piernas inquietas, los movimientos periódicos de las piernas y las parasomnias del sueño de movimientos oculares rápidos (REM) y no REM. El conocimiento de sus características clínicas y nociones sobre su manejo es de gran importancia para el neurólogo y especialista en sueño por su frecuencia e impacto en la calidad del sujeto. Con frecuencia, estos pacientes son referidos a dichos especialistas, y es relevante conocer que ciertos trastornos del sueño pueden asociarse a otras enfermedades neurológicas

Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as restless legs syndrome, periodic leg movements, and REM and NREM parasomnias. The knowledge of their clinical features and management is of utmost importance for the neurologist and sleep specialist. Frequently, these patients are referred to such specialists and it is relevant to know that certain sleep disorders may be associated with other neurological conditions

Sueño saludable: evidencias y guías de actuación. Documento oficial de la Sociedad Española de Sueño / Healthy sleep: evidence and guidelines for action. Official document of the Spanish Sleep Society

La Sociedad Española de Sueño tiene como uno de sus principales objetivos la promoción de un sueño saludable en la población general y profesionales de la salud. El presente documento pretende realizar una revisión de la literatura científica actual sobre hábitos de sueño que sirva de fundamento para establecer unas recomendaciones generales y útiles para la población general española, en el contexto de un sueño saludable, e identificar aquellos principales retos en la investigación sobre hábitos de sueño. El desarrollo del documento se ha realizado por un equipo multidisciplinar de miembros de la Sociedad Española de Sueño integrado por expertos en medicina pediátrica del sueño, neurofisiología clínica, neumología, neurología, cronobiología, fisiología y psicología. Se ha procedido a una revisión de la bibliografía científica existente sobre hábitos de sueño en población general, y se han abordado los siguientes aspectos: estado actual de los hábitos de sueño en la población española; revisión genérica de la cantidad óptima de horas de sueño; impacto del entorno ambiental (ruido, temperatura, iluminación...), horarios de sueño, alimentación y deporte; y apartados específicos para niños y adolescentes, trabajadores a turnos y conducción de vehículos. De todos los aspectos abordados a lo largo de este documento, se concluyen unas recomendaciones generales finales que servirán de guía a la población general y profesionales de la salud, así como se discuten los principales retos ambientales y futuras direcciones de investigación (AU)

One of the main objectives of the Spanish Sleep Society is to promote healthy sleep in both the general population and in health professionals. This document aims to conduct a review of the current scientific literature on sleep habits that can serve as the basis on which to establish a set of general recommendations, regarding healthy sleep, for use by the general population in Spain as well as to identify the main challenges faced by research into sleep habits. The document has been developed by a multidisciplinary team made up of members of the Spanish Sleep Society who are experts in paediatric sleep medicine, clinical neurophysiology, pulmonology, neurology, chronobiology, physiology and psychology. The existing scientific literature dealing with sleep habits in the general population was reviewed, and the following aspects were addressed: the current state of sleep habits in the Spanish population; a generic review of the optimum number of hours of sleep; the impact of the environmental setting (noise, temperature, illumination, etc.), hours of sleep, diet and sport, together with several specific sections for children and teenagers, shift-workers and drivers of different vehicles. The conclusions from all the aspects addressed in this document have resulted in a set of final general recommendations that will serve as a guide for the general population and health professionals. Likewise, the principal environmental challenges and future lines of research are also discussed (AU)

[The importance of sleep problems in children with headache and other neurodevelopmental disorders in neuropaediatric services]. / Importancia de los problemas de sueño en los niños con cefalea y otros trastornos del neurodesarrollo en las consultas de neuropediatria.

INTRODUCTION: Sleep disorders are common in children with neurological disorders. The aim of this study is to know the opinion of neuropediatricians and the prevalence of these disturbances in Spain. PATIENTS AND METHODS: Multicenter cross-sectional study (12 Spanish hospitals, 15 researchers). BEARS survey was collected in three groups: A (2-5 years), (6-12 years), and C (> 12 years). The opinion of neuropediatricians was also collected. RESULTS: 939 questionnaires were filled. The main results in groups B and C were ADHD (32.4% and 30.1% respectively) and headache (25.1% and 27.6% respectively), whereas in group A neurodevelopmental disorders (32.4%) and epilepsy (21.4%) were the main diagnoses. Disturbances in at least one area of sleep were found in 92% of children in group A (n = 209, mean 3 years), 64.2% in group B (n = 534, mean 9.4 years) and 58.2% in group C (n = 196, mean 13.7 years). Sixty-one surveys were answered by neuropediatricians (16.75% of the total sent), estimating that less than a quarter of the patients (24.5%) suffered. Even, up to 23% of doctors claimed that the prevalence of sleep disorders was < 10%. CONCLUSIONS: 58-92% of parents-patients under follow up at a neuropediatrician office in Spain have some degree of disturbed sleep. Although most neurologists emphasize the importance of an early diagnosis and treatment of sleep disorders in children with neurological disorders, its frequency is often underestimated (risk of underdiagnosis).

TITLE: Importancia de los problemas de sueño en los niños con cefalea y otros trastornos del neurodesarrollo en las consultas de neuropediatria.Introduccion. Los trastornos de sueño son frecuentes en niños con trastornos neurologicos. El objetivo del estudio es conocer la opinion de los neuropediatras y su prevalencia real en España. Pacientes y metodos. Estudio transversal multicentrico (12 hospitales españoles, 15 investigadores). Se administro la encuesta Bedtime, Excesive Daytime Sleepiness, Awakenings, Regularity, Sleep-Disordered Breathing (BEARS) y se definieron tres grupos: A (2-5 años), B (6-12 años) y C (> 12 años). Asimismo, se recogio la opinion de neuropediatras de la Sociedad Española de Neuropediatria mediante una encuesta anonima. Resultados. Se recogieron 939 encuestas. Los principales motivos de consulta en los grupos B y C fueron trastorno por deficit de atencion/hiperactividad (32,4% y 30,1%, respectivamente) y cefalea (25,1% y 27,6%, respectivamente), y en el grupo A, los trastornos del neurodesarrollo (32,4%) y la epilepsia (21,4%). Al menos un area del sueño alterada se encontro en el 92,9% de niños del grupo A (n = 209; media: 3 años), en el 64,2% del grupo B (n = 534; media: 9,4 años) y en el 58,2% del grupo C (n = 196; media: 13,7 años). Se recibieron 61 encuestas respondidas por los neuropediatras (16,75% de las enviadas), quienes estimaban que los trastornos del sueño afectaban a menos de una cuarta parte de sus pacientes (24,5%), y hasta un 23% afirmo que la prevalencia era inferior al 10%. Conclusion. El 58-92% de los padres-pacientes que acuden a consultas de neuropediatria refiere tener algun aspecto del sueño alterado. Aunque la mayoria de los neuropediatras subraya la importancia de un diagnostico y tratamiento de los trastornos de sueño de los niños con trastornos neurologicos, se suele infraestimar su frecuencia e importancia.

Importancia de los problemas de sueño en los niños con cefalea y otros trastornos del neurodesarrollo en las consultas de neuropediatría / The importance of sleep problems in children with headache and other neurodevelopmental disorders in neuropaediatric services

Introducción. Los trastornos de sueño son frecuentes en niños con trastornos neurológicos. El objetivo del estudio es conocer la opinión de los neuropediatras y su prevalencia real en España. Pacientes y métodos. Estudio transversal multicéntrico (12 hospitales españoles, 15 investigadores). Se administró la encuesta Bedtime, Excesive Daytime Sleepiness, Awakenings, Regularity, Sleep-Disordered Breathing (BEARS) y se definieron tres grupos: A (2-5 años), B (6-12 años) y C (> 12 años). Asimismo, se recogió la opinión de neuropediatras de la Sociedad Española de Neuropediatría mediante una encuesta anónima. Resultados. Se recogieron 939 encuestas. Los principales motivos de consulta en los grupos B y C fueron trastorno por déficit de atención/hiperactividad (32,4% y 30,1%, respectivamente) y cefalea (25,1% y 27,6%, respectivamente), y en el grupo A, los trastornos del neurodesarrollo (32,4%) y la epilepsia (21,4%). Al menos un área del sueño alterada se encontró en el 92,9% de niños del grupo A (n = 209; media: 3 años), en el 64,2% del grupo B (n = 534; media: 9,4 años) y en el 58,2% del grupo C (n = 196; media: 13,7 años). Se recibieron 61 encuestas respondidas por los neuropediatras (16,75% de las enviadas), quienes estimaban que los trastornos del sueño afectaban a menos de una cuarta parte de sus pacientes (24,5%), y hasta un 23% afirmó que la prevalencia era inferior al 10%. Conclusión. El 58-92% de los padres-pacientes que acuden a consultas de neuropediatría refiere tener algún aspecto del sueño alterado. Aunque la mayoría de los neuropediatras subraya la importancia de un diagnóstico y tratamiento de los trastornos de sueño de los niños con trastornos neurológicos, se suele infraestimar su frecuencia e importancia (AU)

Introduction. Sleep disorders are common in children with neurological disorders. The aim of this study is to know the opinion of neuropediatricians and the prevalence of these disturbances in Spain. Patients and methods. Multicenter cross-sectional study (12 Spanish hospitals, 15 researchers). BEARS survey was collected in three groups: A (2-5 years), (6-12 years), and C (> 12 years). The opinion of neuropediatricians was also collected. Results. 939 questionnaires were filled. The main results in groups B and C were ADHD (32.4% and 30.1% respectively) and headache (25.1% and 27.6% respectively), whereas in group A neurodevelopmental disorders (32.4%) and epilepsy (21.4%) were the main diagnoses. Disturbances in at least one area of sleep were found in 92% of children in group A (n = 209, mean 3 years), 64.2% in group B (n = 534, mean 9.4 years) and 58.2% in group C (n = 196, mean 13.7 years). Sixty-one surveys were answered by neuropediatricians (16.75% of the total sent), estimating that less than a quarter of the patients (24.5%) suffered. Even, up to 23% of doctors claimed that the prevalence of sleep disorders was < 10%. Conclusions. 58-92% of parents-patients under follow up at a neuropediatrician office in Spain have some degree of disturbed sleep. Although most neurologists emphasize the importance of an early diagnosis and treatment of sleep disorders in children with neurological disorders, its frequency is often undesestimated (risk of underdiagnosis) (AU)

Las evoluciones atípicas de la epilepsia rolándica son complicaciones predecibles / The atypical developments of rolandic epilepsy are predictable complications

Introducción. Las evoluciones atípicas de la epilepsia rolándica son parte de un espectro clínico de fenotipos variables, idiopáticos, dependientes de la edad y con una predisposición genéticamente determinada. Objetivo. Estudiar las características electroclínicas sugestivas de una evolución atípica en la epilepsia rolándica. Pacientes y métodos. Se realizó una búsqueda retrospectiva de 133 niños diagnosticados de epilepsia focal benigna atípica (EFBA), síndrome de Landau-Kleffner y epilepsia de punta-onda continua durante el sueño (POCS). Se seleccionaron nueve pacientes que, en el trascurso de su epilepsia rolándica, presentaron un cuadro clínico atípico y un patrón electroencefalográfico (EEG) de estado epiléptico eléctrico durante el sueño (ESES). Resultados. El inicio de la epilepsia rolándica fue, en promedio, a los 5 años. Los pacientes presentaron un empeoramiento clínico y del EEG año y medio más tarde en promedio. En tres pacientes se observaron características de EFBA, y en seis, de POCS. No se encontraron casos de síndrome de Landau-Kleffner. El EEG en vigilia mostró una focalidad centrotemporal izquierda en seis pacientes, y derecha, en tres. Todos los pacientes presentaron un ESES en el EEG de sueño. En tres de ellos se observó un patrón atípico de ESES regional. Además, se detectaron alteraciones cognitivas y conductuales por déficits en áreas específicas del aprendizaje, como lenguaje, memoria, atención e inquietud. Conclusiones. El inicio precoz de la epilepsia rolándica, la aparición de nuevas crisis con un incremento en su frecuencia y una focalidad frontocentrotemporal en el EEG, que aumenta en frecuencia, tanto en vigilia como en sueño, son características electroclínicas sugerentes de una evolución atípica (AU)

Introduction. The development of atypical features in rolandic epilepsy is part of a clinical spectrum of phenotypes that are variable, idiopathic and age-dependent, as well as having a genetically determined predisposition. Aim. To study the electroclinical characteristics suggesting an atypical development in rolandic epilepsy Patients and methods. A retrospective search was performed in 133 children diagnosed with atypical benign focal epilepsy (ABFE), Landau-Kleffner syndrome and continuous spike-wave during sleep (CSWS). Nine patients were selected, all of whom presented atypical clinical features and an electroencephalogram (EEG) pattern of electrical status epilepticus during sleep (ESES) in the course of their rolandic epilepsy. Results. The average age at onset of rolandic epilepsy was 5 years. Patients showed a deterioration of both their clinical features and their EEG recording one and a half years later, on average. ABFE was observed in three of them and CSWS in six. No cases of Landau-Kleffner syndrome were found. The EEG in wakefulness showed the focus to be in the left centrotemporal region in six patients and in three of them it was on the right-hand side. All the patients presented ESES in the EEG during sleep. An atypical pattern was observed in the regional ESES in three of the patients. Moreover, cognitive and behavioural disorders were detected due to deficits in specific learning areas, such as language, memory, attention and restlessness. Conclusions. The early onset of rolandic epilepsy, the appearance of new seizures with an increased frequency and the frontocentrotemporal focus in the EEG, which increases in frequency, both in wakefulness and in sleep, are all electroclinical characteristics of an atypical development (AU)

[The atypical developments of rolandic epilepsy are predictable complications]. / Las evoluciones atipicas de la epilepsia rolandica son complicaciones predecibles.

INTRODUCTION: The development of atypical features in rolandic epilepsy is part of a clinical spectrum of phenotypes that are variable, idiopathic and age-dependent, as well as having a genetically determined predisposition. AIM: To study the electroclinical characteristics suggesting an atypical development in rolandic epilepsy. PATIENTS AND METHODS: A retrospective search was performed in 133 children diagnosed with atypical benign focal epilepsy (ABFE), Landau-Kleffner syndrome and continuous spike-wave during sleep (CSWS). Nine patients were selected, all of whom presented atypical clinical features and an electroencephalogram (EEG) pattern of electrical status epilepticus during sleep (ESES) in the course of their rolandic epilepsy. RESULTS: The average age at onset of rolandic epilepsy was 5 years. Patients showed a deterioration of both their clinical features and their EEG recording one and a half years later, on average. ABFE was observed in three of them and CSWS in six. No cases of Landau-Kleffner syndrome were found. The EEG in wakefulness showed the focus to be in the left centrotemporal region in six patients and in three of them it was on the right-hand side. All the patients presented ESES in the EEG during sleep. An atypical pattern was observed in the regional ESES in three of the patients. Moreover, cognitive and behavioural disorders were detected due to deficits in specific learning areas, such as language, memory, attention and restlessness. CONCLUSIONS: The early onset of rolandic epilepsy, the appearance of new seizures with an increased frequency and the frontocentrotemporal focus in the EEG, which increases in frequency, both in wakefulness and in sleep, are all electroclinical characteristics of an atypical development.

TITLE: Las evoluciones atipicas de la epilepsia rolandica son complicaciones predecibles.Introduccion. Las evoluciones atipicas de la epilepsia rolandica son parte de un espectro clinico de fenotipos variables, idiopaticos, dependientes de la edad y con una predisposicion geneticamente determinada. Objetivo. Estudiar las caracteristicas electroclinicas sugestivas de una evolucion atipica en la epilepsia rolandica. Pacientes y metodos. Se realizo una busqueda retrospectiva de 133 niños diagnosticados de epilepsia focal benigna atipica (EFBA), sindrome de Landau-Kleffner y epilepsia de punta-onda continua durante el sueño (POCS). Se seleccionaron nueve pacientes que, en el trascurso de su epilepsia rolandica, presentaron un cuadro clinico atipico y un patron electroencefalografico (EEG) de estado epileptico electrico durante el sueño (ESES). Resultados. El inicio de la epilepsia rolandica fue, en promedio, a los 5 años. Los pacientes presentaron un empeoramiento clinico y del EEG año y medio mas tarde en promedio. En tres pacientes se observaron caracteristicas de EFBA, y en seis, de POCS. No se encontraron casos de sindrome de Landau-Kleffner. El EEG en vigilia mostro una focalidad centrotemporal izquierda en seis pacientes, y derecha, en tres. Todos los pacientes presentaron un ESES en el EEG de sueño. En tres de ellos se observo un patron atipico de ESES regional. Ademas, se detectaron alteraciones cognitivas y conductuales por deficits en areas especificas del aprendizaje, como lenguaje, memoria, atencion e inquietud. Conclusiones. El inicio precoz de la epilepsia rolandica, la aparicion de nuevas crisis con un incremento en su frecuencia y una focalidad frontocentrotemporal en el EEG, que aumenta en frecuencia, tanto en vigilia como en sueño, son caracteristicas electroclinicas sugerentes de una evolucion atipica.

Tratamiento farmacológico de los trastornos de sueño / No disponible

No disponible

Dreaming without REM sleep.

To test whether mental activities collected from non-REM sleep are influenced by REM sleep, we suppressed REM sleep using clomipramine 50mg (an antidepressant) or placebo in the evening, in a double blind cross-over design, in 11 healthy young men. Subjects were awakened every hour and asked about their mental activity. The marked (81%, range 39-98%) REM-sleep suppression induced by clomipramine did not substantially affect any aspects of dream recall (report length, complexity, bizarreness, pleasantness and self-perception of dream or thought-like mentation). Since long, complex and bizarre dreams persist even after suppressing REM sleep either partially or totally, it suggests that the generation of mental activity during sleep is independent of sleep stage.

Documento de consenso del síndrome de apneas-hipopneas durante el sueño en niños (versión completa) / Consensus document on sleep apnea-hypopnea syndrome in children (full version)

No disponible

[Attention deficit hyperactivity disorder and restless legs syndrome in children]. / Trastorno por deficit de atencion/hiperactividad y sindrome de piernas inquietas en ninos.

Restless legs syndrome (RLS) in the paediatric age is a common disorder and is in many cases associated to attention deficit hyperactivity disorder (ADHD). Yet, it remains 'the great unknown' in paediatrics. We do not usually think of it when examining a child with sleep problems, and there is even a tendency to deny its existence in children. ADHD and RLS have common symptoms and frequently share a common aetiopathogenesis (iron deficiency anaemia). Although important progress has been made in recent years in the research conducted on both disorders, further studies must be carried out to examine different treatments or other aspects of RLS in the paediatric population.

Trastorno por déficit de atención/hiperactividad y síndrome de piernas inquietas en niños / Attention deficit hyperactivity disorder and restless legs syndrome in children

Resumen. El síndrome de piernas inquietas (SPI) pediátrico es un trastorno frecuente y en muchos casos se asocia al trastorno por déficit de atención/hiperactividad (TDAH), pero es ‘el gran desconocido’ en pediatría. Habitualmente no se piensa en él cuando se evalúa a un niño con problemas de sueño, e incluso se tiende a negar su existencia en niños. ElTDAH y el SPI tienen síntomas comunes y comparten una etiopatogenia común en muchos casos (ferropenia). Aunque se han realizado importantes avances en los últimos años en la investigación de ambos trastornos, es necesario realizar más estudios relacionados con diferentes tratamientos o con otros aspectos del SPI en la población pediátrica (AU)

Summary. Restless legs syndrome (RLS) in the paediatric age is a common disorder and is in many cases associated to attention deficit hyperactivity disorder (ADHD). Yet, it remains ‘the great unknown’ in paediatrics. We do not usually think of it when examining a child with sleep problems, and there is even a tendency to deny its existence in children. ADHD and RLS have common symptoms and frequently share a common aetiopathogenesis (iron deficiency anaemia). Although important progress has been made in recent years in the research conducted on both disorders, further studies must be carried out to examine different treatments or other aspects of RLS in the paediatric population (AU)

Insomnio infantil / Pediatric insomnia

Objetivo: Este simposio revisa las causas del insomnio en el niño, sus manifestaciones y el abordaje terapéutico desde diferentes ópticas. Desarrollo: El insomnio es un trastorno que se presenta, fundamentalmente, como una dificultad para iniciar o mantener el sueño. La etiología del insomnio infantil es multifactorial pero es necesario conocer los mecanismos que intervienen en la génesis de la vigilia y del sueño y considerar la existencia de probables trastornos médicos. En el niño, existe una inmadurez cerebral fisiológica que es responsable de un ritmo vigilia-sueño característico. En esta edad, el insomnio aparece, en muchos casos, como consecuencia de un desajuste entre la necesidad de sueño del niño y su entorno familiar y social, que exige un cambio de las conductas o provocado por trastornos de origen médico, con un tratamiento específico. Conclusiones: El insomnio en niños y adolescentes tiene serias consecuencias en el niño, que afectan fundamentalmente a la esfera neurocognitiva y comportamental, y en la vida familiar (AU)

Aims. This symposium reviews the causes of insomnia in children, its manifestations and different therapeutic approachs Method. Insomnia is a disorder in which the child has difficulty in falling or staying asleep. There are multifactorial causes involved in the aetiology of childhood insomnia but it is necessary to understand mechanisms involved in the sleep-wake cycle and take another types of medical disorders in consideration. In children, there is a physiological immaturity lying into an specific sllep-wake pattern. Childhood insomnia seems to be a consequence of mismatch between the child’s need to sleep and parents or social environment, with a behavioural approach, or determined by a medical disorder, with specific treatment. Conclusions. Pediatric insomnia has serious consequences in children, mainly in neurocognitive or behavioural development, and in family quality of life (AU)