A 15-Year-Old Girl With Sleep-Onset Insomnia and Poor Sleep Quality.

CASE PRESENTATION: A 15-year-old girl was referred to us for sleep difficulties and restless sleep. The parent stated that she was always a poor sleeper, having difficulty falling asleep and frequent nocturnal awakenings since she was a very young child, but in the past 6 months the symptoms had worsened. She slept in her own room and in her own bed. Her bedtime was 10:30 pm, staying in bed anywhere from 2 to 5 h before she could fall asleep. During this time, she felt discomfort in her legs with the urge to move her legs and relief after movement. This sensation was worse at night or when sitting for prolonged periods of time. Once she fell asleep, she woke up 2 to 3 times a night. She started her day at 7 am but felt very sleepy and often would fall asleep again until 10 am. During the day she was exhausted and often took a nap from 3 to 5 pm. There was soft snoring and no parasomnias. Her medical history was significant for beta-thalassemia trait. She was not on any medications. Social history included no dietary restrictions and no caffeine use.

Video-polysomnographic characterization of sleep movements in children with restless sleep disorder.

STUDY OBJECTIVES: Children with "restless sleep disorder" (RSD) were previously identified clinically and polysomnographically. In this study, we attempt to characterize their sleep-related movements and describe them in terms of type of movement, duration, and timing. METHODS: Video-polysomnography (vPSG) from 15 school-aged children with RSD, 15 sex- and age-matched children with restless legs syndrome (RLS), and 15 controls was reviewed for identification of sleep-related movements. Data obtained included the routine data collected during PSG and the video assessment of the movements which included time of the night when the movement occurred, type of movement (arms, legs, and body position change), and duration of the movement. RESULTS: vPSG recordings from 15 children with RLS (12 males, 3 females) with a mean age of 11.9 (SD: 3.52), 15 participants with RSD (11 males, 4 females) with a mean age of 9.5 (SD: 3.18), and 15 controls (9 males, 6 females) with a mean age of 10. The total movement index, obtained by summing together all types of movements in each participant and dividing it by the total sleep time, was prominent in children with RSD in all sleep stages. Five movements per hour gave 100% accuracy vs. controls and 90% vs. RLS. Movements occurred all night. CONCLUSIONS: We have characterized the sleep-related movements of children with RSD in comparison to the movements in children with RLS and in controls. We identified that children with RSD move all night and an index of 5 per hour accurately separates RSD from other disorders.