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Parasomnias and sleep-related movement disorders in children: Summary

Disorder	Transition from wakefulness into sleep	NREM sleep	REM sleep	Comments
Parasomnias
Confusional arousals		X*		Very common in young children and usually resolve by late childhood.
Sleepwalking		X*
Sleep terrors		X*
Nightmares			X	Most common in children; persist into adulthood in 2 to 8% of the population.
Sleep paralysis			X	Onset usually in adolescence.
Sleep enuresis		X	X	Defined as age >5 years and two or more episodes/week.
REM sleep behavior disorder			X	Seen more frequently in adults than in children. Strong association with synucleinopathy in adults. In children, associated with narcolepsy type 1, serotonergic antidepressants, or structural brainstem lesions.
Parasomnia overlap disorder		X	X	REM sleep behavior disorder combined with another parasomnia.
Sleep-related movement disorders
Restless legs syndrome (RLS)				Urge to move legs occurs at rest while awake. Often associated with iron deficiency; refer to UpToDate topic on RLS in children.
Periodic limb movement disorder (PLMD)		X		Often associated with iron deficiency and RLS.
Sleep-related leg cramps				May be idiopathic or secondary to other medical conditions. In children these are typically benign and self-limited. The frequency tends to increase with advancing age.
Bruxism		X
Rhythmic movement disorder (RMD)	X	X	(X)	Rhythmic movements at sleep onset are common and benign in infants and toddlers. This is termed rhythmic movement disorder if there is associated self-injury, interference with sleep, or effects on daytime function. The exclusively REM-related rhythmic movements occur more frequently in adults.
Benign sleep myoclonus of infancy	X			Occurs in neurologically normal infants younger than six months of age.
Propriospinal myoclonus at sleep onset	X			Usually adult-onset. Clinically similar to hypnic jerks. Daytime emergence of movements can suggest seizure or spinal cord pathology.
Isolated symptoms and normal variants
Sleep starts (hypnic jerks)	X			Common at all ages; occurs at sleep onset.
Hypnagogic foot tremor	X	X		Common at all ages; typically near sleep onset.
Excessive fragmentary myoclonus		X		Benign and nonprogressive myoclonus that is subtle, mainly characterized by EMG findings during PSG. Commonly an incidental finding.
Catathrenia (sleep-related groaning)			X	Catathrenia is usually categorized with sleep-related breathing disorders because it appears to be associated with prolonged expiration.
Sleep-related medical and neurological disorders
Sleep-related epilepsy		X*		Episodes tend to be brief, stereotyped, and occur in clusters, randomly through the night.

NREM: non-rapid eye movement; REM: rapid eye movement; RLS: restless legs syndrome; PLMD: periodic limb movement disorder; RMD: rhythmic movement disorder; EMG: electromyography; PSG: polysomnography.
* Confusional arousals, sleepwalking and night terrors arise during stage N3 of NREM sleep, which tends to occur during the first third of the night. Sleep-related epilepsy tends to occur during stage N1 or N2 of NREM sleep, and is more likely to occur in clusters and randomly through the night.

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