Medical Technology

Resolving Sleep Problems in Children With AD Can Be Complex

According to Stephen H. Sheldon (DO), approximately 50 percent of children who suffer from atopic dermatologtitis (AD), they suffer from sleep issues. These symptoms range from sleep fragmentation and restlessness to limb movements.

Sheldon, a professor of pediatrics at Northwestern University, Chicago, said that “they awake frequently.” They might not stay awake for long, but they do move around a lot. Children with AD suffer from a loss of approximately 50 minutes of their sleep each night. This can result in an enormous amount of sleep debt in the following day. They have difficulty settling down in the evening. They are unable to fall asleep once they’re in their bed. Many of them also struggle to stay asleep.

He and his colleagues have noticed that children suffering from AD have difficulty with limb movement at the hospital. “Part of the problem is that they’ve been diagnosed with different sleep-related disorders, such as period limb movement disorder, restless leg syndrome, and growing pain,” Sheldon said. “They don’t know how to describe their leg discomfort in restless legs syndrome, period limb movement disorder and limb movements during sleep.

Children who complain of growing pains claim that their legs hurt, he continued. Sometimes, they’ll say that spiders crawl on their legs or their legs are itchy. However, they frequently complain that they have legs pain that keeps them awake and prevents them from moving their legs.

According to the American Academy of Sleep Medicine periodic limb movement disorder of sleeping is defined as a condition wherein the limb movements last at minimum 0.5 seconds and are not separated by more than 90 seconds. “They’re four moves in a row, which are at least five seconds apart,” Sheldon said.

Interestingly, he added, children with limb movement disorder show symptoms during the day, which are similar to adults. “But we see many children who experience frequent limb movements during sleep and whose legs and arms move throughout the night long and don’t display any symptoms during the daytime. Children with these conditions may have trouble falling asleep or staying asleep however, they do not meet all of the American Academy of Sleep Medicine criteria for diagnosis of periodic limb movement disorder, he added.

LourdesM. DelRosso from Seattle Children’s Hospital and her colleagues identified a new problem in their sleep that they described as restless . This is a term that describes those who are unable to satisfy the criteria for other types of sleep disorder, but have a problem with daytime sleep.

Sheldon explained that they performed a lot of movements, more than five times per hour of bodily activity. “They’ll move their trunk and legs, and move their bodies around. We’ve observed that there are many children that came to the sleep disorder center with restless sleep, limb movement disorder, periodic limb movements of sleep, and daytime symptoms that would meet the criteria for periodic limb movement disorder, but also have atopic skin atopic.”

Sheldon and his colleagues used polysomnographic variables to study children suffering from AD. They were referred to Lurie Children’s Hospital with symptoms such as difficulty sleeping and snoring as a result of an allergic reaction. They found increased periods of being awake following the beginning of sleep, “meaning the children fell asleep quite easily at the early hours of the night but they experienced significant wake-up after falling asleep,” he said. “They would awake in the middle of the night and stay awake for long periods of timewhether for one long session or several shorter sessions over the night. They had higher total movement of limbs per hour of rest. This means that their limb movements were more than five per hour of rest and it caused restless sleep and limb movements that meet the criteria for periodic limb movement disorder.”

He noted that the majority of the children had mild to moderate AD. “We believe that the sensory afferent loop that is present in these children isn’t shut off completely when they’re sleeping. This is an area that merits further study however it is intuitive sense that when the sensory afferent loop persists during sleep, it can affect the arousal process in a significant manner.”

Sheldon advised that children with a diagnosis like periodic limb movement disorder, periodic movements of the legs, or restless sleep disorder, should be evaluated for AD. “The first step in treating AD is to determine between periodic limb movement disorder and AD. Both issues should be treated at the same time to address the child’s daytime AD problem as and sleep-related issues that occur with an AD diagnosis.”

Sheldon has not disclosed any relevant financial relationships.

This article was first published on, part the Medscape Professional Network.

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