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1.  Clinical diagnosis and misdiagnosis of sleep disorders 
Sleep disorders are common in all sections of the population and are either the main clinical complaint or a frequent complication of many conditions for which patients are seen in primary care or specialist services. However, the subject is poorly covered in medical education. A major consequence is that the manifestations of the many sleep disorders now identified are likely to be misinterpreted as other clinical conditions of a physical or psychological nature, especially neurological or psychiatric disorders. To illustrate this problem, examples are provided of the various possible causes of sleep loss, poor quality sleep, excessive daytime sleepiness and episodes of disturbed behaviour at night (parasomnias). All of these sleep disorders can adversely affect mental state and behaviour, daytime performance or physical health, the true cause of which needs to be recognised by clinicians to ensure that appropriate treatment is provided. As conventional history taking in neurology and psychiatry pays little attention to sleep and its possible disorders, suggestions are made concerning the enquiries that could be included in history taking schedules to increase the likelihood that sleep disorders will be correctly identified.
doi:10.1136/jnnp.2006.111179
PMCID: PMC2095611  PMID: 18024690
2.  The relative efficacy of two brief treatments for sleep problems in young learning disabled (mentally retarded) children: a randomised controlled trial 
Archives of Disease in Childhood  2004;89(2):125-130.
Background: Settling and night waking problems are particularly prevalent, persistent, and generally considered difficult to treat in children with a learning disability, although intervention trials are few. Scarce resources, however, limit access to proven behavioural treatments.
Aims: To investigate the efficacy of a media based brief behavioural treatment of sleep problems in such children by comparing (1) face-to-face delivered treatment versus control and (2) booklet delivered treatment versus controls.
Methods: The parents of 66 severely learning disabled children aged 2–8 years with settling and/or night waking problems took part in a randomised controlled trial with a wait-list control group. Behavioural treatments were presented either conventionally face-to-face or by means of a 14 page easy to read illustrated booklet. A composite sleep disturbance score was derived from sleep diaries kept by parents.
Results: Both forms of treatment were almost equally effective compared with controls. Two thirds of children who were taking over 30 minutes to settle five or more times per week and waking at night for over 30 minutes four or more times per week improved on average to having such settling or night waking problems for only a few minutes or only once or twice per week (H = 34.174, df = 2, p<0.001). These improvements were maintained after six months.
Conclusions: Booklet delivered behavioural treatments for sleep problems were as effective as face-to-face treatment for most children in this population.
doi:10.1136/adc.2002.017202
PMCID: PMC1719807  PMID: 14736626
3.  Medication for sleep-wake disorders 
Archives of Disease in Childhood  2003;88(10):899-903.
doi:10.1136/adc.88.10.899
PMCID: PMC1719336  PMID: 14500311
4.  Recognition and management of narcolepsy 
Archives of Disease in Childhood  1999;81(6):519-524.
PMCID: PMC1718150  PMID: 10569973
5.  Cognitive function and mood after profound nocturnal hypoglycaemia in prepubertal children with conventional insulin treatment for diabetes 
Archives of Disease in Childhood  1999;81(2):138-142.
OBJECTIVES—To examine the frequency of nocturnal hypoglycaemia, and the effects on cognitive function and mood, in children with insulin dependent diabetes mellitus (IDDM).
DESIGN—Two overnight glucose profiles, in the home environment, and assessments of cognitive function and mood the following day. Twenty nine prepubertal patients with IDDM (median age, 9.4 years; range, 5.3-12.9) and 15 healthy controls (single overnight profile), median age 9.5 (range, 5.6-12.1) years were studied.
RESULTS—Asymptomatic hypoglycaemia (glucose < 3.5 mmol/l) was observed in 13 of 29 patients studied on night 1: four of these and seven others were hypoglycaemic on night 2. The median glucose nadir was 1.9 (range, 1.1-3.3) mmol/l and the median duration of hypoglycaemia was 270 (range, 30-630) minutes. Hypoglycaemia was related to insulin dose, but not glycosylated haemoglobin (HbA1c) values, and was partially predicted by a midnight glucose of < 7.2 mmol/l. Cognitive performance was not altered after hypoglycaemia but a lowering of mood was observed.
CONCLUSIONS—Young children on conventional insulin regimens are at high risk for profound, asymptomatic nocturnal hypoglycaemia, which is difficult to predict. There was no short term effect on cognitive function but mood change was detected.


PMCID: PMC1718013  PMID: 10490521
6.  Clinical services for sleep disorders 
Archives of Disease in Childhood  1998;79(6):495-497.
Children's sleep disorders are common and often harmful to development and well being. The clinical services available to affected children and their families need to be improved. At present, professional interest and expertise in sleep disorders medicine is severely limited by the paucity of appropriate teaching and training. The work of a mainly tertiary sleep disorders clinic was reviewed, which showed that accurate diagnosis of a wide range of sleep disorders is possible, and that treatment needs can be specified. Although families appreciated such assessment, the outcome was unsatisfactory in many cases, often because treatment recommendations were not implemented by referrers. Reasons for this appear to include poor communication between referrers and families, and unavailability of treatment resources. A three tier system of service provision is proposed to improve this situation, which rests essentially on better professional training in the sleep disorders field.


PMCID: PMC1717769  PMID: 10210993
8.  Sleep and psychological disturbance in nocturnal asthma 
Archives of Disease in Childhood  1998;78(5):413-419.
Subjective and objective sleep disturbance was studied in children with nocturnal asthma. Relations between such disturbance and daytime psychological function were also explored, including possible changes in learning and behaviour associated with improvements in nocturnal asthma and sleep. Assessments included home polysomnography, parental questionnaires concerning sleep disturbance, behaviour, and mood and cognitive testing. Compared with matched controls, children with asthma had significantly more disturbed sleep, tended to have more psychological problems, and they performed less well on some tests of memory and concentration. In general, improvement of nocturnal asthma symptoms by changes in treatment was followed by improvement in sleep and psychological function in subsequent weeks. The effects of asthma on sleep and the possible psychological consequences are important aspects of overall care.


PMCID: PMC1717552  PMID: 9659086
10.  Non-convulsive status epilepticus. 
Archives of Disease in Childhood  1995;73(2):106-111.
The clinical, electrographic and reported neuropsychological features of 50 children with non-convulsive status epilepticus (NCSE) were reviewed and the children's progress followed for one to five years. NCSE occurred in a variety of epilepsies, especially the Lennox-Gastaut syndrome. Clinical manifestations ranged from obvious mental deterioration to subtle changes. The condition had often been overlooked or misinterpreted and many children had experienced repeated episodes over long periods. Following diagnosis, immediate treatment was often not attempted or was not successful. Further episodes of NCSE occurred in the majority of children during the follow up period. Failure to recognise NCSE and to treat episodes promptly, and the high rate of recurrence, is of particular concern in view of fears that repeated exposure to this condition might be brain damaging. At least 28 children in the present series showed evidence of intellectual or educational deterioration over the period during which NCSE had occurred, although the exact cause was difficult to determine.
PMCID: PMC1511220  PMID: 7574851
11.  Kleine-Levin syndrome: a cause of diagnostic confusion. 
Archives of Disease in Childhood  1994;71(4):355-357.
The case is described of a boy with the Kleine-Levin syndrome in whom prominent behavioural disturbances and the initial absence of a clear cyclical pattern obscured the diagnosis. Treatment with lithium was effective.
PMCID: PMC1030020  PMID: 7979534
13.  Sleep problems. 
Archives of Disease in Childhood  1992;67(12):1420-1421.
PMCID: PMC1793961  PMID: 1489217
14.  Psychological effects of sodium valproate and carbamazepine in epilepsy. 
Archives of Disease in Childhood  1992;67(11):1330-1337.
Information from standardised tests of intelligence, school attainments, attention, memory and visuomotor function, together with parent and teacher questionnaire information about various aspects of behaviour, was obtained for 63 schoolchildren with newly diagnosed epilepsy before treatment with sodium valproate or carbamazepine, and again at intervals for a total period of 12 months. The same information was collected on 47 matched controls. The children with epilepsy represented those under non-specialised paediatric care. The result showed that both drugs were effective in most cases at modest dosage without causing notable psychological effects 12 months into treatment. Modest and temporary adverse cognitive effects seen earlier in treatment could have been the result of uncontrolled seizure discharge. Improved function was the same in children with epilepsy and controls. Some psychological abnormalities in the children with epilepsy were evident before treatment suggesting early unwanted effects of the epileptic process itself.
PMCID: PMC1793785  PMID: 1471883
16.  Sleep disorders in children. 
BMJ : British Medical Journal  1990;301(6748):351-352.
PMCID: PMC1679923  PMID: 2205316
18.  Controlled trial of trimeprazine tartrate for night waking. 
Archives of Disease in Childhood  1987;62(3):253-257.
Mild hypnotics are often recommended for young children with sleep problems. This study assesses the efficacy of trimeprazine tartrate in 1 to 3 year old children with persistent and severe night waking in a double blind crossover trial with placebo. Children on treatment with trimeprazine had significantly fewer wakings, less time awake at night, and more night time sleep compared with those on treatment with placebo. There were no differences in these sleep variables when the first and last (fourth) week of treatment with drugs were compared. Follow up observations showed no significant difference in any sleep variables from baseline measures. The results are consistent with the idea that trimeprazine tartrate may be a useful short term treatment for night waking in young children.
PMCID: PMC1778326  PMID: 3551850
19.  Pitfalls in the management of epilepsy. 
PMCID: PMC1778129  PMID: 3813646

Results 1-20 (20)