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A coherent body of evidence supports the notion that sleep is a local and use-dependent process. Significant changes in brain morphology and function occur in the first years of life, revealing a postero-anterior trajectory of cortical maturation. On this basis, a recent study demonstrated that regional cortical maturation between early childhood and late adolescence is reflected in regional changes of sleep slow wave activity (SWA) during non-rapid eye movement (NREM) sleep. Our hypothesis is that changes of electroencephalogram (EEG) rhythms during sleep from birth to childhood are also mirrored by parallel regional changes in the EEG rhythms of sleep according to the assumption of a postero-anterior gradient in cortical maturation. We studied all-night EEG of 39 healthy, full-term, infants and children aged between 0 and 48 months, evaluating regional differences in NREM sleep. We confirmed the strictly local nature of sleep with frequency-specific regional differences. Specifically, we found a general shift of maxima of the upper alpha activity from occipital to prefrontal regions, expressed mainly by the ~11 Hz frequency. This shift corresponds to a postero-anterior trajectory of the so-called 'slow spindles'. The theta and alpha EEG activity of the frontal cortex exhibits a clear, positive, correlation with age. We conclude that specific local differences during NREM sleep, parallel cortical maturation also in the first 4 years of life., (© 2016 European Sleep Research Society.)

Our aim was to investigate the natural evolution of cataplexy and polysomnographic features in untreated children with narcolepsy with cataplexy. To this end, clinical, polysomnographic, and cataplexy-video assessments were performed at diagnosis (mean age of 10 ± 3 and disease duration of 1 ± 1 years) and after a median follow-up of 3 years from symptom onset (mean age of 12 ± 4 years) in 21 children with narcolepsy with cataplexy and hypocretin 1 deficiency (tested in 19 subjects). Video assessment was also performed in two control groups matched for age and sex at first evaluation and follow-up and was blindly scored for presence of hypotonic (negative) and active movements. Patients’ data at diagnosis and at follow-up were contrasted, compared with controls, and related with age and disease duration. At diagnosis children with narcolepsy with cataplexy showed an increase of sleep time during the 24 h; at follow-up sleep time and nocturnal sleep latency shortened, in the absence of other polysomnographic or clinical (including body mass index) changes. Hypotonic phenomena and selected facial movements decreased over time and, tested against disease duration and age, appeared as age-dependent. At onset, childhood narcolepsy with cataplexy is characterized by an abrupt increase of total sleep over the 24 h, generalized hypotonia and motor overactivity. With time, the picture of cataplexy evolves into classic presentation (i.e. brief muscle weakness episodes triggered by emotions), whereas total sleep time across the 24 h decreases, returning to more age-appropriate levels. [ABSTRACT FROM PUBLISHER]

The International Classification of Sleep Disorders (ICSD-2) defines parasomnias as "undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousal from sleep." Parasomnias in childhood are common, more often benign, self-limited and typically resolving in adolescence. However, for the diagnosis it is often difficult to distinguish between other epileptic and/or non-epileptic events during sleep. Polysomnography is not always sufficient for the diagnosis and video polysomnography may be indicated to assist in the definition of parasomnias or other sleep disruption thought to be seizure related or in a presumed parasomnia, especially when it is not possible for the clinician to identify the etiology of the motor activity in sleep. The correct recognition of parasomnias is important to avoid misdiagnosis and to choose the appropriate treatment, when needed. We review here the main form of childhood parasomnias divided into three groups: 1) disorders of arousal (from NREM sleep); 2) parasomnias usually associated with REM sleep; 3) other parasomnias. Further studies are needed to elucidate the genetics, the pathophysiology and the triggering factors and also to clarify the relationship between NREM sleep structure and the occurrence of the episodes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To analyze in detail the frequency content of the different EEG components of the Cyclic Alternating Pattern (CAP) in the whole sleep of pre-school and school age children compared to normal young adults. Methods: Fourteen pre-school age and 18 school age children and 16 adults were included in this study. Each participant underwent a polysomnographic overnight recording, after an adaptation night; sleep stages and CAP were scored following standard criteria. Average spectra were obtained for each CAP condition from the signal recorded from C3/A2 or C4/A1, separately in sleep stage 2 and slow-wave sleep (SWS), for each subject. Results: The analysis of the relative power density in the three groups showed that in sleep stage 2 and in SWS, CAP A1, A2, A3 subtypes had a significantly higher power in all frequency ranges in pre-school children than in adults, while school children differed mainly for the lower frequencies (<7Hz). For non-CAP, pre-school and school children differed from adults at almost all frequencies analyzed. Generally, A1, A2 and A3 showed clear spectral differences in the three different groups of subjects with pre-school age children showing slightly less evident differences. Conclusions: CAP subtypes are characterized by clearly different spectra at different ages and also the same subtype shows a different power spectrum, during sleep stage 2 or SWS. This study shows that pre-school children have a different structure of sleep, especially from the microstructural (CAP) point of view: the differences are evident for all the CAP components and for non-CAP in almost all the frequency bands. This finding might be associated to the age-related delta decline in the 0–3Hz frequency reported in children of the same age. Significance: Our data seem to provide information not available before and useful for the understanding of the impact of CAP on the sleep EEG neurophysiological dynamics at different ages. This type of information is crucial for a more adequate interpretation of data provided by a growing number of studies analyzing CAP in groups of pediatric patients. [Copyright &y& Elsevier]

Objective: To examine the impact of home confinement during the COVID-19 pandemic on the sleep patterns and sleep disturbances in Italian children and adolescents.Methods: Participants completed an anonymous online survey, shared via social media and targeting children and adolescents aged 1-18 years, subdivided into age groups: 1-3, 4-5, 6-12, and 13-18 years. Caregivers completed a modified version of the Sleep Disturbance Scale for Children (SDSC), along with demographic information.Results: The final sample consisted of 4314 subjects: 2217 males (50.4%) and 2097 females (49.6%). Age group distribution was: 1-3 years 1263 (29.3%), 4-5 years 893 (20.7%), 6-12 years 1848 (42.8%) and 13-18 years 310 (7.2%). We found a significant delay in bedtime and risetime in all age groups. School-age children and adolescents experienced the most significant delay: weekday bedtime ≥23 was reported by 28.4% of 6- to 12-year-old children during lockdown vs. 0.9% before and by 63.5% vs. 12.3% of 13- to 18-year-old adolescents. Risetime was also delayed with most subjects waking up after 8 in all age groups and sleep duration increased in all groups but not in the younger group. The screen time (excluding online lessons) boosted during the lockdown, mainly in older children but also in younger children. Sleep disorders increased in all groups but not in adolescents. Younger groups had an increased prevalence of difficulty falling asleep, anxiety at bedtime, night awakenings, nightmares and sleep terrors.Conclusion: Our study demonstrates that confinement due to COVID-19 determined a big delay in sleep/wake schedule of children in all age groups as well as an increase of sleep disturbances in all groups but adolescents. [ABSTRACT FROM AUTHOR]