Investigation of sleep disorders including home monitoring.

Many children have a sleep disorder.' Often it is sufficiently frequent or intense for it to seriously concern parents. Particularly high rates are reported for certain groups, such as children with a mental handicap,2 and many physical illnesses are likely to be complicated by sleep disruption.3 There is, therefore, a need for comprehensive coverage of children's sleep disorders in medical education at undergraduate and postgraduate levels to ensure familiarity with the clinical features of sleep disorders, the conditions with which sleep disorders may be confused, and with the many forms of treatment that are available. The place of special sleep studies also needs to be more widely known, including the comparatively recent availability of systems by which objective information about sleep patterns and physiology can be obtained from recordings taken at home or in other non-specialised settings. The range of sleep problems for which such evaluation may be appropriate is wide.4 The three main types (of which there are many varieties) are: sleeplessness of one form or another,5 episodic disturbances of behaviour (parasomnias),6 and excessive sleepiness during the day.7 Diagnostic approach and procedures CLNICAL ASSESSMENT Reflecting the general neglect of sleep disorders, history taking protocols usually contain few items concerning sleep and need to be supplemented with a systematic review of the 24 hour sleep-wake pattern, and sleep arrangements and environment. A sleep diary is often instructive. Important information may be available not only from parents but older children themselves and sometimes from siblings. Sleep questionnaires can provide a useful framework for detailed clinical inquiry as in recent studies of children with Down's syndrome8 or tuberous sclerosis.9 OBJECTIVE ASSESSMENT Detailed inquiry about sleep patterns and problems should be attempted but parents' recollection of their child's sleep patterns and problems may well be incomplete or distorted. Therefore, in some cases at least, more objective assessment is needed for accuracy or, alternatively, when physiological information is required. (1) Video monitoring For episodic disturbances at night, overnight video recordings alone can be highly instructive. Parents can be encouraged to use their family video systems for recordings at home. The disparities between the findings and the usual clinic descriptions of night time attacks are sometimes striking. Overnight video and sound recordings combined with oximetry may also be used (at least as a screening device) for the detection of sleep related breathing problems.'0 (2) Conventional nocturnal polysomnography A major milestone in the understanding of sleep …