Night Terrors in Children: Prevalence and Influencing Factors

Night terrors are defined as sudden arousals from slow wave sleep accompanied by intense fear. They tend to occur most often in the first part of the night. Typically, the night terror attack begins with a scream, the person sits up in bed and sleepwalking may follow (ICSD; 1). There is a marked increase in heart rate and breathing frequency (2), but the person is not oriented, i.e., not completely awakened by the attack. Very often the incident is not remembered in the morning. Single sentences or mental images, e.g., "A dog is biting me." or "Let me go" can be present during the attack (3). Night terrors have to be distinguished from nightmares (detailed recall, second half of the night), posttraumatic reenactments (detailed recall, content reflects a previous trauma) and nocturnal panic attacks (comparable to panic attacks experienced during the day). Exact prevalence rates of the disorder exist to a limited extend. Hublin et al. (4) pointed out that questionnaire surveys can be strongly biased since the phenomenology of night terrors is not a common knowledge and the diagnostic criteria (first part of the night, amnesia etc.) must thus be presented explicitly to explain the term night terror to ensure adequate estimates. Several authors (4,5) estimate that up to 40% of children have experienced at least one night terror attack during childhood. Cross-sectional data yielded prevalence rates (occurrence at least once a year) ranging from 3.5% (6) to 6.2% (7). Kurth, Göhler and Knaape (3) estimated the peak prevalence between five and seven years of age. Gender differences (preponderance of boys) were often not found (3). Interestingly, night terrors co-occur often with other parasomnias such as sleep walking (see above) and nightmares (8,9). Polysomnographic studies (10,11) revealed that the sleep of children with night terrors is disturbed (micro arousals, frequent sleep stage shifts), also in nights without night terror Night Terrors in Children: Prevalence and Influencing Factors