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Parasomnien im Kindesalter – Präsentationsformen und ein Streifzug durch die neuere Literatur

Pediatric parasomnia: presentation and a review of the recent literature

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Zusammenfassung

Parasomnien sind abnorme Episoden von Verhaltensmustern oder physiologischen Ereignissen während des Schlafs oder im Verlauf von Schlaf-Wach-Übergängen. Nach der International Classification of Sleep Disorders (ICSD-3) werden Parasomnien bei Kindern und Erwachsenen gleich kategorisiert und in NREM-Parasomnien, REM-Parasomnien und „Andere“ eingeteilt.

Allerdings unterscheiden sich Parasomnien, insbesondere im Vorschulalter, bezüglich Häufigkeit, Präsentation und Prognose wesentlich von jenen im Erwachsenenalter. Im Vordergrund stehen dabei die NREM-Parasomnien Pavor nocturnus (ICD-10 Code F51.4) und Schlafwandeln (F51.3), die REM-Parasomnie Albträume (F51.5) und die erst ab dem 6. Lebensjahr relevante „sonstige“ Parasomnie Enuresis nocturna. Die Prävalenz kindlicher Parasomnien ist stark altersabhängig, häufig sind die kindlichen Parasomnien selbstlimitierend.

Insbesondere der Pavor nocturnus ist jedoch für viele Eltern besorgniserregend, Kinderärzte sind daher bezüglich Aufklärung und (Verhaltens-)Beratung gefordert. Nur sehr selten ist eine medikamentöse Therapie (z. B. mit Clonazepam) angezeigt.

Kindliche Parasomnien können meist allein aufgrund der Anamnese eingestuft werden, von den Eltern angefertigte Videos sind oft hilfreich. Nur selten (insbesondere bei der Differenzialdiagnose epileptischer Anfälle) ist eine Polysomnografie erforderlich.

Ins Jugendalter perpetuierende oder erst im Jugendalter auftretende Parasomnien haben eine schlechtere Prognose und eine hohe Komorbidität. Letztere muss entsprechend abgeklärt werden, um zwischen Primär- und Sekundärphänomenen unterscheiden und eine adäquate Therapie einleiten zu können.

Abstract

Parasomnias are defined as behavioral or physiological abnormalities during sleep or the sleep–wake transition. According to the International Classification of Sleep Disorders (ICSD-3) parasomnias in children and adults have been categorized and grouped into NREM parasomnias, REM parasomnias, and “others”.

However, parasomnias in early childhood differ significantly from those in adulthood with regard to frequency, presentation, and prognosis. The most relevant disorders in children are the NREM parasomnias night terror (ICD-10 code F51.4) and sleepwalking (F51.3), the REM parasomnia of nightmares (F51.5) and sleep enuresis (relevant only from 6 years of age onward). Overall, the prevalence of parasomnias is very different in different age groups, and pediatric parasomnias tend to be self-limited.

Episodes of night terror are particularly frightening for parents, and parental counselling and coaching represent a special challenge for pediatricians. Only in very rare cases is specific medication (e. g. clonazepam) indicated.

Pediatric parasomnias can usually be correctly classified by (reported) history alone; videos recorded by parents may be helpful and are encouraged. In only selected cases (especially in the differential diagnosis of epileptic seizures) polysomnography may be necessary.

Parasomnias that persist into or appear during adolescence have a worse prognosis and show a high rate of comorbidities. These must be investigated carefully to discriminate between primary and secondary phenomena and to apply adequate treatment.

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  1. Abteilung für Kinder- und Jugendheilkunde, LKH Hochsteiermark, Standort Leoben, Vordernbergerstraße 42, A-8700, Leoben, Österreich

    Reinhold Kerbl, Agnes Karnberger & Irina Grigorow

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  1. Reinhold Kerbl
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Correspondence to Reinhold Kerbl.

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R. Kerbl, A. Karnberger und I. Grigorow geben an, dass kein Interessenkonflikt besteht.

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Kerbl, R., Karnberger, A. & Grigorow, I. Parasomnien im Kindesalter – Präsentationsformen und ein Streifzug durch die neuere Literatur. Somnologie 19, 219–225 (2015). https://doi.org/10.1007/s11818-015-0027-3

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