Approaches to the assessment of arousals and sleep disturbance in children

Childhood arousals, awakenings, and sleep disturbances during the night are common problems for both patients and their families. Additionally, inadequate sleep may contribute to daytime sleepiness, behavioral problems, and other important consequences of pediatric sleep disorders. Arousals, awakenings, and sleep disturbances can be quantified by routine polysomnography, and arousal scoring is generally performed as part of the standard polysomnogram. Here, we review current approaches to quantification of arousals and sleep disturbances and examine outcomes that have been associated with these measures. Initial data suggest that computer-assisted identification of non-visible arousals, cyclic alternating patterns, or respiratory cycle-related EEG changes may complement what can be accomplished by human scorers. Focus on contiguous bouts of sleep or specific sleep stages may prove similarly useful. Incorporation of autonomic arousal measures-such as heart rate variability, pulse transit time, or peripheral arterial tone-into standard reports may additionally capture subtle sleep fragmentation.