CHALLENGES IN THE DIAGNOSIS AND TREATMENT OF PARASOMNIAS IN CHILDREN AND ADOLESCENTS; TEN YEARS OF EXPERIENCE AT DEPARTMENT OF SLEEP DISORDERS

Poremećaji spavanja čest su i značajan socioekonomski i zdravstveni problem u djece i odraslih.Spavanje je akivan proces u kojem se izmjenjuju različite faze i ciklusi spavanja. Parasomnije su skupina poremećaja spavanja koje su obilježene neobičnim i neželjenim noćnim ponašanjem. Iako mogu biti veoma dramatične i česte su u dječjoj dobi, uglavnom su benigne i spontano prolaze sazrijevanjem i odrastanjem. NREM parasomnije su parasomnije pobuđenosti koje se dešavaju iz dubokog sna u prvoj polovini noći, a najzastupljenije su smetena pobuđenost, noćni strahovi i mjesečarenje. Nakon epizode NREM parasomnije djeca mogu biti konfuzna ili smetena i neće se sjećati događaja. REM parasomnije se dešavaju u drugoj polovini noći iz REM spavanja, a najznačajnije su noćne more, paraliza spavanja i REM poremećaj ponašanja. Druge parasomnije znatno su manje prisutne u djece, izuzev noćne enureze i katatrenije. Epizode parasomnije ponekad je teško razlikovati od noćnih epilepsija poput noćne epilepsije frontalnog režnja, što predstavlja veliki izazov u kliničkom radu. Polisomnografija (PSG) i Cjelonoćna encefalografija (CEEG) s video monitoringom su dijagnostičke metode kojima se koristimo u medicini spavanja. Higijena spavanja podrazumijeva sve mjere i postupke kojima možemo pomoći kod uspostave kvalitetnijeg spavanja, a preporučuju se kod parasomnija. Za vrijeme događaja važno je ne buditi, već utješiti i osigurati dijete od mogućih ozljeda ili nezgoda.Sleep disorders are a common and important socioeconomic and health problem in children and adults. Sleep is an active process in which different stages and cycles of sleep apear. Parasomnias are in a group of sleep disorders characterized by unusual and unwanted nocturnal behavior. Although they can be very dramatic, they are common in childhood, generally benign and spontaneously undergo with maturation and growing up. NREM parasomnias are parasomnias of arousal that arise from deep sleep in the first half of the night, and most known are: confused arousal, night terors and sleepwalking. After an episode of NREM parasomnia, child may be confused or harassed and will not remember the event. REM parasomnias occur in the second half of the night from REM sleep. The most significant are night mares, sleep paralysis and REM behavior disorder. Other parasomnias are not common in childhood, exceptionaly nocturnal enuresis and catathrenia. Occurrence of the parasomnias is sometimes difficult to separate from nocturnal epilepsy such as nocturnal frontal lobe epilepsy, and this is a major challenge in clinical work. Polysomnography (PSG) and overnight encephalography (OEEG) with video surveillance are diagnostic methods used in sleep medicine. Sleep hygiene includes all measures and procedures that help establish a better quality sleep, and is recommended for parasomnias treatment. When episode of parasomnia occures it is important not to awake child, comfort and secure it from possible injury or accident