The clinical and laboratory assessment of the sleepy child.

Excessive sleepiness is defined as sleepiness that occurs in a situation when an individual would usually be expected to be awake and alert. Hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness (EDS) or prolonged nighttime sleep, which affects the everyday life of the patient. Clinical surveys have reported that EDS is a complaint observed in up to 68% of normal high school children, with a negative impact in academic achievement and extracurricular activity. Clues toward recognizing childhood daytime sleepiness may be sleeping longer hours than expected for age, daytime naps beyond normal for age, being sleepy when other children of the same age are active and alert, and sleeping more than previously. Causes of EDS are arbitrarily divided into 3 categories: insufficient nighttime sleep, fragmented nighttime sleep, and increased drive of sleep. A list of various causes of EDS in children has been discussed. A detailed history along with examination of the upper airway is crucial in evaluating patients with EDS. Appropriate screening tools such as sleep logs, sleepiness scales, and sleep questionnaires further help in identifying and quantifying the degree of sleepiness. Confirmatory tests such as polysomnography, multiple sleep latency test, and actigraphy along with referral to a sleep physician may be necessary in appropriate cases. Details of other ancillary testing such use of cerebrospinal fluid orexin levels, HLA subtyping, and so on have also been provided.