Non-24-Hour Sleep-Wake Disorder in Children and Adolescents: A Case Series.
Ruo Yan Chen, Gurinder Grewal, James Lee et al.
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Case in brief
A single-center retrospective series described six sighted children and adolescents diagnosed with non-24-hour sleep-wake disorder. Sleep histories, diaries, and actigraphy showed free-running sleep cycles of 24–29 hours, with progressive sleep delays and periodic day–night reversal. All had neurodevelopmental disorders; five had autism spectrum disorder, three had attention-deficit/hyperactivity disorder, and two had anxiety disorders. Behavioral and functional difficulties worsened during circadian misalignment. Melatonin, bright light, and behavioral strategies had variable success, and sustained entrainment was difficult. Several families chose flexible free-running schedules and reported better mood and functioning when the children’s natural sleep patterns were accommodated.
What made this case unusual
The series highlights non-24-hour sleep-wake disorder in sighted pediatric patients, all of whom had neurodevelopmental disorders—an association that may be overlooked when evaluating progressive sleep timing shifts.
Diagnostic / clinical pearl
Progressive sleep delays and recurring day–night reversal in a sighted child warrant consideration of non-24-hour sleep-wake disorder; sleep diaries and actigraphy can help document free-running cycles.
Why it matters
Sustained circadian-based treatment may be difficult because of adverse effects, inconsistent adherence, and family burden, so management may need to account for family circumstances and functional outcomes.