Evaluation of the sleepy child: Causes and diagnostic clues

Excessive daytime sleepiness may be caused by certain medications, including antihistamines, antihistamine-decongestant combinations, and phenobarbital or other agents used for epilepsy, or it may be a manifestation of sleep-disordered breathing. Although obstructive sleep apnea is relatively rare in adolescents, it should be considered in those who have chronic snoring, especially if they are obese. Children with obstructive sleep apnea may have hypertension and/or tachypnea. Poor-quality sleep and daytime sleepiness also may be the result of nocturnal asthma. In adolescents, the most common cause of daytime sleepiness is self-imposed sleep deprivation, heightened by a biologic tendency toward a delay of sleep phase; however, substance abuse may be a factor in some patients. Also consider the possibility of depression, which often causes hypersomnia in adolescents, and narcolepsy, which can cause excessive daytime sleepiness despite adequate sleep.