Paeds Cases · adolescent-and-young-adult-medicine
Sleep, fatigue and circadian disorders in adolescents — short case and counselling station
Observed structured encounter testing adolescent sleep assessment, recognition of the dominant mechanism, stepped-care management, and safe identification of a presentation that requires urgent referral.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a 15-year-old girl with delayed sleep-wake phase disorder requiring mechanism recognition, counselling and a phase-advance plan. Station B is a 17-year-old boy with narcolepsy type 1 (cataplexy) requiring recognition of the red flag, an urgent referral plan and a driving-safety discussion.
Station objectives
- Take a focused adolescent sleep history, including a two-week sleep diary, weekday–weekend pattern, and a mood and safety screen. [10] [11]
- Name the dominant mechanism (insufficient sleep, insomnia, delayed phase, hypersomnolence, OSA, or fatigue) and distinguish sleepiness from fatigue. [9]
- Build and explain a stepped-care management plan matched to the mechanism. [13]
- Recognise the red flags of narcolepsy and obstructive sleep apnoea and construct an urgent, safe referral. [16]
References6ShowHide
- [9]Crowley SJ, Acebo C, Carskadon MA Sleep, circadian rhythms, and delayed phase in adolescence. Sleep medicine, 2007.PMID 17383934
- [10]Carskadon MA Sleep in adolescents: the perfect storm. Pediatric clinics of North America, 2011.PMID 21600346
- [11]Beebe DW Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatric clinics of North America, 2011.PMID 21600347
- [13]Blake M, Waloszek JM, Schwartz O, et al. The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents. Journal of consulting and clinical psychology, 2016.PMID 27775416
- [15]Salanitro M, Wrigley T, Ghabra H, et al. Efficacy on sleep parameters and tolerability of melatonin in individuals with sleep or mental disorders: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews, 2022.PMID 35691474
- [16]Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. Journal of clinical sleep medicine : JCSM, 2021.PMID 34743789