Carla Estivill-Domènech, Carla Estivill-Domènech. Case report: Diagnosis and intervention of a non-24-h sleep–wake disorder in a sighted child with a psychiatric disorder. Front. Psychiatry, 05 January 2024. Sec. Sleep Disorders. Volume 14 – 2023 | https://doi.org/10.3389/fpsyt.2023.1129153
Overview:
- Circadian Rhythm Sleep-Wake Disorders (CRSWD) are sleep issues linked to circadian function. These disorders cause insomnia or excessive sleepiness due to the circadian pacemaker not aligning with a 24-hour light/dark cycle. Free-running disorder or Hypernycthemeral Syndrome (N24SWD) leads to a prolonged sleep-wake cycle, often seen in blind individuals. N24SWD is rare among those with healthy vision but affects 70% of blind individuals. In sighted cases, it mostly occurs in young men (80%), with 28% having a psychiatric disorder.
Specific Case:
- The patient, a 14-year-old boy with psychiatric pathology and PANDAS syndrome, experienced sudden intense anxiety, mood swings, and obsessive-compulsive-like issues associated with a streptococcal A infection. He also had a non-24-hour sleep-wake disorder (N24SWD), leading to severe insomnia and irregular sleep patterns.
- The patient’s irregular sleep pattern worsened daily routines, including school attendance, and exacerbated psychiatric symptoms.
- The association of PANDAS and N24SWD in the same case is unique and not previously reported in the literature.
Treatment:
- The initial treatment focused on acute infection and psychiatric symptoms.
- Sleep pathology was addressed with light therapy and melatonin.
- After 8 months of various trials, a treatment plan normalized symptoms, established a regular sleep pattern, and reduced daytime anxious symptoms
Gabriella True