Gender Differences in Pediatric Parasomnias

Parasomnias are described as abnormal events that occur in sleep. They are common and are classified according to when they occur: in non-REM sleep, REM sleep or independent of sleep stage. Certain factors, such as familial predisposition, make an individual more susceptible to having parasomnia behavior. However, the prevalence of further precipitating factors such as exogenous or endogenous sleep disruption, sleep deprivation or stressors during wake may provoke parasomnias for the first time, increase in frequency, or cause them to persist past the expected age of resolution. Most parasomnias present initially in early childhood in a gender-independent fashion, with few exceptions. Usually, non-REM parasomnia activity will resolve before the pubertal period, while REM parasomnias persist throughout the lifespan. There is a discrepancy of nightmare (a REM parasomnia) incidence between the genders in adolescence, although this may be due to a number of social factors. Post-puberty, there is a notable difference in the presentation of specific parasomnias. Nocturnal enuresis, a sleep stage independent parasomnia, does appear to have a biologically driven predominance in young males, and therefore is one of the few/only parasomnias with a marked gender difference in pre-pubertal children.