A Systematic Review and Meta-Analysis of the Biological, Psychological, and Neurological Mechanisms of Somnambulism in Pediatric Populations

Somnambulism, or sleepwalking, is a non-rapid eye movement (NREM) parasomnia that disproportionately affects pediatric populations, yet no comprehensive quantitative synthesis has integrated the biological, psychological, and neurological mechanisms underlying this disorder in children. The fragmented nature of existing research has impeded the development of unified etiological models and evidence-based clinical guidelines. The purpose of this study was to conduct a systematic review and meta-analysis synthesizing the evidence on the prevalence, biological, psychological, and neurological mechanisms of somnambulism in pediatric populations. Following PRISMA 2020 guidelines, systematic searches were conducted across seven electronic databases (PubMed/MEDLINE, PsycINFO, Embase, Web of Science, Scopus, CINAHL, and Cochrane Library). Random-effects meta-analyses with Freeman-Tukey double arcsine transformation were performed using R with the metafor package. Inclusion criteria required original empirical studies with pediatric participants (ages 0–18) reporting quantitative data on somnambulism mechanisms. A total of 24 studies encompassing 140,907 participants published between 1980 and 2018 met inclusion criteria. The pooled pediatric prevalence of somnambulism was 10.07% (95% CI: 5.85%–15.28%), with substantial heterogeneity (I² = 98.76%). Neurological mechanism studies yielded a pooled standardized mean difference of 0.86 (95% CI: 0.48–1.25), indicating significantly altered EEG activity and sleep architecture in affected children. Biological analyses confirmed genetic heritability of approximately 44%, with familial risk odds ratios ranging from 3.0 to 7.0. Psychological factors demonstrated significant psychiatric comorbidity (OR = 1.9–3.4). Mean study quality on the Newcastle-Ottawa Scale was 7.54 out of 9, indicating generally high methodological rigor. These findings confirm that somnambulism affects approximately 1 in 10 children and is driven by a multi-mechanism etiology involving interacting biological, psychological, and neurological pathways. The results underscore the need for integrated clinical assessment approaches that address genetic vulnerability, psychological triggers, and neurophysiological instability, and they provide a quantitative foundation for developing targeted, multidisciplinary interventions for affected children and their families.