Night Terrors and Delirium in a Child With Presumed Rapid-Onset Obesity With Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation

Comorbid neuropsychiatric conditions, including major depressive disorder, anxiety, bipolar disorder, and psychosis, are reported among children with rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD). The association of ROHHAD with parasomnias is poorly understood. We describe the presentation and management of night terrors superimposed on delirium in a child with presumed ROHHAD. The child developed an acute altered mental status and increased anxiety during a hospitalization for sepsis and pulmonary emboli, three years after initial rapid-onset obesity. She also had nocturnal-onset limb thrashing and distress beginning an hour after falling asleep and lasting up to several hours, diagnosed as night terrors. Delirium and anxiety improved with quetiapine and clonidine, while the severity of her night terrors improved with anticipatory awakening and haloperidol. Children with ROHHAD may be at risk for night terrors, and their symptoms may present atypically. Early recognition and individualized management may improve safety and quality of life for these children.