Clinical phenotyping of chronic insomnia in early childhood: family-history-informed vulnerability profiles in a retrospective chart review.

OBJECTIVE

To describe a pragmatic clinical phenotyping framework for chronic insomnia in early childhood that integrates the predominant insomnia presentation with family-history markers where relevant, and to report its distribution and basic demographic correlates in a tertiary pediatric sleep sample.

METHODS

We performed a retrospective chart review of consecutive children evaluated for chronic insomnia at a tertiary pediatric sleep center. Using a prespecified clinical algorithm integrating the predominant insomnia presentation with family-history markers where relevant, children were classified into four phenotype labels: behavioral insomnia, restless/iron-vulnerability phenotype, maintenance/allergy-vulnerability phenotype, and early-awakening/mood-migraine-vulnerability phenotype. Age and sex were summarized descriptively, and age differences across phenotypes were examined with one-way analysis of variance.

RESULTS

The sample included 438 children (42.2% female), with a mean age of 22.0 ± 14.8 months. The maintenance/allergy-vulnerability phenotype was most frequent (44.3%), followed by the restless/iron-vulnerability phenotype (21.0%), behavioral insomnia (17.6%), and the early-awakening/mood-migraine-vulnerability phenotype (17.1%). Mean age differed across phenotype labels (F = 10.407, p < 0.001). By descriptive inspection, behavioral and maintenance/allergy-vulnerability presentations occurred at younger ages than the restless/iron-vulnerability and early-awakening/mood-migraine-vulnerability labels. Sex distribution was similar across phenotypes.

CONCLUSIONS

In this tertiary pediatric sleep sample, a pragmatic clinical algorithm identified one behavioral phenotype and three family-history-informed vulnerability phenotypes with different age distributions. These findings support the feasibility of pragmatic clinical phenotyping in routine care. Prospective studies using standardized assessments are needed to test stability, external validity, and treatment relevance.