The Practice of Pediatric Sleep Medicine: Results of a Community Survey

Abstract

ABSTRACT. Objective. To assess knowledge, screening, evaluation, treatment practices, and attitudes regarding sleep disorders in children and adolescents in a large sample of community-based and academic pediatricians.Design. Cross-sectional survey. Participants. Six hundred twenty-six pediatricians in Rhode Island, Massachusetts, and Connecticut.Instrument. The Pediatric Sleep Survey, a 42-item questionnaire assessing general and specific sleep knowledge categories; clinical screening, diagnostic, and treatment practices for common pediatric sleep disorders; and practitioner attitudes regarding the impact of sleep disorders in the clinical setting and as a public health issue.Results. On the knowledge section, the mean Total Knowledge score for the respondents was 18.1 ؎ 3.5 out of 30 items, with 23.5% of the sample responding correctly on half or less of the items. Pediatricians scored highest on items relating to developmental and behavioral aspects of sleep and parasomnias, whereas the mean percentage of correct responses was <50% for items relating to sleep disordered breathing, excessive daytime sleepiness, and sleep movement disorders. Although only 16.5% and 18.2% of the sample reported not screening routinely for sleep disorders in infants and toddlers, this percentage rose to 43.9% in adolescents. Furthermore, only 38.3% regularly question the adolescents themselves about their sleep. Only about one quarter of the respondents screen toddlers and school-aged children for snoring. In evaluating and treating pediatric sleep problems, 53.2% of the sample never or rarely order overnight sleep studies to assess for obstructive sleep apnea and few use alternative treatment strategies, such as continuous positive airway pressure. A quarter of the sample at least occasionally recommends diphenhydramine and almost half suggests a psychological evaluation for children with night terrors. Finally, the percent of pediatricians rating the impact on children of sleep problems in a variety of domains as important or very important ranged from 49.7% (nonintentional injuries) to 92.6% (academic performance). However, only 46% of the sample felt confident or very confident about their own ability to screen for sleep problems, whereas 34.2% and 25.3% similarly rated their ability to evaluate and treat sleep problems in children.Conclusions. problematic sleep behaviors in school-aged children, 20 and significant daytime drowsiness in 10% to 40% of high school students. [21][22][23] The prevalence of obstructive sleep apnea (OSA) in toddlers and preschoolers is conservatively estimated to be 1% to 3% 24 and the prevalence of partial arousal parasomnias ranges from 3.5% for sleep terrors 25 to 15% to 40% for sleepwalking. 26 Childhood sleep disorders may also extend their impact by causing increased stress for parents, adding to marital disruption, and resulting in negative effects on parental sleep and daytime function. 27 Thus, inadequate recognition and treatment may have significant repercussions not only for the individ...

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