Study Objectives: Sleep-disordered breathing (SDB) is a highly prevalent condition affecting 2% to 4% of children. However, the prevalence and characteristics of SDB in children younger than 2 years and the effect of prematurity as a risk factor remains unclear. Methods: Children younger than 24 months referred for PSG at two medical centers between the years 2014 to 2018 were included in this retrospective analysis. We excluded children with genetic syndromes. Polysomnography (PSG) was performed and scored according to American Academy of Sleep Medicine guidelines. Results: Ninety-eight children were included (age 14.1 ± 6.4 [2-23] months), with 31 born prematurely (PRETERM; 24 to 34 weeks gestational age). PRETERM had increased odds of SDB (age and sex adjusted), using a cutoff of AHI ≥ 5 events/h with an odds ratio of 4.3 (95% confidence interval 1.5-12.9). Gestational age was the only significant predictor for SDB in this cohort, every additional week of gestation reducing the odds of SDB by 12.5%. PRETERM SDB was also characterized by more severe nocturnal hypoxemia, increased frequency of central apnea, and altered sleep architecture. Conclusions: Current findings underscore the importance of prematurity antecedents as a risk factor for SDB in young symptomatic children younger than 2 years referred for a PSG. Future studies focused on improved estimates of the prevalence of SDB among nonreferral young children appear warranted.

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Adequate pain management is one of the biggest challenges of the modern healthcare system. Physician perception of patient subjective pain, which is crucial to pain management, is susceptible to a host of potential biases. Here we explore the timing of physicians’ work as a previously unrecognized source of systematic bias in pain management. We hypothesized that during night shifts, sleep deprivation, fatigue, and stress would reduce physicians’ empathy for others’ pain, leading to underprescription of analgesics for patient pain relief. In study 1, 67 resident physicians, either following a night shift or not, performed empathy for pain assessment tasks and simulated patient scenarios in laboratory conditions. As predicted, following a night shift, physicians showed reduced empathy for pain. In study 2, we explored this phenomenon in medical decisions in the field. We analyzed three emergency department datasets from Israel and the United States that included discharge notes of patients arriving with pain complaints during 2013 to 2020 ( n = 13,482). Across all datasets, physicians were less likely to prescribe an analgesic during night shifts (compared to daytime shifts) and prescribed fewer analgesics than generally recommended by the World Health Organization. This effect remained significant after adjusting for patient, physician, type of complaint, and emergency department characteristics. Underprescription for pain during night shifts was particularly prominent for opioids. We conclude that night shift work is an important and previously unrecognized source of bias in pain management, likely stemming from impaired perception of pain. We consider the implications for hospitals and other organizations employing night shifts.

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