Pediatric sleep: current knowledge, gaps, and opportunities for the future

Abstract

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society’s Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g., autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps in our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e., actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

Machine learning data sources in pediatric sleep research: assessing racial/ethnic differences in electronic health record–based clinical notes prior to model training

“…Thus, efforts to prevent racial/ethnic inequities and manage pediatric sleep problems in primary care require routine and multidimensional screening protocols ( Meltzer et al, 2021 ). In addition, the results highlight that it is also important for future work to consider the heterogeneity in patients’ susceptibility (e.g., social and environmental determinants; co-occurring health problems) that can influence their perception of, providers’ identification of, pediatric sleep problems ( Rubens et al, 2016 ; Billings et al, 2021 ; Reynolds et al, 2023 ).…”

“…Therefore, future work is needed to determine whether the differential patterns observed in providers’ documentation of sleep problems are related to unique differences in symptom presentation or literacy across racial/ethnic subpopulations. More specifically, future research should examine whether variation is due to patient self-report or caregiver report, differing community beliefs and literacy about sleep as a health experience, and/or the social and environmental determinants that are potential drivers of existing pediatric sleep disparities ( Reynolds et al, 2023 ; Yang et al, 2023 ). Using a cross-sectional retrospective cohort design and EHR data, this study is not capable of determining whether provider–patient interactions, implicit cognitive bias of providers or patients, or informed presence influences the ways Peds B-SATED keywords or global dimensions are captured or missed in primary care providers’ documentation ( Phelan et al, 2017 ).…”

“…Racial/ethnic disparities are well documented and persistent in pediatric sleep at the population level ( Billings et al, 2021 ; Meltzer et al, 2021 ; Reynolds et al, 2023 ). However, these disparities are often preventable and linked to social determinants of health at the individual, family, healthcare, and broader community/societal levels ( Billings et al, 2021 ; Fanta et al, 2021 ; Yip et al, 2022 ; Clarkson-Townsend et al, 2023 ; Gueye-Ndiaye et al, 2023 ).…”