Pediatric sleep disorders in an outpatient sleep clinic: Clinical presentation and needs of children with neurodevelopmental conditions.

Abstract

Although sleep problems in youth with neurodevelopmental conditions (NDC) tend to be more prevalent and severe than those of typically developing (TD) youth, their clinical presentations and needs are rarely compared in real-world settings. This study compared sleep patterns, diagnostic impressions, and treatment recommendations between a diverse outpatient sample of TD youth and those with NDC. Data were collected from electronic medical records for 327 consecutive patients (58.4% male; 52.6% White, age range = 0–20 years) presenting for an initial consultation at an outpatient sleep clinic in an urban children’s hospital. Of the sample, 45.3% had a preexisting NDC, with 7% diagnosed with autism spectrum disorder (ASD), 9.9% with Trisomy 21 or other genetic disorder, 26.8% with another developmental delay, and 16.5% with ADHD. Obstructive sleep apnea (OSA) was the most frequent diagnosis overall (64.5%). However, patients with Trisomy 21 or other genetic disorders were especially more likely than TD youth to receive an OSA diagnosis and to receive medical treatment recommendations or referrals, but less likely to receive behavioral recommendations. Although patients with ADHD presented with higher rates of OSA symptoms, patients with ADHD and/or ASD did not differ in any other ways from TD patients in their sleep patterns, diagnosis, or treatment recommendations. Findings underscore the range of sleep problems in TD youth and those with NDC. The breadth of services provided at pediatric sleep centers highlights the importance of referral to such centers when sleep problems are present, especially in children with NDC.

Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers

“…35 Additional details about coding variables have been described elsewhere. 9,21 Sleep patterns and referral questions are based on caregiver and/or patient report, whereas diagnostic impressions were provided by the attending sleep medicine physician. Diagnoses provided at the end of the visit are considered to be provisional "impressions," as diagnoses such as OSA require further assessment and confirmation via subsequent overnight polysomnography.…”

“…5-8 Aspects of sleep routines and the sleep environment also differ by race, with Black children showing later bedtimes and decreased likelihood of following a regular bedtime routine, 5,6,8,9 as well as higher rates of parent-child bed-sharing. 10,11 Later bedtimes and less regular bedtime routines have been associated with increased child sleep disturbances, 2,12,13 and research on the effect of bed-sharing on child sleep is mixed.…”

“…[3][4][5] Community-based studies have shown that Black preschoolers are more likely than their White peers to exhibit symptoms of behavioral sleep disturbances, such as increased bedtime resistance, longer sleep onset latency, and shorter total sleep duration. [5][6][7][8] Aspects of sleep routines and the sleep environment also differ by race, with Black children showing later bedtimes and decreased likelihood of following a regular bedtime routine, 5,6,8,9 as well as higher rates of parent-child bed-sharing. 10,11 Later bedtimes and less regular bedtime routines have been associated with increased child sleep disturbances, 2,12,13 and research on the effect of bed-sharing on child sleep is mixed.…”

Actigraphy technology: Informing assessment and intervention for sleep disturbances in young children.

“…Given the prevalence of pediatric sleep problems and their impact on children’s development and caregiver quality of life, interdisciplinary pediatric sleep clinics have been developed to evaluate and treat sleep disturbances (Meltzer, Moore, & Mindell, 2008; Williamson, Patrick, Rubens, Moore, & Mindell, 2016). An advantage of an interdisciplinary setting is that families receive medical and behavioral recommendations (Meltzer et al, 2008) to comprehensively address sleep concerns.…”

“…An advantage of an interdisciplinary setting is that families receive medical and behavioral recommendations (Meltzer et al, 2008) to comprehensively address sleep concerns. Prior studies highlight the need for these services, characteristics of children presenting to sleep clinics (e.g., presence of NDDs), and the feasibility of operating a pediatric sleep clinic (Meltzer et al, 2008; Williamson et al, 2016). Most clinical psychologists do not receive formal training in treating sleep disorders (Meltzer, Phillips, & Mindell, 2009).…”