Clinician-to-Clinician Update Clinician-to-Clinician Update

Diagnostic Tools, Expert Team Provide Relief for Sleep Complaints

December 2014

Epidemiologic studies indicate that up to 40% of children in the United States experience one or more sleep complaints 1, 2 and about 4% have a formal sleep disorder diagnosis.3 Rates are higher among children and adolescents with neurodevelopmental disorders 4, medical conditions 5 and psychiatric diagnoses.6, 7 Untreated sleep complaints in children may lead to significant behavioral and cognitive deficits 8, 9 and are associated with an increased risk of accident and injury.10, 11

Sleep complaints are often not treated appropriately. In a study of 498 children presenting to a pediatric clinic with sleep complaints, only about 5% were given sleep-specific treatment recommendations or referrals.3 This may be, in part, because the diagnosis of sleep disorders and problems can be highly challenging. The signs of medical sleep disturbances and those of behavioral sleep problems overlap, and both types of issues may present in a given patient. Treatment is frequently complex and long term.

At University of Minnesota Masonic Children’s Hospital, our sleep specialists—pulmonologists with specialty training in sleep medicine—have the tools and expertise necessary to diagnose and care for children with both medical sleep disorders and behavioral sleep problems.

sleep-complaints-diagram-443x297
— Sleep complaints in children are associated with a variety of conditions.

Pediatric sleep disorders we treat include:

  • Insomnia
  • Hypersomnolence
  • Narcolepsy
  • Sleep-disordered breathing
  • Circadian sleep disorders
  • Parasomnias
  • Rhythmic movement disorders

Behavioral sleep problems we treat include:

  • Bedtime refusal
  • Night waking
  • Sleep-related anxiety
  • Deficient sleep
  • Poor sleep hygiene

For diagnostic testing, we offer:

  • Actigraphy - to determine sleep patterns and circadian rhythms
  • Polysomnography (for patients 2 years of age and over) – to record biophysiological changes that occur during sleep including brain activity, eye movements, muscle activity, airflow and heart rhythm
  • Multiple sleep latency testing (MSLT) – to measure how quickly patients fall asleep in an optimal sleep environment and to diagnose narcolepsy and idiopathic hypersomnia.

Once a diagnosis is made, our specialists work closely with the patient, the parents or caregivers, and the referring physician to implement a comprehensive treatment plan tailored to each patient’s needs and goals. Treatment may include behavioral modifications, medication, oral appliance therapy, continuous positive airway pressure therapy, or surgery.

References

1. Owens JA, Spirito A, McGuinn M, Nobile C. Sleep habits and sleep disturbance in elementary school-aged children. J Dev Behav Pediatr. 2000;21:27-36.

2. Archbold KH, Pituch KJ, Panahi P, Chervin RD. Symptoms of sleep disturbances among children at two general pediatric clinics. J Pediatr. 2002;140:97-102.

3. Meltzer LJ, Johnson C, Crosette J, Ramos M, Mindell JA. Prevalence of diagnosed sleep disorders in pediatric primary care practices. Pediatrics. 2010;125:e1410-e1418.

4. Hodge D, Carollo TM, Lewin M, Hoffman CD, Sweeney DP. Sleep patterns in children with and without autism spectrum disorders: developmental comparisons. Res Dev Disabil. 2014;35:1631-1638.

5. Hoffmire CA, Magyar CI, Connolly HV, Fernandez ID, van Wijngaarden E. High prevalence of sleep disorders and associated comorbidities in a community sample of children with Down syndrome. J Clin Sleep Med. 2014;10:411-419.

6. Armstrong JM, Ruttle PL, Klein MH, Essex MJ, Benca RM. Associations of child insomnia, sleep movement, and their persistence with mental health symptoms in childhood and adolescence. Sleep. 2014;37:901-909.

7. Ivanenko A, Crabtree VM, Obrien LM, Gozal D. Sleep complaints and psychiatric symptoms in children evaluated at a pediatric mental health clinic. J Clin Sleep Med. 2006;2:42-48.

8. Goodlin-Jones B, Tang K, Liu J, Anders TF. Sleep problems, sleepiness and daytime behavior in preschool-age children. J Child Psychol Psychiatry. 2009;50:1532-1540.

9. Quach J, Hiscock H, Canterford L, Wake M. Outcomes of child sleep problems over the school-transition period: Australian population longitudinal study. Pediatrics. 2009;123:1287-1292.

10. Hayes D Jr. Impact of inadequate sleep on unintentional injuries in adolescents. Adolesc Med State Art Rev. 2010;21:491-507, ix.

11. Avis KT, Gamble KL, Schwebel DC. Does excessive daytime sleepiness affect children’s pedestrian safety? Sleep. 2014;37:283-287.

When to refer

Patients with the following signs/symptoms may be referred:

  • Ongoing complaints of sleep issues by caregiver or patient
  • Excessive daytime sleepiness
  • Difficulty getting to sleep
  • Frequent night wakings
  • Persistent unusual sleep schedule that causes distress to caregiver or patient
  • Sleep disordered breathing
  • Rhythmic movement disorders that disrupt sleep

Contact

Pediatric Specialty Care Discovery Clinic
University of Minnesota Masonic Children’s Hospital
2512 Building, Third Floor
2512 S. 7th St.
Minneapolis, MN 55454

Appointments
612-365-6777

Physician Referrals
888-KIDS-UMN
(888-543-7866)

Collaborative Care

We are committed to maintaining the vital link between the patient and the referring provider, working closely with you to maintain continuity of care. Once your patient has been seen, reports are made available to you as soon as the same day of visit.

Because many patients with sleep complaints require a multidisciplinary approach, our program works closely with other University of Minnesota Health specialist clinicians in pulmonology, otolaryngology, behavioral health, neurology, surgery and other specialties as indicated. Our sleep specialists have access to the wide variety of physicians and scientists at University of Minnesota Masonic Children’s Hospital. With this access, our sleep program is continuously discovering the newest ways to make current, evidence-based care advances and clinical research studies available to you and to your patients.

Related Articles

December 2014

Hyperactivity and Behavioral Problems Caused by Obstructive Sleep Apnea

Approximately 6% of children in the United States have obstructive sleep apnea. Learn how the effective treatment of sleep disordered breathing can greatly improve or eliminate the symptoms of sleep apnea. 

Continue reading

December 2014

Pediatric Sleep Specialty Updates

Meet Helena Molera Ramirez, MD, sleep medicine specialist and learn about the pediatric polysomnography laboratory

Continue reading