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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1393-1394

COMMENTARY

Pediatric Sleep Medicine Comes Into Its Own

Carole L. Marcus, MBBCh

Sleep Center,
Children’s Hospital of Philadelphia,
University of Pennsylvania,
Philadelphia, PA 19104

Abbreviations: NIH; National Institutes of Health

Sleep disorders are common in children. Some of these disorders are unique to pediatrics, such as apparent life-threatening events. Other disorders differ significantly in their presentation in children compared with adults, such as obstructive sleep apnea syndrome, in which excessive daytime sleepiness, the cardinal symptom in adults, is rare in young children. Some sleep disorders such as narcolepsy are usually diagnosed during adulthood, although their symptoms most commonly begin during childhood.1 Pediatric sleep disorders range from the common conditions encountered by every pediatrician (such as toddlers who keep their parents awake at night [sleep-onset association disorder] and teenagers who won’t go to bed at night [delayed sleep phase syndrome]) to those that are rare and life threatening (such as congenital central hypoventilation syndrome). Despite the frequency, severity, and uniqueness of pediatric sleep disorders, this field of medicine has not received much attention from either the pediatric or sleep medicine community.

The times are changing. Recently, there have been several developments highlighting the importance of pediatric sleep medicine, including changes proposed by the American Board of Pediatrics,2 and new initiatives recommended by the National Institutes of Health (NIH).

The sleep boards are administered currently by the American Academy of Sleep Medicine rather than the American Board of Medical Specialties. This examination is the only examination available to pediatricians who want to certify that they have expertise in the management of sleep disorders. The sleep boards contain minimal pediatric content. Nevertheless, many managed care organizations require that children with sleep disorders be evaluated in American Academy of Sleep Medicine-certified sleep laboratories, which has led to several undesirable scenarios. Children with sleep problems are referred to internal medicine specialists who have passed the sleep boards but have little knowledge about pediatrics or pediatric disorders. Alternatively, many pediatric sleep specialists have taken the sleep boards despite the fact that much of the knowledge tested is irrelevant to their clinical practice (eg, sleep complications of Parkinson’s disease or alcoholism). Steps are being taken to change this. The American Board of Pediatrics, in conjunction with the American Board of Internal Medicine and the American Board of Psychiatry and Neurology, is seeking approval from the American Board of Medical Specialties to issue certificates of added qualifications in sleep medicine. Each board will award its own certificate but use a common examination. In doing so, the American Board of Pediatrics is acknowledging that "the new subspecialty has a unique body of knowledge and a scientific basis and there [are]...a sufficient number of current and potential subspecialists to justify the certification process."2 Ultimately, this may lead to the development of specific pediatric sleep board examinations.

In a second major development, the NIH has issued a revised 2003 National Sleep Disorders Research Plan,3 with a strong emphasis on pediatric issues. In recent years, the NIH has paid increasing attention to the importance of sleep disorders in children, which includes issuing two requests for applications in recent years: one on childhood obstructive sleep apnea and one on sleep and sleep disorders in children. Twelve investigators were funded as a direct result of these initiatives. These requests for applications and other NIH-funded studies already have resulted in a large number of published, rigorously conducted scientific studies of pediatric sleep disorders, significantly raising the level of science in this area.4–29 The success of these initiatives has no doubt influenced the new NIH research plan. In this plan, the need for developmental studies of sleep processes is highlighted, and equal credence is given to the study of pediatric and adult sleep disorders.

In summary, the importance of childhood sleep disorders has become increasingly recognized in recent years by the lay community, pediatricians, and now professional associations30–32 and scientific bodies. Depending on age, children sleep as much as 50% to 65% of their lives. Increasing attention to this "other half of life" can only improve the health and development of our children.


   FOOTNOTES
 
Received for publication Aug 18, 2003; Accepted Aug 18, 2003.

Address correspondence to Carole L. Marcus, MBBCh, Division of Pediatric Pulmonology, 5th Floor Wood, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104. E-mail: marcus{at}email.chop.edu


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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics




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