Pediatric sleep medicine integrates with multidisciplinary clinics to facilitate communication and treatment

Oct. 15, 2019

Sleep concerns are common in all children, but often more so in those children who are part of special populations or those with medically complex needs. As confirmed by a study published in Pediatrics in 2012, obstructive sleep apnea (OSA) in children is present in up to 5% of children. Up to 50% of children will have a sleep complaint at some point in their lives. Up to 10% of children will have difficulty with insomnia, as confirmed in 2006 in a study published in Sleep and 2014 in a study published in the Journal of Pediatric Psychology.

"OSA and other forms of sleep-disordered breathing are even more prevalent in certain special populations and other comorbid sleep difficulties can also be present," says Julie M. Baughn, M.D., a pediatric pulmonologist at Mayo Clinic's campus in Rochester, Minnesota. "Most children with OSA will benefit and their OSA may often be resolved by undergoing adenotonsillectomy. Many special populations may need additional surgeries or require the use of positive airway pressure. Mayo Clinic's Center for Sleep Medicine team recognizes the need for multidisciplinary care in these children, to treat a multitude of sleep concerns."

Children with genetic disorders such as Down syndrome (trisomy 21), Prader-Willi syndrome, Angelman syndrome and achondroplasia; neuromuscular disorders such as muscular dystrophy, myotonic dystrophy and spinal muscular atrophy; cerebral palsy; and spina bifida are all at increased risk of OSA as well as other forms of sleep disordered breathing. As noted in a study published in Sleep in 2011, these children require polysomnography to diagnose and treat the sleep-disordered breathing.

"Children with autism, Angelman syndrome or neurodevelopmental delay can have difficulty going to sleep and staying asleep. When children have sleep difficulties it significantly impacts their caregivers and families. Sleep concerns impact the mental health, cognition and well-being of children," says Dr. Baughn.

Children's sleep disorders impact caregivers and families, too

Mayo Clinic sleep medicine specialists recognize the multidisciplinary nature of sleep issues in children and the significant impact these issues have on the child's caregiver or family. Knowing the importance of communication, team members collaborate with physicians in multidisciplinary clinics at Mayo Clinic Children's Center, including the multidisciplinary Aerodigestive Clinic and neuromuscular clinic.

"The team recognizes the high risk of sleep-disordered breathing in children with spina bifida and cerebral palsy," says Dr. Baughn. "When treatment for OSA is considered, the best therapy for the child can be discussed, as there is open communication between the sleep specialist and the child's other providers. The ability of the sleep specialist to not only provide diagnostic interpretation of a polysomnography, but to provide a comprehensive sleep consultation is an asset that allows patient and family-centered treatment of patients and their families.

"Our sleep medicine team works closely with endocrinologists in children with Prader-Willi syndrome who require polysomnography before and after initiation of growth hormone. We work with neurologists and pulmonologists in children with spinal muscular atrophy who are receiving nusinersen, a new genetic modifying treatment. Treatment for OSA in children is typically multidisciplinary and involves the expertise of an otolaryngologist.

The multidisciplinary model facilitates timely communication about treatment options. In the multidisciplinary Aerodigestive Clinic, the input of gastroenterologists, otolaryngologists, pulmonologists and sleep medicine specialists are all considered in the treatment plan given to a family.

Other multidisciplinary clinics at Mayo Clinic Children's Center may not see children at risk of OSA, but do see children with other sleep disorders. Mayo Clinic Children's Center has an active Angelman Syndrome Clinic, where children with Angelman syndrome will receive a sleep consult.

Children evaluated through the pediatric diagnostic and referral clinic who are diagnosed with postural orthostatic tachycardia syndrome can have comorbid insomnia, delayed sleep phase syndrome and hypersomnia. Children seen in developmental pediatrics, particularly those with attention-deficit/hyperactivity disorder and autism have difficulty with insomnia and restless sleep.

"Mayo Clinic's team of sleep medicine specialists is committed and passionate about the team approach to sleep concerns in children," says Dr. Baughn. "That concern is never more important than in children with medically complex needs."

For more information

Marcus CL, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:576.

Morgenthaler TI, et al. Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children ― An American Academy of Sleep Medicine report. Sleep. 2006;29:1277.

Meltzer LJ, et al. Systematic review and meta-analysis of behavioral interventions for pediatric insomnia. Journal of Pediatric Psychology. 2014;39:932.

Aurora RN, et al. Practice parameters for the respiratory indications for polysomnography in children. Sleep. 2011;34:379.

Aerodigestive Clinic. Mayo Clinic.

Angelman Syndrome Clinic. Mayo Clinic.