The practice of pediatric sleep medicine: Results of a community survey

Objective. To assess knowledge, screening, evaluation, treatment practices, and attitudes regarding sleep disorders in children and adolescents in a l arge sample of community-based and academic pediatricians. Design. Cross-sectional survey. Participants. Six hundred twenty-six pediatricians in Rhode Island, Massach usetts, and Connecticut. Instrument. The Pediatric Sleep Survey, a 42-item questionnaire assessing g eneral and specific sleep knowledge categories; clinical screening, diagnos tic, and treatment practices for common pediatric sleep disorders; and prac titioner attitudes regarding the impact of sleep disorders in the clinical setting and as a public health issue. Results. On the knowledge section, the mean Total Knowledge score for the r espondents was 18.1 +/- 3.5 out of 30 items, with 23.5% of the sample respo nding correctly on half or less of the items. Pediatricians scored highest on items relating to developmental and behavioral aspects of sleep and para somnias, whereas the mean percentage of correct responses was <50% for item s relating to sleep disordered breathing, excessive daytime sleepiness, and sleep movement disorders. Although only 16.5% and 18.2% of the sample repo rted not screening routinely for sleep disorders in infants and toddlers, t his percentage rose to 43.9% in adolescents. Furthermore, only 38.3% regula rly question the adolescents themselves about their sleep. Only about one q uarter of the respondents screen toddlers and school-aged children for snor ing. In evaluating and treating pediatric sleep problems, 53.2% of the samp le never or rarely order overnight sleep studies to assess for obstructive sleep apnea and few use alternative treatment strategies, such as continuou s positive airway pressure. A quarter of the sample at least occasionally r ecommends diphenhydramine and almost half suggests a psychological evaluati on for children with night terrors. Finally, the percent of pediatricians r ating the impact on children of sleep problems in a variety of domains as i mportant or very important ranged from 49.7% (nonintentional injuries) to 9 2.6% (academic performance). However, only 46% of the sample felt confident or very confident about their own ability to screen for sleep problems, wh ereas 34.2% and 25.3% similarly rated their ability to evaluate and treat s leep problems in children. Conclusions. The results of this survey suggest that there are still signif icant gaps among practicing pediatricians both in basic knowledge about ped iatric sleep disorders, and in the translation of that knowledge into clini cal practice. Despite their acknowledgment of the importance of sleep probl ems, many pediatricians fail to screen adequately for them, especially in o lder children and adolescents. Additional educational efforts regarding ped iatric sleep issues are warranted, and should be targeted at the medical sc hool, postgraduate training, and continuing medical education levels.