Few Pediatricians Trained to Address Sleep Disorders

Nancy A. Melville

August 30, 2011

August 30, 2011 — The vast majority of pediatricians believe it is their role to advise parents or guardians on sleep hygiene for their children, yet very few have ever received training do to so, according to new research published online August 28 and in the September print issue of Pediatrics.

As many as 33% of preadolescents and 40% of adolescents report experiencing some form of sleep problems, including sleep apnea, snoring, and sleep difficulty, according to lead author Firoza Faruqui, DO, from the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio, and colleagues. Sleep issues as seemingly benign as snoring have been linked in studies to lower academic performance and higher body mass index in early childhood, and sleep apnea has been linked to issues ranging from difficulties in social and emotional development to cardiac problems.

In a survey of a national random sample of 700 general pediatricians who were members of the American Academy of Pediatrics, researchers found that as many as 96% of 346 physicians who responded indicated that they believed it was their job to counsel parents or guardians regarding sleep hygiene.

Yet only 18% of respondents reported having received formal training in sleep disorders.

The pediatricians who had received training on sleep disorders had improved knowledge scores of sleep problems, were more confident in counseling parents or guardians on sleep issues, and, importantly, saw fewer barriers to screening, according to the researchers.

"[T]he results of this study indicate that only 1 in 5 pediatricians has received formal training on pediatric sleep disorders," the authors write.

"This finding is critical because pediatricians who had been formally trained had significantly more knowledge regarding sleep disorders and reported fewer barriers to counseling youths and/or their guardians regarding sleep problems."

At least 50% of pediatricians who responded said they screened for sleep problems including bed-wetting, usual bedtime or wake time, and snoring or breathing pauses, yet questions on the survey relating to bed-wetting and snoring were answered correctly by only 29% and 13% of pediatricians, respectively.

Although pediatricians most often screened for obstructive sleep apnea, only 13% answered questions correctly about the condition, and the lowest percentage, only 8%, answered questions correctly about narcolepsy.

The finding that 12% of pediatricians felt a parent would let them know if the child was having sleep problems is a problem in itself, the authors assert.

"It would be difficult, if not impossible, for parents to be expected to know the signs and symptoms of sleep disturbances when our data clearly demonstrate that pediatricians have difficulty recognizing these problems as well," they write.

Fewer than 1 in 6 (<15%) of pediatricians were very confident in their abilities to counsel pediatric patients on sleep issues by using the 5 A's model of asking, advising, assessing, assisting, and arranging follow-up contacts; however, those with formal training expressed greater confidence in the technique.

"These findings support the need for formal education on sleep disorders for all pediatricians," the authors write.

Study limitations include the cross-sectional design, high rate of nonresponders, self-reported responses with possible recall bias, and possible systematic bias from the closed-format survey format.

The study received monetary support from the University of Toledo, Department of Pediatrics, and Mercy Children's Hospital, Ohio. One coauthor has received faculty development research funds from the Ball State University, Ohio.

Pediatrics. 2011;128:539-546. Published online August 28, 2011. Abstract


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