Editor’s Message: Pediatric Sleep Medicine Comes of Age
Home sleep testing (HST) has several key advantages over in-lab polysomnography (PSG), including being more convenient for most patients and costing them less. And while I expect the upward trend of HST usage to continue, I’ve heard from many readers that it can be challenging to conduct the high volume of HSTs needed to run a profitable business. If you’re seeking additional growth avenues, there is a patient population you should consider accommodating: children. Pediatric sleep medicine is poised to grow, and in-lab PSG is the standard of care for children who need sleep studies.
I recently hosted a webcast during which a poll revealed almost 20% of the audience had not received a pediatric referral in the past year. The presenters offered ways to transition an adults-only lab to one that can take both adults and children, several of which I want to share here.
An important early step is to gain expertise in the different sleep study criteria that apply to children versus adults. Your best reference guide is the American Academy of Sleep Medicine Scoring Manual, which includes sections on pediatrics, said Shalini Paruthi, MD, director of the pediatric sleep and research center at SSM Cardinal Glennon Children’s Medical Center. “There’s a lot of excellent information in the smaller fine print,” she said. Noteworthy distinctions include differing respiratory rules in how to score certain respiratory events, the need to monitor hypoventilation via CO2 monitors, and the awareness that a certain amount of periodic breathing may be normal in kids.
Making your sleep center family friendly includes buying extra equipment, such as cribs and parent beds, said Joel Porquez, BS, CCSH, RPSGT/RST, founder and principal at Sleepkidzzz.com. It also includes learning to finesse children and their caregivers. He advises that whichever caregiver typically puts the child to sleep at home should be the one who attends the sleep study, even if that means an alternate caregiver must put siblings to bed at home. Porquez said, “When the child [at the lab] gets upset and they look at daddy, and daddy’s not used to putting them to bed, they look at you and ask, ‘Where’s mommy?’” Encourage sleep techs to first gain the caregiver’s trust, which will assist in gaining the child’s trust.
During the webcast, there were many questions about PAP therapy in children. So many in fact, that I asked a pediatric sleep expert to write a feature on this subject for our July/August issue. During the webcast, Paruthi shared that, in her experience, children who are 3 years old and above can tolerate PAP. She advised using masks that are designed for children or that are adult extra smalls or petites. Paruthi has also found success scheduling pediatric patients with weekly psychologist visits for mask acclimatization behavioral therapy.
Start by accepting pediatric patients at an age your center is comfortable with handling, then go progressively younger. And be sure to spread the word for referrals. Robert S. Rosenberg, DO, FCCP, medical director of the Sleep Disorders Center of Prescott Valley, said, “Let your [local] pediatricians know that you have a sleep lab with sleep specialists who are interested in pediatric sleep disorders…and, believe it or not, you’ll find that your beds get full quite quickly.”
Sree Roy is editor of Sleep Review. CONTACT email@example.com