Pediatric sleep: current knowledge, gaps, and opportunities for the future

Abstract

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

Keywords: adolescent sleep; attention deficit hyperactivity disorder; autism; cardiometabolic health; circadian rhythm disorders; insomnia; insufficient sleep; narcolepsy; pediatric sleep; sleep apnea.

Figure 1.

The 3 Ms for circadian rhythm sleep disorders future directions. The 3 Ms for future research directions: motivating teens to change sleep behaviors; evaluating the efficacy of strategically timed melatonin for delayed circadian rhythms; mechanisms linking delayed circadian rhythm disorders and mental health.

Figure 2.

Drawing and description from a pediatric sleep patient. A 15-year-old female: “‘My bed, and my pillow, and (inaudible). My head is usually somewhere around here. Sometimes at night, I just have to flip my whole body around or else it just bugs me. So then, I just sleep at the bottom of the bed for like a week, and then I can go back to sleeping like I’m supposed to. Feeling tired; (inaudible) blue eyes, and they’re bloodshot because I didn’t get any sleep; (inaudible) all over them. And my legs, they’re like tingly, (inaudible) wavy. And my arms kind of do the same thing. So I just have to keep moving them, or else it just bugs me all night long, and then I definitely don’t get any sleep.’” From J Child Neurol. 2011;26:1365-76. Reproduced with permission from SAGE Publications.

Figure 3.

Biological, medical, and behavioral overlap in ASD and sleep. Visual representation of the biological, medical, and behavioral overlap and the multifactorial nature of ASD and its impact on sleep.

Figure 4.

Visual schedule for healthy routines. Sample visual schedule that could be used in an intervention setting to promote healthy implementation of rituals and routines for children.