Rates of diagnoses of sleep disorders in children with chronic medical conditions

Pranshu A Adavadkar; Andrea A Pappalardo; Anne Elizabeth Glassgow; Christina Zhang; Alan Schwartz; Lee J Brooks; Molly A Martin

doi:10.5664/jcsm.10064

Rates of diagnoses of sleep disorders in children with chronic medical conditions

J Clin Sleep Med. 2022 Aug 1;18(8):2001-2007. doi: 10.5664/jcsm.10064.

Authors

Pranshu A Adavadkar^{1

2}, Andrea A Pappalardo^{1

2}, Anne Elizabeth Glassgow¹, Christina Zhang³, Alan Schwartz^{1

4}, Lee J Brooks⁵, Molly A Martin¹

Affiliations

¹ Department of Pediatrics, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.
² Department of Medicine, University of Illinois Children's Hospital, University of Illinois at Chicago, Chicago, Illinois.
³ Department of Pediatrics, University of Southern California, Los Angeles, California.
⁴ Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois.
⁵ Department of Pediatrics, Rowan SOM, Stratford, New Jersey.

Abstract

Study objectives: This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics.

Methods: Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least 1 CMC from a large metropolitan area. The study population (n = 16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data.

Results: Fourteen percent of the population (mean age of 9.1 years [standard deviation = 5.2]; 35.8% African American; 56.4% male; 77 with more than 1 CMC) received a sleep disorder diagnosis. The most frequent diagnosis was sleep-disordered breathing (11.2%), followed by nocturnal enuresis (1.2%) and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with 1 CMC (19.7% vs 5.8%; P < .001). Insomnia rates in Hispanic/Latinx (1.2%) and African American (0.8%) children and adolescents were significantly lower (both P < .001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs.

Conclusions: Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests underdiagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Underrecognition of sleep disorders has short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs.

Citation: Adavadkar PA, Pappalardo AA, Glassgow AE, et al. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med. 2022;18(8):2001-2007.

Keywords: chronic medical conditions; diagnosis of sleep disorders; rates of sleep diagnoses; sleep in high-risk children.

MeSH terms

Adolescent
Child
Chronic Disease
Ethnicity
Female
Humans
Male
Minority Groups
Sleep Apnea Syndromes* / epidemiology
Sleep Initiation and Maintenance Disorders*
Sleep Wake Disorders* / diagnosis
Sleep Wake Disorders* / epidemiology