Prevalence of diagnosed sleep disorders in pediatric primary care practices.
OBJECTIVE
The primary aim was to determine the prevalence of International Classification of Diseases, Ninth Revision (ICD-9), sleep disorders diagnosed by pediatric providers in a large, primary care network. Secondary aims were to examine demographic variables related to these diagnoses and to examine the frequency of prescriptions for medications potentially used to treat sleep disorders.


METHODS
Electronic medical records were reviewed for 154957 patients (0-18 years) seen for a well-child visit in 2007. Information collected included ICD-9 sleep diagnoses, demographic variables, comorbid attention-deficit/hyperactivity disorder and autism spectrum disorders, provider type, and medications.


RESULTS
Across all ages, 3.7% of youths had an ICD-9 diagnosis for a sleep disorder. The most-common diagnoses were sleep disorder not otherwise specified, enuresis, and sleep-disordered breathing. Predictors of sleep disorders varied according to developmental age group and included growth parameters, comorbid attention-deficit/hyperactivity disorder or autism spectrum disorder, and provider type. Potential sleep-related medications were prescribed for 6.1% of the sample subjects.


CONCLUSIONS
This study is one of the first to examine comprehensively ICD-9 sleep diagnoses given by primary care providers in a large representative sample of children 0 to 18 years of age. The 3.7% of patients with ICD-9 sleep diagnoses is significantly lower than prevalence rates reported in epidemiological studies, which suggests that primary care providers may be underdiagnosing sleep disorders in children and adolescents. Because sleep disorders are treatable when recognized, the results from this study suggest a significant need for additional education and support for primary care providers in the diagnosis and treatment of pediatric sleep disorders.
Meltzer
Lisa J
LJ
Children's Hospital of Philadelphia, Division of Pulmonary Medicine, 3535 Market St, 14th Floor, Philadelphia, PA 19104, USA. meltzerl@email.chop.edu
Johnson
Courtney
C
Crosette
Jonathan
J
Ramos
Mark
M
Mindell
Jodi A
JA
D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004775:Enuresis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011320:Primary Health Care; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000453:epidemiology*
J Adolesc Health. 2008 Mar;42(3):294-302
18295138
Sleep. 2009 Sep;32(9):1183-9
19750923
Pediatrics. 2001 Sep;108(3):E51
11533369
Acta Paediatr. 1999 Aug;88(8):858-65
10503686
Sleep. 2007 Aug;30(8):1013-7
17702271
Child Dev. 2006 Nov-Dec;77(6):1668-79
17107453
Arch Pediatr Adolesc Med. 1997 May;151(5):473-80
9158439
Pediatrics. 1994 Aug;94(2 Pt 1):194-200
8036073
Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1527-32
10228121
J Pediatr. 2002 Jan;140(1):97-102
11815771
Sleep Med Rev. 2008 Oct;12(5):339-46
18406637
J Dev Behav Pediatr. 2000 Feb;21(1):27-36
10706346
Sleep. 1998 May 1;21(3):235-8
9595601
J Child Neurol. 2009 Jul;24(7):846-51
19617460
Eur J Pediatr. 1996 Jan;155(1):56-62
8750813
Pediatrics. 2005 Jan;115(1 Suppl):241-9
15866858
Sleep. 2006 Oct;29(10):1263-76
17068979
Pediatrics. 2009 Apr;123(4):1171-6
19336377
Sleep. 1993 Apr;16(3):249-54
8506458
Mov Disord. 1999 Nov;14(6):1000-7
10584676
Sleep Med Rev. 2002 Aug;6(4):287-306
12531133
Pediatrics. 2007 Aug;120(2):253-66
17671050
Pediatrics. 2009 May;123(5):1287-92
19403493
Sleep Med. 2010 Aug;11(7):692-700
20621556
Sleep. 2008 May;31(5):619-26
18517032
J R Coll Physicians Lond. 1998 Mar-Apr;32(2):149-53
9597633
Pediatrics. 2007 Jun;119(6):1047-55
17545369
Pediatr Neurol. 2008 Jul;39(1):33-9
18555170
Arch Dis Child. 2004 Aug;89(8):708-12
15269066
Pediatrics. 2008 Dec;122(6):e1164-7
19047218
J Psychosom Res. 2005 Dec;59(6):399-405
16310022
Pediatrics. 1996 Sep;98(3 Pt 1):414-9
8784366
Pediatrics. 2003 May;111(5 Pt 1):e628-35
12728122
Pediatrics. 2006 Jun;117(6):e1223-32
16740821
Pediatrics. 2001 Apr;107(4):E60
11335781
Pediatrics. 2002 Apr;109(4):704-12
11927718
J Clin Sleep Med. 2005 Jan 15;1(1):49-59
17561616
Pediatr Neurol. 2005 Feb;32(2):102-8
15664769
Pediatrics. 2001 Jun;107(6):1375-80
11389260
Pediatrics. 2006 Feb;117(2):e247-56
16452333
MMWR Surveill Summ. 2007 Feb 9;56(1):12-28
17287715
Pediatrics. 2000 Jul;106(1 Pt 1):67-74
10878151