Sleep disorders in kids tied to increased health care use

Key takeaways:

• Youth with chronic conditions and a sleep disorder had almost twice the odds of increased health care use.
• Circadian rhythm sleep disorder was most strongly associated with increased health care use.

The presence of a sleep disorder was associated with increased health care use in youth with chronic medical conditions, a study in the Journal of Clinical Sleep Medicine showed.

“The results were impressive, suggesting a clear role of sleep disorders in [health care use (HU)] in children with chronic medical conditions (CMCs),” Pranshu A. Adavadkar, MD, an associate professor in the department of pediatrics at the University of Illinois Chicago, said in a press release.

According to the researchers, although sleep disorders have been associated with greater HU in adults, “similar studies in pediatric population are limited.”

They added that the incidence of HU is higher in children with CMCs, making it “vital” to examine the impact of sleep disorders on HU in this population.

In the study, Adavadkar and colleagues analyzed the Medicaid claims data of 16,325 youth, aged 0 to 18 years, enrolled in the Coordinated Healthcare for Complex Kids project.

Each child and adolescent had at least one CMC — like asthma, obesity or overweight, diabetes or ADHD — whereas 77% had multiple CMCs.

Youth were also divided into three groups based on their amount of ED visits or hospitalizations at 12 months before study enrollment:

• low HU use (no ED visits or hospitalizations);
• medium HU use (one to three ED visits or one hospitalization); and
• high HU use (four or more ED visits or two or more hospitalizations)

Across all age groups, sleep-disordered breathing (SDB) was the most prevalent sleep disorder.

The researchers found that youth with CMCs and any sleep disorder had almost twice the odds (OR = 1.83; 95% CI, 1.67-2.01) of having increased HU vs. those without a sleep disorder.

Circadian rhythm sleep disorder (OR = 2.45; 95% CI, 1.07-5.64) was most strongly linked to increased HU, followed by SDB (OR = 1.51; 95% CI, 1.17-1.95) and insomnia (OR = 1.46; 95% CI, 1.06-2.02).

The significant association between HU and circadian rhythm sleep disorder “could be attributed to disrupted sleep patterns, impaired daytime functioning and metabolic dysfunction associated with circadian rhythm misalignment,” Adavadkar and colleagues suggested.

They also noted that the risk for increased HU decreased with age (OR = 0.94; 95% CI, 0.94-0.95), and Hispanic (OR = 0.57; 95% CI, 0.45-0.72) and Black (OR = 0.58; 95% CI, 0.46-0.73) youth had a nearly 50% lower risk for increased HU vs. white youth.

“The role of racial disparities in sleep-related health care-seeking behaviors among caregivers needs to be examined as data suggest that, despite worse sleep quality and higher rates of sleep disorders, parents and caregivers in ethnic minority groups may be less likely to seek medical attention for their children,” they wrote.

The study had some limitations. Adavadkar and colleagues pointed out that most participants were from diverse groups — thus affecting the study’s generalizability — whereas the potential underdiagnoses of sleep disorders in pediatric populations “may have attenuated the measured association between sleep disorders and HU.”

Ultimately, “understanding the specific sleep disorders that significantly increase health care utilization risk can inform targeted interventions and screenings for better management of these high-risk children,” Adavadkar said.

References:

• Adavadkar P, et al. J Clin Sleep Med. 2024;doi:10.5664/jcsm.10936.
• Health care utilization is increased in high-risk children who have a sleep disorder. https://aasm.org/health-care-utilization-is-increased-in-high-risk-children-who-have-a-sleep-disorder. Published April 1, 2024. Accessed April 3, 2024.