Obstructive Sleep Apnea (OSA) in children effects of 2-3% of all children, however in light of the rising prevalence of childhood obesity, the estimated prevalence has increased to 6-10% of all children. While the first line of therapy for Pediatric OSA in children consists of upper airway surgery via surgical removal off the adenoids and tonsils, it has become increasingly clear that surgery efficacy is limited in older and//or obese children. As a result, alternative therapies, including positive airway pressure  (PAP) therapy has become mainstay for a lot of children. The application of PAP devices in children is unique and requires further attention to ensure that PAP therapy is successful.

Objectives:

1. Provide an overview of Obstructive Sleep Apnea in children
2. Distinguish indications for Positive Airway Pressure (PAP) therapy in children
3. Discuss obstacles of PAP adherence in  children
4. Share real world data of PAP adherence in children

Rakesh Bhattacharjee, MD, FRCPC, DABP(SM), CBSM, DBSM, FAASM

Director of Sleep Medicine, Rady Children’s Hospital

Associate Clinical Professor of Pediatrics, UCSD

Continuing Education:

• 1 AAST CEC after passing a short knowledge assessment in the AAST Learning Center

Access:

• Free with AAST Membership
• $30 for Non-Members

Jacinta Jiménez, PsyD, is an award-winning psychologist and board-certified leadership coach, and for 15+ years has been dedicated to the betterment of people through innovative programming stemming from the latest research in positive psychology, neuroscience and motivational psychology. She is an accomplished author and was a key team member in the creation and implementation of the Anger and Irritability Management System, a mobile app produced by the Mobile Behavior Design Lab and the National Center for PTSD. Currently, she serves as the vice president of Coaching Innovation at BetterUp, a virtual coaching platform dedicated to helping people live with greater clarity, purpose and passion. 

AAST Managing Editor Monica Roselli recently spoke with Jiménez on what people are looking for in a coach, how a coach can be successful and more. Hear Jiménez's thoughts on what the world of coaching looks like today and where she believes the future of the profession is heading in this Q&A

Most research on the use of artificial intelligence (AI) in the sleep field has focused on its use in the diagnosis of obstructive sleep apnea and in polysomnography scoring. However, in recent years, the use of AI, particularly conversational AI, for sleep coaching people with insomnia has been of great interest, and recent findings have been encouraging.

In this column,  Laura Linley, CRTT, RPSGT, FAAST, revisited the Medicare (MCR) provider compliance tips related to polysomnography/sleep studies and found that there are no substantive new changes or tips posted for this service line. As a health care provider, you should understand Medicare coverage before providing services or items to Medicare patients. Because extensive coverage information is readily available, Medicare has made it known that they expect health care providers to know their coverage requirements in order to avoid payment denial.

Description: Sleep health has taken a big hit globally in the wake of the pandemic. This isn’t news, nor is it surprising to learn that our healthcare peers on the COVID-19 frontline are suffering from long-term sleep and mental health problems. One particular population of medical professionals, registered nurses, are the target for recent research suggesting an alarming mental health impact on those working the frontlines. In this month’s Journal Club, we’ll review how sleep, or lack of sleep, or poor sleep, can affect psychological health in general and consider sleep health among healthcare workers prior to the pandemic. Then we’ll break down the NORFUL et al study into two separate sections, the first one examining the foundation of the study specifically tuned to psychological health concerns, and the second section focused on the sleep health implications of the study as well as insights into how this might impact us on the job in sleep clinics and research laboratories.

Recorded: 2/27/2023

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Category: Journal Club

Access Period: 30 days from date of purchase.

Sleep coaching is a rapidly expanding field, and Certified Clinical Sleep Health (CCSH) professionals can apply their skills to a wide variety of client bases. We asked four sleep coaches with different specializations to dive into their personal approaches to coaching and sleep education, and share how they utilize their CCSH in their patients’ care. By Bethany Larrañaga, featuring Brendan Duffy, RPSGT, RST, CCSH; Geoff Eade, RPSGT, CCSH; Amy Korn-Reavis, RRT, RPSGT, CCSH; and Nicole Sondermann, RPSGT, CCSH.

Sleep disturbances are highly prevalent in infants and toddlers. Dr. Mindell will present empirically-based strategies for the management of bedtime problems and night wakings in young children. Factors that contribute to the development of these issues will be presented. Behavioral interventions discussed will include the importance of sleep schedules, bedtime routines, and the development of self-soothing skills.

Objectives:

1. Understand prevalence of sleep disturbances in infants and toddlers
2. Discuss factors associated with behaviorally-based sleep problems in young children 
3. Review empirically-based treatments for bedtime problems and night wakings

Jodi A Mindell Ph.D., DBSM

Professor, Department of Psychology

Saint Joseph’s University/Children’s Hospital of Philadelphia

Continuing Education:

• 1 AAST CEC after passing a short knowledge assessment in the AAST Learning Center

Access:

• Free with AAST Membership
• $30 for Non-Members

Description: A patient with COPD has a diagnostic portion with OSA and has a split night study using a variety of PAP platforms.

Presenter: Richard S. Rosenberg, PhD

Recorded: 7/12/2019

CEC Credit(s): 1.0

Target Audience: Sleep technologists and other allied health professionals.

Estimated Time to Completion: Approximately one hour

Category: Case of the Month

Access Period: 30 days from date of purchase.

This content is provided free of charge by Respicardia.

Join us for a pre-recorded web course discussing Central Sleep Apnea as well as the clinical evidence for phrenic nerve stimulation.
Topics include:

• CSA pathophysiology and prevalence
• How phrenic nerve stimulation therapy works in stabilizing breathing
• Appropriate patients for phrenic nerve stimulation
• Clinical results at 6, 12 and 18 months

Presenters:

Dr. Alan Schwartz

• Professor of Medicine, ret. (Johns Hopkins School of Medicine)
• Clinical Associate Professor (University of Pennsylvania Perelman School of Medicine)
• Profesor Extraordinario Visitante (Universidad Peruana Cayetano Heredia, Lima PERU)
• Former medical director of the Johns Hopkins Sleep Disorders Center and co-director of the Johns Hopkins Center for Interdisciplinary Sleep Research and Education

Dr. Robin Germany

• Chief Medical Officer of Respicardia
• Clinical Assistant Professor, Division of Cardiovascular Disease, University of Oklahoma

CEC Credit(s): 1.0

Length: 52 minutes

Access Period: 30 days from the start date.

This one-of-a-kind e-learning resource follows the BRPT's Pediatric Sleep Certificate Exam Blueprint and is designed to help students close knowledge gaps in pediatric sleep care before sitting for the certificate exam. Each module includes a glossary and a knowledge check section to reinforce learning. Topics included in preview on next tab.

Module 1 - Pediatric Polysomnography 1.0 CEC

Author: Rita Brooks, MEd., R. EEG/EP T., RPSGT, FAAST

This module is the first in a series of Pediatric resources being developed for those new to pediatrics and pediatric sleep testing and therapy.  The module provides an overview of the specific knowledge and skills the sleep technologist performing pediatric testing requires.  A review of the development of sleep in infants and children, information on pediatric sleep evaluation and questionnaires, and indications for polysomnography in pediatric patients is provided.  Information regarding pediatric equipment requirements and testing considerations for the young and very young pediatric patient is provided.  Tips on communicating with pediatric patients and their parents and getting the leads on these young patients are included, along with testing set-up, instrumentation, recording and documentation requirements for pediatric polysomnography.  This module provides a useful introduction to pediatric polysomnography for the sleep technologist.

Module 2 - Pediatric Scoring 1.0 CEC

Author: Laree Fordyce, RPSGT, RST, CCSH, CCRP

This module reviews the most recent AASM pediatric scoring rules, focusing on the specifics of the infant and child sleep staging and arousal scoring rules and respiratory event scoring in these age groups.  Terminology describing infant age relevant to infant scoring is explained, along with the specific nomenclature used in infant and pediatric sleep staging.  The specific respiratory event scoring differences that apply to the pediatric patient are reviewed, along with cardiac event scoring rules for pediatrics.  The module provides and reviews pediatric sleep stage and event scoring examples throughout the module and provides rationale for the additional monitoring parameters essential in pediatric polysomnography.  This module provides an in-depth review and explanation of how to utilize the pediatric scoring rules to evaluate sleep disorders in infants and children. 

Module 3 - Pediatric Sleep Development & Sleep Related Breathing Disorders 1.0 CEC

Author: Julie DeWitte, RCP, RPSGT, RST, FAAST

This module reviews the development of sleep in children from infancy through adolescence and provides an overview of a variety of sleep and sleep related breathing disorders in pediatric patients.  An assortment of case studies is provided that illuminate several sleep and breathing disorders that are seen in pediatrics and discusses treatment options and management of these various types of disorders.

Module 4 - Pediatric Treatment Options & Guidelines 1.0 CEC

Author: Debra Medin

In this module we define and describe the common modalities used to treat sleep disordered breathing in the pediatric patient.  Indications, contraindications, and precautions for each modality of treatment are outlined, along with the appropriate interfaces for pediatric therapies.  Troubleshooting methods for mask leaks, excessive pressure on the face, and humidification are described, and tips for achieving successful therapy in the pediatric patient are provided.  Treatment goals and patient follow-up guidelines for each type of therapy, as defined by best practices and the American Academy of Sleep Medicine Task Force, are also provided.  This module provides a thorough review of treatment options for sleep related breathing disorders in the pediatric patient.

Module 5 - Pediatric Insomnia & Circadian Rhythm Sleep Disorders 1.0 CEC

Author: Kimberly Trotter, MA, RPSGT, FAAST

This module reviews insomnias and circadian rhythm sleep disorders in the pediatric population.  The evolution, emergence, and prevalence of insomnia disorders, signs and symptoms of the primary pediatric insomnias and management and treatment options for these disorders are discussed.  Pediatric circadian rhythm sleep disorders including delayed sleep phase syndrome (DSPS) and its causes and symptoms are reviewed and differentiated from the insomnias in the pediatric population.  A discussion of appropriate behavioral and environmental interventions for pediatric sleep disorders is also included.  This module provides an excellent overview of the primary insomnia and circadian rhythm sleep disorders that affect pediatric patients.

Module 6 - Pediatric Parasomnias & Hypersomnias 1.0 CEC

Author: Laree Fordyce, RPSGT, RST, CCSH, CCRP 

This module provides an excellent review of the parasomnias and hypersomnias that affect the pediatric population.  A review of the different types of primary and secondary excessive daytime somnolence (EDS) in the pediatric population that includes age specific signs and symptoms of hypersomnolence in the pediatric patient is provided.  The review of parasomnias focuses on recognizing risk factors for and identifying common parasomnias in the pediatric population and discusses when to utilize polysomnography for evaluation of parasomnias.  The causes of both pediatric hypersomnias and parasomnias and how the appropriate medical history and testing affect proper diagnosis and treatment are reviewed, and the importance of parental education and reassurance in the management of these disorders is discussed.  This module provides an extensive overview of two of the more common pediatric sleep disorders.

Module 7 - Sleep & Medical Disorders in Special Populations 1.0 CEC

Author: Kimberly Trotter, MA, RPSGT, FAAST

This module provides an extensive overview of the numerous different types of medical disorders that may be seen in pediatric special populations.  Each disorder is defined and provides information on how sleep is affected in infants and children with these medical disorders, including the anticipated PSG changes seen in these populations.  In pediatric sleep medicine, the ability to recognize these disorders is important in order to best care for these children during their night in the sleep lab.  This module provides valuable information for any sleep technologist who works with pediatric patients.

Module 8 – Addendum

This module provides supplemental materials as additional learning and for reference on many of the topics covered in this course.  These materials include both technical guidelines developed and endorsed by the AAST and professional practice guidelines from the American Academy of Sleep Medicine (AASM) that set the standards for our work in sleep medicine and technology. These reference materials are provided as an enhancement to this course.  Please note that some of the materials provided are not pediatric specific, however all of these references contain information that is relevant in some manner to the care of pediatric sleep patients.