Evaluating Telemedicine in Pediatric Sleep Care

In addressing pediatric sleep disorders, telemedicine was indicated to provide complete and appropriate care for conditions such as insomnia and circadian rhythm disorders, whereas obstructive sleep apnea (OSA) was better evaluated in office, according to a review article published in Sleep Medicine Clinics.

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, utilization of telehealth has grown exponentially as patients seek to receive physician consultation without risk of infection. Expanding on this rise in use, the review’s author, Shalini Paruthi, MD, director of the Pediatric Sleep and Research Center at SSM Cardinal Glennon Children’s Medical Center, noted that telemedicine warrants consideration in pediatrics as well, particularly in sleep care.

With sleep centers and laboratories nationwide having to close their practices temporarily during the pandemic, Paruthi sought to examine how telemedicine is currently being applied in pediatric sleep care, as well as any notable challenges.

“There are a multitude of potential benefits to incorporating telemedicine into pediatric sleep practices, including and not limited to saving travel time and costs; fewer school absences; less missed work time for parents; and bringing multiple caregivers together conveniently,” said Paruthi.

When determining whether some pediatric sleep disorders may be appropriately evaluated, diagnosed, and treated via telemedicine, Paruthi noted that a significant factor is whether findings from physical examination add any significant information. Sleep conditions that do not require this information include circadian rhythm disorders, in particular delayed sleep-wake phase disorder and insomnia, and sleep-related movement disorders, such as restless leg syndrome.

In addressing how telemedicine is incorporated in pediatric sleep care, Paruthi wrote that it can be delivered synchronously or asynchronously and through modalities such as phone, video, text, and applications (apps). Studies conducted before the pandemic found several benefits of telemedicine in pediatric sleep care, particularly in the treatment of insomnia via cognitive behavioral therapy for insomnia, also known as CBTi.

Conversely, Paruthi highlighted that some sleep disorders may be better evaluated in office or with a hybrid model of some in-office visits and some virtual video visits. For example, in OSA, it is helpful to assess the oropharynx thoroughly and to listen to the cardiovascular and pulmonary examinations for possible right-heart–sided consequence, which is rare, prior to proceeding to polysomnogram or otolaryngology referral.

In addition to the challenges that may warrant in-person evaluation, the issue of care coordination was referenced. Beyond the ease of physical checkout, complete care is essential because virtual consultations do not include nurses or medical assistants who can check vital signs.

“All of these are valuable pieces of information within the evaluation of possible sleep apnea, in which a clinician may encounter children with failure to thrive or children with obesity,” Paruthi wrote.

In concluding, Paruthi says that an ideal setting for pediatric sleep medicine would be characterized by a hybrid model of both telehealth and in-person visits. “Patient outcomes, patient and caregiver satisfaction, clinician and staff satisfaction, and insurance plans will dictate either the sustainability or the decline of telemedicine after the COVID-19 pandemic ends.”

Reference

Paruthi S. Telemedicine in pediatric sleep. Sleep Med Clin. Published online September 15, 2020. doi:10.1016/j.jsmc.2020.07.003