Abstract Rationale Insomnia symptoms are common in children referred for sleep evaluation, yet their prevalence and distribution across referral sources have not been systematically characterized. Understanding how insomnia symptoms vary by referral pathway may identify populations at risk for underrecognized sleep disturbance and guide early behavioral intervention strategies within pediatric sleep medicine. Methods We conducted a retrospective analysis of 1,458 pediatric patients (0-18 years) evaluated in the Rady Children’s Hospital Sleep Laboratory. Clinical and polysomnographic data were extracted from sleep study reports and intake assessments, including the San Diego Sleep Survey to assess insomnia symptoms. Patients were categorized by referral source: Otolaryngology (ENT), Sleep Medicine, or Neurology. The primary outcome was the presence of insomnia symptoms, defined by a positive survey response. Between-group differences were examined using chi-square tests for categorical variables and ANOVA for continuous variables. Logistic regression evaluated whether referral source independently predicted insomnia symptoms after adjusting for age and obstructive sleep apnea (OSA) severity. Results Insomnia symptoms were reported in 55% of the cohort. Prevalence differed significantly by referral source, with ENT-referred patients demonstrating a higher proportion of insomnia symptoms compared with those referred by Sleep Medicine (58% vs. 49%, p 0.05) but similar to Neurology referrals (60%, p = NS). The odds of insomnia among ENT referrals were significantly elevated relative to Sleep Medicine (OR = 1.41, 95% CI 1.14-1.75). ENT patients also exhibited higher mean sleep-disordered breathing scores (19.7 ± 5.8) than those from Sleep Medicine (18.6 ± 6.2) or Neurology (16.1 ± 6.0, p 0.05). Age and sex distributions were similar across groups. Conclusions In this large pediatric sleep laboratory cohort, insomnia symptoms were most prevalent among ENT-referred children, suggesting that those referred primarily for evaluation of suspected OSA frequently present with broader sleep difficulties than recognized at referral. These findings underscore the importance of routine insomnia screening across all referral pathways—including surgical populations—where airway obstruction is often the initial focus. Future investigations will build on these findings to examine children meeting criteria for comorbid insomnia and OSA (COMISA), aiming to clarify clinical predictors, refine screening approaches, and inform tailored behavioral and respiratory treatment strategies. This abstract is funded by: N/A
Bhattacharjee et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: