From Curiosity to Core Discipline: The Evolution and Future Directions of Pediatric Sleep Medicine

Pediatric sleep medicine has undergone a profound shift from a narrow focus on life-threatening sleep and breathing disorders in children to a broader, developmentally informed view of sleep health across the lifespan. Increasingly, clinicians recognize that sleep disturbances in childhood can shape long-term health and neurodevelopmental trajectories. Against a backdrop of constrained workforce resources and limited access to behavioral sleep medicine specialists, questions about how to define, measure, and manage pediatric sleep disorders have become central to both pediatric and adult-focused sleep practices.

Pediatric sleep specialist Carol Rosen, MD, professor emerita of pediatrics at Case Western Reserve University School of Medicine, recently presented a session titled “From Niche to Necessity: The Transformation and Future of Pediatric Sleep Medicine,” at the 2026 SLEEP Annual Meeting, held June 14-17 in Baltimore, Maryland.¹ In her talk, she traced the evolution of pediatric sleep medicine from a clinical curiosity to a recognized medical specialty and argued that it now functions as a core necessity in sleep medicine. Her session highlighted the distinctive contributions of pediatric sleep medicine as well as the access and workforce challenges that threaten the field’s ability to meet patient needs.

In a follow-up interview with NeurologyLive^®, Rosen expanded on these themes, describing a small interview-based project she conducted with mid-career leaders in pediatric sleep medicine to identify current tensions in the field. She emphasized the limitations of relying on the Apnea-Hypopnea Index (AHI) as a single metric across the pediatric age spectrum. Rosen underscored the importance of including children in the scientific and therapeutic development shaping sleep medicine while highlighting major unmet needs in pediatric insomnia, circadian disorders, and behavioral sleep problems, emphasizing the need for collaborative efforts to advance the field.

NeurologyLive: Can you provide a brief overview of your SLEEP 2026 presentation, ‘From Niche to Necessity: The Transformation and Future of Pediatric Sleep Medicine’?

Carol Rosen, MD: I have been in the field of pediatric sleep medicine for about 4 decades. I was there when it was considered a clinical curiosity, and I watched it evolve into a clinical discipline and then into a medical specialty. I’ve seen all of that through a pediatric lens.

We’ve really gone from a “niche,” where we were mainly curious about questions related to development, health, and some of the life-threatening conditions involving sleep and breathing in children, to a point where we’re now asking different questions more about sleep health and the trajectory of sleep problems over time.

In this talk, I wanted to make the argument that pediatric sleep medicine is now a medical necessity. I focused on what pediatric sleep medicine contributes to the broader field of sleep medicine. At a general level, our core contributions include a developmental perspective, lifespan thinking, and the systematic inclusion of the family surrounding the patient. I see those as core values that we add to pediatric sleep medicine.

Another important part of my talk was to explore what’s happening now in pediatric sleep medicine. I actually did a small research project specifically for this presentation. I assembled a group of mid-career leaders in pediatric sleep medicine and conducted an interview project. I asked them 4 questions about where we are now, video recorded their responses, summarized their answers, and analyzed the themes and tensions that emerged. That became the backbone of the presentation so that it would be current and up to date.

From there, I tried to make some predictions about where our field is going. Interestingly, instead of focusing primarily on things that are coming up in many fields, such as AI, analytics, and new technologies, the future I described turned out to be more of a value proposition: What do we bring that is truly worthwhile, and what will need to change going forward in pediatric sleep medicine?

That may be a somewhat long-winded overview, but that’s where I started and where I went. I think I made a good argument that we are no longer “niche” and explained why we are now a necessity. I described pediatric sleep medicine clinicians as “superheroes” in the field, but I also talked about our “kryptonite,” which includes problems of access and workforce.

Overall, I was pleased with how the talk went, and I hope I left pediatric sleep medicine physicians feeling better about the field and about the importance of remaining intellectually linked to our adult colleagues as we move forward.

What were the key themes, tensions, and clinical takeaways from your presentation on the evolution of pediatric sleep medicine from a niche interest to a core medical necessity?

We can start with some of the tensions. One of the key tensions—and this might surprise some people—relates to how sleep medicine has been very OSA-centric, very obstructive sleep apnea–centric. The metric that has dominated is the AHI.

The first major tension that emerged was that this single AHI number, applied across the entire spectrum of pediatric ages, really isn’t working for us. We need to move beyond that. Our future is going to be less AHI-centric and less OSA-centric.

Another theme was that our future is going to be more multidisciplinary, which is actually a natural fit for pediatricians. That has always been part of our history. We work with behavioral sleep medicine specialists, neurologists, pulmonologists, dentists, psychologists, nurses—we are very comfortable in that multidisciplinary space. Those were 2 of my main “future” predictions.

In terms of messages to the field, there were 2 I especially wanted to emphasize. First, going forward, children need to be included in the development of the science that will define our field. Too often, data sets and algorithms are built on adult populations first, and new therapeutics are typically tested in adults before children. It is critical that children be included in the future of sleep medicine.

Second, we need to stay connected and work closely with our adult colleagues. Some of the old divisions, pediatrics versus adults, need to be left behind. We are stronger when we work together.

From your perspective, what are the most important unanswered questions and unmet clinical needs in pediatric sleep medicine?

There are many unanswered questions, especially if we start thinking more broadly instead of defining everything by an apnea threshold. We need to look at trajectories, who this child is going to be in the future, rather than only asking how severe their disease is right now.

Pediatric sleep medicine physicians consistently identify major unmet needs in insomnia, circadian rhythm disorders, and behavioral sleep problems. One of the big tensions in our field involves access to behavioral sleep medicine specialists. They are extraordinary, but they are severely under-resourced, and yet we are “linked at the hip” with them. That lack of access is a major challenge for our field and something we will need to find real solutions for going forward.

Is there a final message you’d like to share with sleep clinicians about the future of pediatric sleep medicine?

I feel that I’ve touched on the major points. I think we contribute a great deal to the field of pediatric sleep medicine. At times there are tensions, and we may not always feel that our voice is fully heard, but we are an important part of the broader field. We simply need to keep working together to move pediatric sleep medicine forward.

Transcript edited for clarity. Click here for more coverage of SLEEP 2026.

REFERENCES
1. Rosen C. From Niche to Necessity: The Transformation and Future of Pediatric Sleep Medicine. Presented at: 2026 SLEEP Annual Meeting; June 14-17; Baltimore, Maryland.