The underlying evidence comes from the Medical Expenditure Panel Survey, administered by the US Agency for Healthcare Research and Quality, covering the years 2017 through 2022. This survey is unusual in that it captures data from households themselves as well as from their medical providers, including clinics, hospitals, home health agencies, and pharmacies, along with a sample of insurance plans offered by employers. Crucially, the analysis adjusted for covariates and comorbidities that either facilitate or impede access to health care, or that influence the perceived need for care. That methodological rigor matters, because the question of whether sleep disorders drive excess spending, or whether sicker children simply use more services of every kind, is exactly the kind of confounding that national datasets can help untangle when handled carefully.

The new US figures echo what researchers in Israel documented more than two decades ago. Studies published in the early 2000s showed that children with obstructive sleep apnea syndrome used health care services at markedly higher rates than their peers, and, strikingly, that health care utilization and expenditures fell after the children were treated, often with adenotonsillectomy. Davidson Ward suggests this pattern may hold true across the full spectrum of pediatric sleep disorders: diagnose and treat the sleep problem, and downstream medical costs decline. If that generalizes, the economic case for early identification becomes compelling, because the alternative is paying indefinitely for the complications of an untreated, and frequently reversible, condition.

Yet the 2.88 billion dollar figure almost certainly understates the true cost. The commentary points out that the study did not capture indirect costs such as missed school time, impaired quality of life for the child, and lost wages when parents stay home to care for a chronically sleepless child. Spending on over-the-counter sleep aids and related medications was also excluded. In addition, the survey window included the early years of the COVID-19 pandemic, when families may have avoided seeking care altogether, potentially suppressing recorded expenditures. Even with these limitations, the study’s central message stands: identifying and managing sleep disorders in children is one of those rare interventions that promises both fiscal savings and broad gains in well-being.

So what should be done? The commentary lays out a multi-pronged agenda, beginning with research. Davidson Ward calls for exploring the causes and management of pediatric sleep disorders through both new and existing data, and notes hopefully that the HHS Make America Healthy Again report on children’s well-being mentions sleep health several times, mainly in the context of screen time competing with sleep time. A particular gap involves pediatric insomnia, especially in children with special needs such as autism, where even evidence-based behavioral interventions can fall short. Researchers are encouraged to follow the activities of the National Center on Sleep Disorders Research, which maintains a listserv announcing funding opportunities in the field.

Access to care is the second pillar, and it starts with education. An international survey cited in the commentary found that sleep education in pediatric residency programs is minimal, and that this gap leaves pediatricians reporting unease with treating sleep disorders in children. The proposed fixes are structural: the American Board of Pediatrics and the Accreditation Council for Graduate Medical Education are partnering to shorten pediatric fellowships for trainees aiming to become clinician educators, which could enlarge the applicant pool and make the extra year of sleep medicine fellowship more attractive. Meanwhile, the Advancing Innovation in Residency Education initiative allows pulmonary fellows to train in sleep medicine concurrently with their primary fellowship, and permits board certified or board eligible physicians in relevant specialties to train part-time as fellows. The goal is to expand a pediatric sleep medicine workforce that currently numbers only around 270 specialists nationwide, and the commentary suggests the model could extend to neurology, psychiatry, and otolaryngology.

Technology offers a third route to wider access. Telehealth, the commentary notes, removes the burden of travel for families and allows clinical services to expand without the overhead of brick-and-mortar clinics; the American Academy of Sleep Medicine describes telehealth as having immediate potential to dramatically increase sleep medicine accessibility and clinical efficacy. Diagnostics are another bottleneck. In-laboratory polysomnography remains the gold standard for diagnosing sleep-disordered breathing, but wait times are long. Evidence that home sleep apnea testing is applicable to children and adolescents is accumulating, and forthcoming clinical practice guidelines from the AASM could support insurance coverage for the approach, freeing pediatric sleep laboratories to concentrate on the most complicated cases. The commentary also advocates for wearable devices designed and tested specifically for children, with FDA approval and insurance coverage from the outset, rather than laborious post-market comparisons against adult-oriented gold standards.

Efficiency gains could come from artificial intelligence as well. AI tools that assist in the analysis of polysomnographic data, the commentary argues, should free up clinician time for patient care, easing a workflow in which manual sleep study scoring is notoriously labor intensive. On the therapy side, the commentary urges expansion of proven treatments: hypoglossal nerve stimulation is FDA approved for adolescents with Down syndrome, and Davidson Ward asks why it should not be available for other children who cannot tolerate mask-based positive pressure therapy. Palatal expansion shows promise for relieving obstructive sleep apnea and, she suggests, might be a covered benefit for children on public insurance. She also calls for children to be included in clinical trials of pharmacologic therapies, noting that off-label treatment creates insurance barriers and breeds understandable skepticism among parents, patients, and providers, and recommends that sleep medications be incorporated into the Pediatric Trials Network.

Finally, the commentary makes an explicit appeal for advocacy, aimed at clinicians and the public alike. It points readers to the National Sleep Foundation’s Best Slept Sleep for a Stronger Nation campaign, the AASM’s Sleep for a Stronger Nation initiative and its Community Sleep Health and Public Awareness Grant, and the annual Health Datapalooza sponsored by AcademyHealth, which convenes leaders from government, industry, academia, and the patient community to explore emerging data applications. Clinicians are encouraged to give Grand Rounds, serve as resources for local school boards and child advocacy groups, and support organizations that lobby for sleep health. The broader vision is societal: age-appropriate school start times, help for families managing the conflict between screen time and bedtime, and reduced risk of drowsy driving among teenagers, all of which would create an environment that supports sleep rather than undermining it.

The stakes extend well beyond the health care ledger. As the commentary emphasizes, healthy sleep benefits every domain of a child’s development, from learning and mood to long-term cardiometabolic health, and untreated sleep disorders raise the risk of comorbidities that compound costs over a lifetime. The convergence of new national expenditure data, federal open data initiatives under the OPEN Government Data Act, workforce reforms in training, and maturing home diagnostic technologies gives the field an unusual window of opportunity. The closing sentiment of the commentary is simple and, for a field that has long operated in the shadow of adult sleep medicine, quietly defiant: those who practice pediatric sleep medicine should be proud of their role, because they help children sleep, and in doing so they help families, schools, and the health system as a whole.

Subject of Research: Health care costs and treatment access for pediatric sleep disorders in the United States

Article Title: Pediatric sleep disorders are common and costly: how can we help?

Article References: Ward, S. L. D. (2026). Pediatric sleep disorders are common and costly: how can we help?. Journal of Clinical Sleep Medicine, 22(1), Article 127. https://doi.org/10.1007/s44470-026-00152-1

Image Credits: AI Generated

DOI: 10.1007/s44470-026-00152-1

Keywords: pediatric sleep disorders, obstructive sleep apnea, health care expenditures, polysomnography, home sleep apnea testing, telehealth, sleep medicine workforce, hypoglossal nerve stimulation, pediatric insomnia, Medical Expenditure Panel Survey, sleep health advocacy, artificial intelligence