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Paediatric Respiratory & Sleep Clinical Network

The Respiratory and Sleep Clinical Network unites clinicians and researchers to improve sleep and respiratory health for tamariki and rangatahi through advocacy, data collection, and equitable care.

The Respiratory and Sleep Clinical Network, newly formed through the merger of the Sleep Medicine Clinical Network and the Cystic Fibrosis Clinical Network, is a multidisciplinary team comprising clinicians and researchers. Its clinical focus includes data collection and advocacy for better resource allocation, along with diagnostic investigation and treatment of sleep and respiratory disorders in tamariki and rangatahi. By promoting improvements through collective participation, partnership and engagement, the network aims to address health disparities influenced by ethnicity, geography, poverty, and systemic disadvantage, thereby improving conditions related to sleep and respiratory health.

Network priorities

Addressing Respiratory Disease Tamariki in Aotearoa experience higher rates and burdens of respiratory diseases compared to peers in similar countries, with marked inequities among Māori and Pasifika children who suffer disproportionately from conditions like asthma, bronchiolitis, pneumonia, and bronchiectasis.

Resource Allocation Paediatric respiratory care is under-resourced in Aotearoa. There is a shortage of specialists, nurses, physiotherapists, and physiologists, leading to inadequate access to necessary investigations and treatments, such as lung function testing and acute physiotherapy, even during emergency hospital admissions.

Enhancing Sleep Medicine Services Paediatric sleep medicine services are limited in Aotearoa New Zealand and unable to meet clinical demand, resulting in lengthy wait lists for assessment and diagnosis. Despite advances in treatments like CPAP and BiPAP for sleep-disordered breathing, access remains limited, particularly outside major urban centres, exacerbating geographic and ethnic disparities.

Surgical Interventions The network is also focused on reducing barriers to timely ENT surgery for children with obstructive sleep apnoea due to adenoidal and/or tonsillar hypertrophy.

Service Development Efforts are underway to develop nationally connected paediatric sleep medicine services with tertiary centres in Christchurch, Wellington, and Auckland and a national quaternary service in Auckland for patients requiring life-support long-term ventilation. Enhancing access to care and providing training are among the top priorities.

Clinical Resources and Guidelines

Sleep Disordered Breathing (SDB)

The New Zealand Guidelines for the Assessment of Sleep-Disordered Breathing in Childhood 2014 was produced by the National Paediatric Sleep Medicine Clinical Network as an evidence-based summary for the assessment of children with sleep disordered breathing. It aims to address the following clinical management issues for paediatric health care professionals in New Zealand:

  1. How should general practitioners and paediatricians approach the investigation of a child who snores?

  2. Which children should be referred from around New Zealand to a sleep disorders centre for further evaluation?

  3. What treatments are available for disorders of breathing during sleep in childhood and what are the known benefits of these treatments?

Full guideline: a pdf copy of the full guideline: New Zealand Guidelines for the Assessment of Sleep Disordered Breathing in Childhood 2014 can be downloaded here.

Obstructive Sleep Apnoea

Obstructive sleep apnoea syndrome (OSA) is a relatively common and potentially serious medical condition in children causing sleep disruption and abnormal physiology. A guideline in regard to OSA can be found here: https://www.starship.org.nz/guidelines/obstructive-sleep-apnoea/

Oximetry

A guideline intended to assist clinicians with the performance, reporting and interpretation of paediatric overnight pulse oximetry studies can be found here: https://www.starship.org.nz/guidelines/oximetry/

Sleep and Sleep Disordered Breathing in Cystic Fibrosis.

Chronic respiratory disease such as cystic fibrosis can be associated with sleep disturbance due to problems such as cough, wheeze, nasal obstruction or side effects of medication. A guideline in relation to this can be found here: https://www.starship.org.nz/guidelines/sleep-and-sleep-disordered-breathing-in-cystic-fibrosis

BEARS mnemonic

The BEARS mnemonic can be used as a guide for history taking. Parents should be asked about snoring or noisy breathing in particular. https://www.starship.org.nz/guidelines/sleep-and-sleep-disordered-breathing-in-children/ (page 48) Chamness JA. Taking a pediatric sleep history. Pediatr Ann 2008; 37:502-508.

If symptoms of snoring or noisy breathing are noted, a paediatric OSA screening questionnaire should be completed https://media.starship.org.nz/osas-screening-questionnaire/osas_screening_questionnaire.pdf This questionnaire is based on the Chervin Paediatric Sleep Questionnaire.

For the linked questionnaire add up the "Yes" scores for the 22 items. A score greater than 7 with no missing items, or a percentage value of 0.33, has a 78% sensitivity and a 72% specificity for detecting polysomnograph (PSG) diagnosed OSA (AHI >5).

Whānau Resources

KidsHealth, supported by the Paediatric Society of New Zealand, is the go-to source for whānau seeking trusted child health information and resources.

Here are some links to relevant pages on the KidsHealth website:

Breathing illnesses

Illnesses that affect breathing are common in tamariki and rangatahi. Find out more about some breathing illnesses and what to do if your child is sick. 

Bronchiolitis

Bronchiolitis is a chest condition that causes breathing problems in pēpi (babies). It's caused by a virus. Bronchiolitis is usually a mild illness but some sicker pēpi need to go to hospital.

Bronchiolitis

Bronchiectasis In Children

Bronchiectasis is a chest disease.

Bronchiectasis

Croup

Croup is a viral illness in young tamariki which causes narrowing of the upper airways. Croup is often a mild illness but can quickly become serious, so don't hesitate to get medical help.

Croup In Children

Whooping cough

Whooping cough can make pēpi very sick and some pēpi can die. Having whooping cough immunisation in pregnancy protects pēpi in their first weeks of life. Start immunising pēpi the day they turn 6 weeks old to keep protecting them.

Whooping Cough

Pneumonia

Pneumonia is an infection of the lungs. It causes cough, fever and problems with breathing. Most tamariki make a complete recovery from pneumonia.

Pneumonia In Children

Pleural effusion and empyema

A pleural effusion is when extra fluid builds up in the space around the lungs. The most common cause of pleural effusion is pneumonia, an infection of the lungs.

Pleural Effusion & Empyema In Children

Cough

Coughing is common in tamariki (children), especially when they are preschool age. A cough that lasts longer than 4 weeks is not normal and may be a sign of more serious disease.

Cough In Children

Pre-school wheeze

Pre-school wheeze is an infection of the lungs that starts with a cough or cold. It's more common in tamariki under the age of 3 years as their airways are smaller. Pre-school wheeze can also be called viral wheeze, episodic wheeze, or viral-induced wheeze.

Pre-School Wheeze

Asthma

Asthma is a condition that leads to narrowing of the airways of the lungs. Symptoms include wheeze, cough and difficulty breathing.

Asthma

Pneumothorax

A pneumothorax happens when air gets trapped between the lung and chest wall. It’s more common in teenagers and young adults. Symptoms include sudden sharp chest pain and difficulty breathing.

Pneumothorax In Children & Young People

Signs that children are struggling to breathe

Watch the videos and know the signs and the different noises pēpi and tamariki can make when they are having trouble breathing. That way you can act fast and get help. 

Signs That Children Are Struggling To Breathe

Vaping and Young People

Vaping & Young People | KidsHealth New Zealand's Trusted Voice On Children's Health

Sleep & Breathing Problems In Neuromuscular Conditions

Sleep & Breathing Problems In Neuromuscular Conditions | KidsHealth New Zealand's Trusted Voice On Children's Health

Flu In Children

Flu In Children | KidsHealth New Zealand's Trusted Voice On Children's Health

 

Respiratory Syncytial Virus (RSV) Infection

 

Respiratory Syncytial Virus (RSV) Infection | KidsHealth New Zealand's Trusted Voice On Children's Health

 

 

Often parents can misinterpret an infant in REM sleep for being awake or waking up and can possibly disturb an infant’s sleep. Here is an example of REM sleep, which may be helpful to show families, so they can distinguish REM sleep.

 

 

Name Role Location
Cass Byrnes Co-chair Auckland
Ranui Maxwell  Project Coordinator Christchurch
David McNamara Co-chair Wellington
Angela Campbell Member Wellington
Barbara Galland Member Dunedin
Barry Taylor Member Dunedin
Diane (Dee) Muller Member Wellington
Karen Munro Member Auckland
Murali Mahadevan Member Auckland
Sam Dalton Member Christchurch
Samuel Greig Member Christchurch
Sarah Currie Member Hastings
Sam Dalton Member Christchurch
Renee Duchatel Member Christchurch
Karen Munro Member Auckland
Laura Rensford Member Auckland
Sarah Mooney Member Auckland
Hollie White Member Wellington
Rebecca Scoones Member Auckland
Oka Sanerivi Member Gisborne

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