How one sleep study helped change the lives of thousands of children

In a single, makeshift room at the Monash Medical Centre in 1987, a movement began.

Under the guidance of Professor Michael Adamson AM, the first paediatric sleep studies were quietly run in the after-hours hush of Monash University’s Department of Paediatrics. What started with one bed, one sleep technologist in Sue Cranage, analogue equipment, and a handful of dedicated researchers has now grown into a globally-recognised centre for paediatric sleep medicine and research.

“It was an unusual set-up,” recalls Associate Professor Margot Davey, who took over as Director of the Melbourne Children’s Sleep Centre in 2003.

“Michael Adamson had a passion for sleep and neonatal care when very few people took it seriously. His belief in the field helped us lay the foundation.”

Origins in SIDS research

The early research focus was on sudden infant death syndrome (SIDS), driven in part by the work of Professor Rosemary Horne. Her PhD in the 1980s explored whether fluctuations in blood pressure could trigger arousal from sleep, a key factor in understanding SIDS.

“Even back then, it was well-understood that SIDS happened during sleep,” she says. “Our work showed that babies sleeping on their tummies, the biggest risk factor for SIDS, had impaired arousal responses and reduced control of heart rate and blood pressure. It’s important for parents to understand why they are recommended to sleep their babies on their backs.”

Their team explored how prone sleeping, preterm birth, and maternal smoking impacted infant physiology. These physiological findings helped explain the epidemiological links between sleep position and SIDS risk, contributing to national and international infant safe sleep guidelines.

But their efforts went beyond discovery. “We were doing bench-to-bedside before it was a buzzword,” says Professor Horne. “We built a research bed out of a cupboard and a corridor. Everything we discovered was channelled into improving practice.”

Building a statewide service

Clinical demand soon followed. Parents and paediatricians began referring children with sleep concerns, from snoring to more complex respiratory and sleep conditions. But sleep medicine still wasn’t recognised as a specialty, and support was minimal.

“I was paid for one hour a week when I started in 1994,” says Associate Professor Davey. “We had a tiny team, bulky analogue equipment, and no digital monitors, so we literally ran studies in the dark. The setup relied on paper recordings and staff keeping watch overnight with minimal lighting to avoid interference. We relied on several of Professor Adamson’s family friends via donations to pay off our equipment debt.”

By 2001, the Department of Respiratory and Sleep Medicine at Monash Medical Centre officially took over the lab, expanding its infrastructure. It grew from one to six beds, supported by research staff, and became a statewide clinical service for children with sleep disorders over the next two decades.

“It was a gradual, determined evolution,” says Professor Horne. “And it was only possible with visionary leadership from people like Professor Nick Freezer and Professor Adrian Walker, who gave us the space, the support, and the encouragement to grow.”

From research room to global impact

The team began to secure competitive funding from the National Health and Medical Research Council (NHMRC), starting with studies into obstructive sleep apnoea and its effects on cardiovascular and neurocognitive development. Associate Professor Gillian Nixon joined in 2006, helping to build new research pathways and integrate ear, nose and throat (ENT) and respiratory care.

“A major goal has been simplifying and scaling diagnostic testing,” she says. “We pioneered overnight oximetry to measure oxygen saturation in blood and initiating CPAP or continuous positive airway pressure for treatment of sleep apnoea in a child's own home, which has since become standard practice. We treat many more complex patients now, including those reliant on ventilation.”

The team also established a research database in 2004. Now, with more than 18,000 sleep studies, it captures high-frequency physiological signals alongside detailed clinical and demographic data. Parents provide informed consent for their child’s data to be used for research.

“It’s the only paediatric sleep lab in the world that we know of with this kind of infrastructure,” says Professor Horne. “We’ve measured everything from heart rate variability to cerebral oxygenation. And because of this database, we can study things that couldn’t be done clinically.”

Home testing and new horizons

Today, the Monash paediatrics sleep team is leading the charge into home-based diagnostics. Their current MRFF-funded project is testing how existing devices can safely and accurately assess children outside the hospital environment, with the goal of earlier diagnosis and intervention.

“Children who snore often go untreated, and yet the consequences can accumulate as they grow,” says Associate Professor Nixon. “We’re now seeing evidence that treating preschool children with sleep-disordered breathing can improve not just behaviour, but long-term cardiovascular health.”

The team is also exploring the broader relationship between sleep, screen time, and mental health through new collaborations with psychology researchers.

“Sleep doesn’t just sit in the medical box,” says Associate Professor Davey. “It cuts across developmental, psychological, and behavioural domains. It’s integral to everything.”

A culture of collaboration and curiosity

One of the program’s greatest strengths is its blend of scientific rigour and clinical compassion. Professor Horne and Associate Professor Davey have long championed cross-disciplinary training, nurturing a team where PhDs are the norm, not the exception.

“Many of our staff started with honours or PhDs and stayed in the clinical program as sleep scientists,” says Professor Horne. “They may not want academic careers, but they’re passionate about sleep and contribute deeply to our research.”

This culture has shaped new leaders, including their newest consultant, Dr Lauren Nisbet, who completed a combined Bachelor of Medicine, Bachelor of Surgery/PhD under Horne and has now circled back as a clinician-scientist with a part-time research fellowship funded by Monash Partners and Equity Trustees.

“It’s come full circle,” says Associate Professor Davey. “We’re training a new kind of professional – people who value sleep science and clinical care equally.”

Where to next?

With new trials underway, a unique data resource and growing awareness of sleep as a critical health pillar, the future of paediatric sleep medicine at Monash is bright.

“It’s no longer a fringe field,” says Associate Professor Davey. “The American Heart Association has named sleep as a new cardiovascular health metric. We’ve come a long way from being ‘the crying baby department’.”

Their next questions focus on identifying critical windows for intervention, expanding access through home testing, and better understanding the role of sleep in mental health.

“Sleep is not a luxury,” says Professor Horne. “It’s essential. And we want every child to get the best chance at healthy development, starting with a good night’s rest.”

This article is part of the “60 Years of Impact” series celebrating the Department of Paediatrics at Monash University.