To assess the effectiveness of a simple, 5-item pediatric sleep screening instrument, the BEARS (B=Bedtime Issues, E=Excessive Daytime Sleepiness, A=Night Awakenings, R=Regularity and Duration of Sleep, S=Snoring) in obtaining sleep-related information and identifying sleep problems in the primary care setting.
Pediatric residents' continuity clinic in a tertiary care children's hospital. Methods: BEARS forms were placed in the medical records of a convenience sample of 2 to 12 year old children presenting for well child visits over the 5 month study period. Sleep-related information recorded in the BEARS visit and in the pre-BEARS visit, which was the subject's most recent previous well child check (WCC), was coded with respect to whether or not a sleep problem was indicated, and whether sleep issues were addressed.
A total of 195 children had both a documented pre-BEARS and BEARS WCC visit. BEARS visits were significantly more likely than the pre-BEARS visits to have any sleep information recorded (98.5% vs. 87.7%, p<0.001), and to have information recorded about bedtime issues (93.3% vs. 7.7%, p<0.001), excessive daytime sleepiness (93.9% vs. 5.6%, p<0.001), snoring (92.8% vs. 7.2%, p<0.001), nighttime awakenings (91.3% vs. 29.2%, p<0.001), and regularity and duration of sleep (65.3% vs. 31.5%, p<0.001). Significantly more sleep problems were identified during the BEARS visits in the domains of bedtime issues (16.3% vs. 4.1%, p<0.001), nighttime awakenings (18.4% vs. 6.8%, p<0.001) and snoring (10.7% vs. 4.6%, p=0.012). Finally, almost twice as many BEARS charts had sleep mentioned in the Impression and Plan (13.1% vs. 7.3%), which approached significance (p=0.07).
The BEARS appears to be a user-friendly pediatric sleep screening tool which significantly increases the amount of sleep information recorded as well as the likelihood of identifying sleep problems in the primary care setting.
"Screening (PCP report) PCPs reported asking several sleep screening questions >75% of visits. 15e30% did not regularly screen for sleep concerns 25e45% used a single question to screen for sleep concerns Fewer than half of PCPs ask youth directly about sleep Minority of PCPs reported screened for snoring (ranging 7.6% for infants to 24% for toddlers) Owens & Dalzell 2005  Screening intervention Included screening tool in medical charts Notable increases in PCP sleep screening practices Abbreviations: PCP ¼ primary care provider. Table 2 Studies examining relevance, prevalence, and rates of encounter of sleep issues in pediatric primary care. "
[Show abstract][Hide abstract] ABSTRACT: Night wakings and bedtime problems in infants and young children are prevalent, persistent, and associated with a variety of impairments in youth and their families. Assessment strategies include clinical interview, sleep diaries, actigraphy, and subjective measures. A number of treatment approaches with varying degrees of empirical support are available, and several novel strategies have been evaluated in recent years. Appropriate sleep scheduling and a bedtime routine are important components of any treatment program.
"and inattention), screening for such conditions is an essential component in the assessment of children with symptoms of inattention or hyperactivity.50 Sleep assessments during the ADHD diagnostic process are feasible in primary care settings through brief screening tools (eg, BEARS51 [B = bedtime issues, E = excessive daytime sleepiness, A = night awakenings, R = regularity and duration of sleep, S = snoring]) and parent report surveys (eg, Pediatric Sleep Questionnaire,52 Child Sleep Habit Questionnaire53). A review of sleep problems should occur during the baseline assessment (ie, when diagnosing ADHD), as well as on an ongoing basis during the management of the disorder.51 "
[Show abstract][Hide abstract] ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is often associated with comorbid sleep disturbances. Sleep disturbances may be a risk factor for development of the disorder, a symptom of the disorder, or a comorbid condition affected by a similar psychopathology. Various studies have examined the impact of sleep deprivation on the presence/exacerbation of ADHD symptomology, as well as longitudinal and concurrent associations between different sleep disturbances and ADHD, yet the notion of sleep disturbances as a predecessor to ADHD remains unclear. As such, this review examines the evidence for sleep disturbances as a risk factor for the development of ADHD, as well as the mechanisms underlying the association between sleep patterns and ADHD. Additionally, clinical implications regarding the comorbid nature of sleep disturbances and ADHD will be considered.
Nature and Science of Sleep 05/2012; 4:73-80. DOI:10.2147/NSS.S31269
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