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Preliminary analysis of the concurrent validity of the Spanish translation of the BEARS sleep screening tool for children
Abstract
Accessible summary
What is known on the subject?
• Paediatric sleep problems are clinical conditions that often coexist with other mental health problems and meet criteria that warrant the implementation of screening procedures, including high prevalence, and significant clinical impact.
• Researchers have designed the BEARS, a user‐friendly paediatric sleep screening tool that seems to increase the amount of sleep information recorded, as well as the likelihood of identifying sleep problems during routine health encounters. Nonetheless, there are no studies using the BEARS in Spanish‐speaking samples.
What this paper adds to existing knowledge?
• Using a sample of children with mental health problems, this study provides support for the use of the Spanish version of the BEARS to identify the most common sleep problems seen in paediatric populations.
What are the implications for practice?
• Considering how frequent sleep problems are, it is especially important for health professionals working with children in general, and with children with mental health problems in particular, to be aware of and be encouraged to use simple brief screening tools for paediatric sleep problems.
Abstract
Objective
Research studies describe a high prevalence of sleep problems in children with mental health problems, up to 50%, and its role as a risk factor in the development of psychopathology. These often go unnoticed and are not evaluated in the clinical field. Our objective was to assess the concurrent validity of the BEARS, a brief paediatric sleep screening instrument, using the Children Sleep Habits Questionnaire (CSHQ) as the comparison instrument.
Methods
In this cross‐sectional descriptive study, the BEARS was applied by a registered nurse to a sample of parents of children aged 2–16 years (n = 60, 71.7% male) who attended a mental healthcare facility (located in Murcia, Spain) for the first time to receive a group psychoeducational intervention. The association between the information collected with the BEARS and scores on the related subscales of the CSHQ was assessed by Mann–Whitney U tests.
Results
Children who, according to the BEARS, had a sleep problem obtained scores on the CSHQ‐related subscales significantly higher than children who did not have a sleep problem (all Ps < 0.05).
Conclusion
Our results support the concurrent validity of the Spanish translation of the BEARS to detect sleep problems in paediatric nursing assessments. Further studies, with bigger and more heterogeneous samples, are warranted.
... The Children's sleep habit questionnaire (CSHQ) is a 33-item parent-report developed for children aged 4-10 [34], and has been used in youth ranging from 2-16 years old [35,36]. Parents are asked to recall sleep behaviors occurring over a "typical" recent week [34][35][36]. ...
... The Children's sleep habit questionnaire (CSHQ) is a 33-item parent-report developed for children aged 4-10 [34], and has been used in youth ranging from 2-16 years old [35,36]. Parents are asked to recall sleep behaviors occurring over a "typical" recent week [34][35][36]. Items are rated on a three-point scale: "usually" if the sleep behavior occurred five or more times/week; "sometimes" for two to four times/ week; and "rarely" for zero to one [34][35][36]. ...
... Parents are asked to recall sleep behaviors occurring over a "typical" recent week [34][35][36]. Items are rated on a three-point scale: "usually" if the sleep behavior occurred five or more times/week; "sometimes" for two to four times/ week; and "rarely" for zero to one [34][35][36]. There are eight scales: Bedtime resistance, Sleep onset delay, Sleep duration, Sleep anxiety, Night wakings, Parasomnias, Sleep-disordered breathing, and Daytime sleepiness [34][35][36]. ...
Background
A lifestyle including poor diet, physical inactivity, excessive gaming and inadequate sleep hygiene is frequently seen among Dutch children. These lifestyle behaviors can cause long-term health problems later in life. Unhealthy lifestyle and poor physical health are even more prevalent among children with mental illness (MI) such as autism, attention-deficit/hyperactivity disorder, depression, and anxiety. However, research on lifestyle interventions among children with MI is lacking. As a result, there are currently no guidelines, or treatment programs where children with MI and poor lifestyle can receive effective support. To address these issues and to provide insight into the effectiveness of lifestyle interventions in children with MI and their families, the Movementss study was designed. This paper describes the rationale, study design, and methods of an ongoing randomized controlled trial (RCT) comparing the short-term (12 weeks) and long-term (1 year) effects of a lifestyle intervention with care as usual (CAU) in children with MI and an unhealthy lifestyle.
Methods
A total of 80 children (6–12 years) with MI according to DSM-V and an unhealthy lifestyle are randomized to the lifestyle intervention group or CAU at a specialized child and adolescent mental hospital. The primary outcome measure is quality of life measured with the KIDSCREEN. Secondary outcomes include emotional and behavior symptoms, lifestyle parameters regarding diet, physical activity, sleep, and screen time, cognitive assessment (intelligence and executive functions), physical measurements (e.g., BMI), parenting styles, and family functioning, prior beliefs, adherence, satisfaction, and cost-effectiveness. Assessments will take place at the start of the study (T0), after 12 weeks (T1), six months (T2), and 12 months of baseline (T3) to measure long-term effects.
Discussion
This RCT will likely contribute to the currently lacking knowledge on lifestyle interventions in children with MI.
Trial registration
trialsearch.who.int/ NL9822. Registered at November 2nd, 2021.
... The responses were restricted to the last 7 days, and the frequency option was categorized as 'yes' or 'no'. This questionnaire has shown adequate validity and reliability in young populations [27,28]. On the website of the Spanish Association of Primary Care Pediatrics, it is provided the Spanish translation of BEARS that was used in this study (http://www.aepap.org/gtsiaepap/). ...
... On the website of the Spanish Association of Primary Care Pediatrics, it is provided the Spanish translation of BEARS that was used in this study (http://www.aepap.org/gtsiaepap/). Recently, Bastida-Pozuelo et al. [28] analysed the validity of the BEARS questionnaire evaluating how well it performs to distinguish young populations with specific sleep problems using the Children Sleep Habits Questionnaire scores as the gold standard. These authors shown the participants aged 2-16 years who, according to the BEARS, had a sleep problem obtained scores on the Sleep Habits Questionnaire scores-related subscales significantly higher than children and adolescents who did not have a sleep problem (all Ps < 0.05). ...
... However, the extent to which each of metabolic abnormalities factors interact with snoring and contributes to the development of metabolic consequences in snoring youth population has yet to be delineated [40]. Finally, it is important to highlight that the BEARS questionnaire has been postulated as a useful pediatric sleep screening tool for identifying sleep problems [27] and recently a previous article supports the concurrent and reliability validity of the Spanish translation of the BEARS to detect sleep problems in pediatric nursing assessments [28,41]. ...
Background: There is increasing recognition that sleep is a risk factor for metabolic syndrome (MetS). The aim of the present study was to analyze the relationship between self-reported sleep duration, sleep-related problems and the presence of MetS in children and adolescents from Bogotá, D.C., Colombia.
Methods: This is a cross-sectional analysis from the FUPRECOL study (2014-15). Participants included 2,789 (54.2% girls) youth from Bogota (Colombia). MetS was defined as the presence of ≥3 of the metabolic abnormalities (hyperglycemia, hypertriglyceridemia, low high-density lipoprotein cholesterol [HDL-c], hypertension, and increased waist circumference) according to the criteria of de Ferranti/Magge and colleges. Self-reported sleep duration and sleep-related problems were assessed with the BEARS questionnaire.
Results: Logistic regression analysis showed that boys who meet recommended duration of sleep had a decreased risk of elevated blood glucose levels (Odds Ratio [OR]=0.71, 95%CI [0.40–0.94]; p=0.031) compared to boys who have short-long sleep duration. Also, compared to young without sleep problems, excessive sleepiness during the day was related to low HDL-c levels in boys (OR=1.36, 95%CI [1.02–1.83]; p=0.036) and high triglyceride levels in girls (OR=1.28, 95%CI [1.01–1.63]; p=0.045). Girls with irregular sleep patterns had decreased HDL-c levels (OR=0.71, 95%CI [0.55–0.91]; p=0.009).
Conclusions: Recommended sleep duration was associated with a decreased risk of elevated fasting glucose levels in boys, and sleep problems was related to lower HDL-c in girls and higher triglyceride levels in boys. These findings suggested the clinical importance of improving sleep hygiene to reduce metabolic risk factors in children and adolescents.
... The Sleep-Screening Tool for Sleep Disturbances in Childhood (BEARS;Owens and Dalzell, 2005;Ramírez- Vélez et al., 2018), the BEARS, is a 9-item test used to detect sleep disturbances in children and adolescents between 2 and 18 years of age. The BEARS is considered a reliable measure of sleep disturbances for children and adolescents(Owens and Dalzell, 2005;Bastida-Pozuelo & Sanchez-Ortuno, 2016;Ramírez-Vélez et al., 2018). The BEARS has 5 subscales, and all of them were used for analyses in this study: bed-time problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep and snoring. ...
... Although the original version used a dichotomous response, in the current study, items were scored on a 7-point Likert-type scale (1 = totally disagree and 7 = totally agree). The BEARS was also validated in the Spanish population(Bastida-Pozuelo & Sanchez-Ortuno, 2016). The scale demonstrated good reliability and internal consistency for this study, with a Cronbach's alpha of 0.732. ...
The present study therefore aims to examine trait and state anxiety, sleep habits and executive functioning during 1 year and a half of the COVID-19 pandemic in children and adolescents through the lens of parents. Assessments were conducted at three different times: April 2020 (T1), October 2020 (T2) and October 2021 (T3). The main sample included 953 children and adolescents aged 6 to 18 years, and scales were used to assess anxiety (STAIC), sleep habits (BEARS) and executive functioning (BRIEF-2). The results showed that 6 months after the outbreak of the pandemic, state and trait anxiety, sleep disturbances and executive dysfunctions increased significantly. One and a half year later, trait anxiety and sleep disturbances have been maintained, while state anxiety and executive dysfunction have decreased their scores obtaining scores similar to those of April 2020. In conclusion, there has been a further decrease in children and adolescents' mental health since the beginning of the pandemic, and it seems to remain at the present time, such as trait anxiety as a part of the personality.
... Children's Sleep Habits Questionnaire (CSHQ; The CSHQ is a 45-item parent report developed for children aged 4-10 , and has been used in youth ranging from 2-16 years old (Bastida-Pozuelo & Sánchez-Ortuño, 2016;Bonuck et al., 2017). Items are rated on a 3-point scale. ...
... Other, shorter versions have also been validated, including a 33-item version , a 23-item short form, which eliminates the parasomnia and sleep-disordered breathing items (Bonuck et al., 2017), and a 24-item version for children aged 2-5, which has four scales (Sleep initiation, Sleep distress, Sleep transition, Sleep duration; Sneddon et al., 2013), and a 19-item version (Okada et al., 2017). Versions of the CSHQ have been translated and evaluated in a number of different cultures (e.g., Bastida-Pozuelo & Sánchez-Ortuño, 2016;Fallahzadeh et al., 2015;Loureiro et al., SLEEP ASSESSMENT UPDATE 2014;Lucas-de la Cruz et al., 2016;Mavroudi et al., 2018;Okada et al., 2017;Schlarb et al., 2010;Tan et al., 2018;Tzchishinsky et al., 2008;Waumans et al., 2010). CSHQ scores tend to correlate only modestly with the companion youth self-report (Sleep Self Report; Owens, Maxim et al., 2000;Loureiro et al., 2014;Schwerdtle et al., 2016;van Litsenburg et al., 2010), and with other youth self-reports of sleep problems (Liu et al., 2018). ...
Background:
Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic.
Method:
We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018).
Results:
Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains.
Conclusion:
Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.
... Sleep disorders were evaluated using the BEARS sleep screening tool (B = Bedtime problems, E = Excessive daytime sleepiness, A = Awakenings during the night, R = Regularity and duration of sleep, S = Snoring) [25], a questionnaire validated in children and adolescents [26]. This tool was used during a clinical interview conducted to identify prevalent sleep problems in the participants. ...
Physical fitness, particularly cardiorespiratory fitness, has been shown to positively impact sleep quality. However, the relationship between overall physical fitness and sleep‐related problems in adolescents remains underexplored. Therefore, the aim of this study was to analyze the association between overall physical fitness and sleep‐related problems in adolescents. This cross‐sectional study included 812 adolescents (median age: 14 years [interquartile range = 12–17]; 54.9% girls) from the Eating Healthy and Daily Life Activities (EHDLA) data. Physical fitness was measured objectively using the Assessing the Levels of PHysical Activity and fitness (ALPHA‐Fit) battery for children and adolescents and a flexibility test, while sleep‐related problems were evaluated using the BEARS sleep screening tool (B = Bedtime problems, E = Excessive daytime sleepiness, A = Awakenings during the night, R = Regularity and duration of sleep, S = Snoring). Generalized linear models were used to examine the association of overall physical fitness with the different components of sleep‐related problems. The odds of experiencing sleep‐related problems decreased significantly with each kilogram increase in handgrip strength (odds ratio [OR] = 0.97, 95% confidence interval [CI] 0.94–0.99), and with each standard deviation increase in overall physical fitness (OR = 0.76, 95% CI 0.59–0.99). In contrast, despite not statistically significant, an increase in long jump appeared to reduce the sleep‐related problems (OR = 0.91; 95% CI 0.82–1.02), while a longer time in the 4×10‐m shuttle run test might increase sleep problems (OR = 1.12; 95% CI 0.98–1.28). In conclusion, greater levels of physical fitness, particularly muscular strength, may be key for reducing sleep‐related problems, emphasizing the importance of personalized training programs.
... The scale consists of a series of items covering different sleep-related issues: difficulties at bedtime (e.g., trouble lying down or falling asleep), excessive daytime sleepiness (e.g., behaviors indicating sleepiness during the day), night awakenings, sleep regularity and duration, and snoring. A previous study demonstrated the concurrent validity of the Spanish translation of the BEARS scale for detecting sleep problems in children and adolescents aged 2-16 years (Bastida-Pozuelo and Sánchez-Ortuño, 2016). The responses are scored on a scale from 0 to 1, where 0 indicates the absence of the problem. ...
Objective
The current study aims to provide a comprehensive analysis of the relationships between social network (SN) use, messaging apps use, and addictive behaviors related to SNs, and sleep-related problems in a sample of Spanish adolescents.
Methods
This was a cross-sectional study using data from the Eating Healthy and Daily Life Activities (EHDLA) project, which involved adolescents aged 12–17 years from three secondary schools in Valle de Ricote (Region of Murcia, Spain). A sample of 632 adolescents was studied. The use of SN (i.e., Facebook, Twitter, Instagram, Snapchat or TikTok) or messaging applications (i.e., WhatsApp) was assessed via a scale including one item for each SN, in which adolescents were asked what type of SN they used and the usage profile of each SN. The Short Social Networks Addiction Scale-6 Symptoms (SNAddS-6S) was used to determine SN addictive behaviors. Generalized linear regression analyses with a negative binomial distribution were performed to determine the associations of SN use or SN addictive behaviors with sleep-related problems. These analyses were adjusted for age, sex, body mass index, socioeconomic level, physical activity, sedentary behavior, and adherence to the Mediterranean diet.
Results
Higher SN use was related to greater presence of sleep-related problems [prevalence ratio (PR) = 1.04; 95% confidence interval (CI) 1.01–1.07; p = 0.015]. Additionally, the higher the score on the addictive behaviors toward SN use scale was, the more sleep-related problems were identified (PR = 1.15; 95% Cl 1.09 to 1.21; p < 0.001). Specifically, only the use of Twitter was significantly associated with sleep-related problems (PR = 1.10; 95% Cl 1.01 to 1.21; p = 0.035). In terms of addictive behaviors related to SN use, mood modification, relapse, withdrawal, and conflict were significantly associated with sleep-related problems (mood modification: PR = 1.58; 95% CI 1.36 to 1.84; p < 0.001; relapse: PR = 1.24; 95% CI 1.07 to 1.43; p = 0.004; withdrawal: PR = 1.28; 95% CI 1.08 to 1.51; p = 0.004; conflict: PR = 1.19; 95% CI 1.01 to 1.39; p = 0.037).
Conclusion
Our results suggest a relationship between SN use, SN addictive behaviors, and sleep-related problems in adolescents. These cross-sectional results should be confirmed in longitudinal and intervention studies.
... BEARS sleep screening tool is used to determine sleep problems in preschool children (2-5 years), school children (6-12 years) and adolescents (13-18 years) [32,33]. The tool assesses the following parameters: Bedtime problems (B), Excessive daytime sleepiness (E), Awakening during night (A), Regularity and duration of sleep (R), and Snoring (S). ...
Background
Literature indicates that L-carnosine may be deficient in autism spectrum disorder (ASD) children. The aim of the present study was to estimate the level of L-carnosine in plasma and correlate it with the Autism Treatment Evaluation Checklist (ATEC) and Childhood Autism Rating Scale 2nd Edition, Standard Version (CARS2-ST) scores. To measure L-carnosine level, a bio-analytical method was developed using reverse phase high- liquid chromatography and validated as per International Conference on Harmonization guidelines.
Method
Children were supplemented with L-carnosine (10–15 mg/kg) along with standard care therapies for 2 months. Before and after supplementation, scores on the ATEC, CARS2-ST, BEARS sleep screening tool, 6-item Gastrointestinal Severity Index, and Parental Stress Scale were evaluated, and L-carnosine was measured at the end of the trial.
Results
The calibration curve was linear in the range of 100–600 ng/mL (R² = 0.998). The level of L-carnosine quantified was 33.7 ± 0.2 ng/mL. There was no significant difference found in any of the outcome measures (p > 0.05).
Conclusions
Despite the fact that L-carnosine is detectable in the blood, it was found to be ineffective in the management of ASD in children.
Clinical Trial Registration
The study was registered in the Clinical Trial Registry-India, registration number: CTRI/2019/07/020102.
... In previous studies that employed the BEARS questionnaire to identify obstructive sleep apnea (OSA) in children, however, it was observed that while the BEARS questionnaire was effective in detecting sleep disturbances, it did not provide any information about other clinical factors that are associated with OSA [21][22][23]. On the other hand, in studies that utilized the FAIRST questionnaire to diagnose OSA in children, the authors reached the conclusion that it is a concise, validated tool that solely relies on clinical evaluation [11,24]. ...
Background and Objective The prevalence of sleep-disordered breathing is extremely high, yet it is largely ignored. Significant adverse medical and psychological outcomes are associated with sleep-related respiratory disorders, including obstructive sleep apnea (OSA). Treatment and an early diagnosis will aid in averting additional severe consequences. Our study aimed to assess prevalence of OSA among 6–9-year-old children in Visnagar.Methods The approval of the school authorities and ethics committee was received. A sample size of 455 was determined. Clinical inspection was used to determine the prevalence of OSA in children aged 6 to 9 years using the “FAIREST-6” and BEARS criteria. The cases were classified as mild, moderate, or severe. By employing the chi-square test and Fisher’s exact test, inferential statistics were calculated.Results Prevalence of 8.13% (n = 37) among sample of 453 participants was observed. Gender predilection was found to be in 43.2% (n = 16) among females and 56.8% (n = 21) among males. Those diagnosed with OSA were categorized as mild 17 (45.94%), moderate 12 (32.43%), and severe 8 (21.62%).Conclusions OSA prevalence was determined 8.13% in the Visnagar population of children and adolescents aged 6 to 9 years using the FAIREST and BEARS questionnaire.
... To assess the sleep pattern at home (prior to hospitalization), the Spanish version of the BEARS Questionnaire was used [26]. This questionnaire assesses five main aspects of sleep: bedtime problems, excessive daytime sleepiness, nighttime awakenings, regularity and duration of sleep, and snoring. ...
Background: Hospitalized children need adequate sleep to favor early recovery. Methods: To study the sleep pattern of children admitted to a pediatric inpatient unit, a cross-sectional study was carried out at a reference hospital in northern Spain. The main study variables were medical specialty of admission, sleep-inducing treatment, hours of sleep at home and during admission, number of nocturnal awakenings, and reasons for awakening. Differences in the hours of sleep and nighttime awakenings between the initial period and at six months were calculated using the Student’s t-test. Results: We included 100 baseline patients and 100 post-intervention patients. Up to 4% of the baseline sample and 3% of the six-month sample had been prescribed a sleep-promoting drug. Regarding awakenings, 79% of the children in the baseline sample suffered awakenings, with a mean of 1.98 awakenings (range 1–13). At six months, the percentage of children who experienced awakenings decreased by 17%, with a mean of 1.34 (range 1–5). In the baseline sample, 48% were caused by nursing care, decreasing to 34% after the intervention. Conclusions: An educational intervention with the implementation of targeted evidence-based practices is a useful measure for improving the sleep pattern by decreasing the number of awakenings.
... Parents or legal guardians reported participants' sleep-related problems. This screening tool aids in the early detection of sleep-related issues due to its ease of application and demonstrated adequate performance [22]. ...
Purpose: The current research aimed to investigate the connection between food insecurity and sleep issues among Spanish adolescents aged from 12 to 17 years from the Valle de Ricote (Region of Murcia, Spain). Methods: Data from the Eating Healthy and Daily Life Activities Study, which included a sample of 836 adolescents (55.3% girls), were analyzed. Food insecurity was evaluated using the Child Food Security Survey Module in Spanish (CFSSM-S), while sleep-related problems were evaluated using the Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing (BEARS) sleep screening tool. Generalized linear models were employed to explore the association between food insecurity and sleep-related issues. Results: Compared with their counterparts with food security, adolescents with food insecurity had greater probabilities of bedtime problems (24.1%, 95% confidence interval (CI) 16.9% to 33.0%, p = 0.003), excessive daytime sleepiness (36.4%, 95% CI 27.5% to 46.3%, p < 0.001), awakenings during the night (16.7%, 95% CI 10.8% to 25.1%, p = 0.004), and any sleep-related problems (68.1%, 95% CI 57.5% to 77.1%, p < 0.001). Conclusions: This study suggests that food insecurity is related to greater sleep-related problems among adolescents. Implementing strategies to mitigate food insecurity may contribute to improved sleep health among adolescents, highlighting the importance of integrated public health interventions.
... Sleep habits were assessed with the BEAR questionnaire. The BEAR questionnaire is one of the most commonly used tools to identify sleep problems in children and has already been validated in Spain [16][17][18][19]. BEAR is the acronym for B-bedtime, E-excessive daytime sleepiness, A-awakening during the night, and R-regularity and duration of sleep. ...
Introduction: The COVID-19 lockdown has caused important changes in children’s routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that the COVID-19 lockdown is associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during the lockdown decreed by the Spanish government between March and June 2020. Methodology: We compared the BEAR (bedtime, excessive daytime sleepiness, awakening during the night, and regularity and duration of sleep) scores of 478 participants (median age = 7.5 years; 48% girls) in the SENDO project during the periods before, during, and after lockdown. The questionnaires were filled out by one of the parents. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. The interaction of time with a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test. Results: The mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99), and 1.07 (sd 1.55), respectively. These findings indicate a deterioration in sleep quality during the period of confinement. Parental level of education was found to be an effect modifier (p for interaction = 0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without. Conclusion: Our study shows that the COVID-19 lockdown was associated with a significant worsening of sleep quality. Moreover, although the end of the lockdown brought about a slight improvement, mean scores on the BEAR scale remained significantly higher than before the lockdown, suggesting that the consequences for sleep quality could persist over time. This worsening was higher in children whose parents had lower educational degrees. Helping children maintain healthy sleeping habits despite the circumstances and providing early psychological support when needed is important to prevent negative psycho-physical symptoms due to lockdown that could persist over the years.
... Questions related to sleep, such as problems at bedtime, excessive daytime sleepiness, waking during the night, regularity and duration of sleep, and snoring, were evaluated. This instrument was validated in a Spanish version to screen for sleep-related problems in the pediatric population [21]. Adolescents were categorized as "at least one sleep-related problem" and "no sleep-related problems". ...
Background:
Considering the evident risk in the literature between the use of screen devices and sleep, there are still few studies on the relationship between each electronic screen device, media programs and sleep duration and sleep-related problems among adolescents and which variables interfere in these relationships. Therefore, this study has the following objectives: (1) to determine which are the most common electronic display devices related to sleep time and outcomes and (2) to determine which are the most common social network applications, such as Instagram and WhatsApp, associated with sleep outcomes.
Methods:
This was a cross-sectional study with 1101 Spanish adolescents between 12 and 17 years old. Age, sex, sleep, psychosocial health, adherence to the Mediterranean diet (MD), sport practice, and time spent on screen devices were assessed by an ad hoc questionnaire. Linear regression analyses were applied, adjusting for several covariables. Poisson regression was applied between the sexes. A p value < 0.05 was considered statistically significant.
Results:
Cell phone use was more associated with sleep time (13%). In boys, time spent on cell phones (prevalence ratio [PR] = 1.09; p < 0.001) and videogames (PR = 1.08; p = 0.005) had a higher prevalence ratio. When psychosocial health was included in the models, we found the greatest association (Model 2: PR = 1.15; p = 0.007). For girls, time spent on the cell phone was significantly associated with sleep-related problems (PR = 1.12; p < 0.001), and adherence to the MD became the second most important in the model (PR = 1.35; p < 0.001), followed by psychosocial health and cell phone use (PR = 1.24; p = 0.007). Time spent on WhatsApp was associated with sleep-related problems only among girls (PR = 1.31; p = 0.001) and was the most important variable in the model along with MD (PR = 1.26; p = 0.005) and psychosocial health (PR = 1.41; p < 0.001).
Conclusions:
Our results suggest a relationship between cell phones, video games, and social networks with sleep-related problems and time.
... The parents/guardians will report the results of the BEARS scale. The Spanish version of the BEARS scale has been found to be valid for screening sleep-related problems in pediatric evaluations [53]. ...
Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention’s “halo” effect on parents’/guardians’ 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6–13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.
... Sleep habits were assessed with the BEAR questionnaire, one of the most used tools to identify sleep problems in children, that has already been validated in Spain (12,13,14,15). It is a user-friendly screening tool that helps identify sleeping problems in children and includes the questions: 1) Are you reluctant to go to bed?, 2) Do you have any difficulty falling asleep?, 3) Do you usually wake up more than two times per night?, 4) If you wake up at night, do you have any difficulty falling back asleep? ...
Introduction: Covid-19 lockdown has caused important changes in children's routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that Covid-19 lockdown was associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during lockdown decreed by the Spanish government between March and June 2020. Methodology: We compared the BEAR score of 478 participants in the SENDO project at the periods before, during and after lockdown. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. Interaction of time with and a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test. Results: Mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99) and 1.07 (sd 1.55), respectively, showing a worsening of sleep quality as a result of confinement. Parental level of education was found to be an effect modifier (p for interaction=0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without. Conclusion: We found that the mean score in the BEAR questionnaire significantly worsened during lockdown and significantly improved after it. However, it did not reach the initial level. The mean score in the BEAR questionnaire referred to the period after lockdown was significantly higher than before.
... Sleep was assessed with the BEARS sleep screening tool [36,37]. BEARS includes five questions on sleep problems: excessive daytime sleepiness, awakenings during the night and problems returning to sleep, insufficient regularity and duration of sleep, and snoring with a positive or negative response. ...
The COVID-19 pandemic is having negative consequences not only for people’s general health but also for the masticatory system. This article aimed to assess confinement and its new normal impact on well-being, sleep, headaches, and temporomandibular disorders (TMD). An anonymous survey was distributed to a Spanish university community. Participants completed a well-being index (WHO-5), a questionnaire related to sleep quality (the BEARS test), a headache diagnostic test (the tension type headache (TTH) and migraine diagnosis test), and the DC-TMD questionnaire. Questions were addressed in three scenarios: before confinement, during confinement, and the new normal. A total of 436 responses were collected (70% women, 30% men). A reduction in well-being and sleep quality was recorded. Respondents reported more TTH and migraines during and after confinement. Overall, confinement and return to normal did not increase TMD symptoms, and only minor effects were observed, such as more intense joint pain and a higher incidence of muscle pain in women during confinement. Reduced well-being is correlated with sleep quality loss, headaches, and TMD symptoms. This study provides evidence that pandemics and confinement might have had a negative impact on population health. Well-being was strongly affected, as were sleep quality, depression risk, TTH, and migraine frequency. In contrast, the temporomandibular joint and muscles showed more resilience and were only slightly affected.
... Questions related to sleep, such as problems at bedtime, excessive daytime sleepiness, waking during the night, regularity and duration of sleep, and snoring were evaluated. This instrument was validated in a Spanish version to screen for sleep disorders in the pediatric population (21). Children who reported at least one sleep-related problem were categorized as having a "problem" and those who did not report as "no problem". ...
Background: It is expected that children involved in daily physical activities and/or sports should be protected from the risk associated with the sedentary profile in sleep conditions. This is because physical activity is a protective behavior and is inversely associated with the early development of risk factors in the young population. Although there are many studies including sleep conditions and physical activity, we still do not know whether regular sports practice could be associated with better sleep conditions. Therefore, this study has the following objectives, (1): to determine which are the most common electronic display devices related to sleep time and conditions; (2) determine which is the most common social network application such as Facebook, Tik-Tok, Instagram, Twitter and WhatsApp associated with sleep time and conditions and (3) verify the role of sports engagement as protective behavior in these relationships.
Methods: Cross-sectional study, with 1101 Spanish adolescents, between 12 and 17 years old. Age, sex, sleep, psychosocial health, adherence to the Mediterranean diet, adherence to sport, and time spent on screen devices were assessed by questionnaire. Linear regression was applied, adjusting the associated variables. Poisson regression was applied between the sexes. Values of p<0.05 were considered significant. The analyzes were performed using the Statistical Package for the Social Sciences 27.0.
Results: the cell phone was more associated with sleep time. In boys, time spent on cell phones and video games had a higher prevalence ratio. When psychosocial health was included in the models, we found the greatest association. For girls, time spent on the cell phone was significantly associated with sleep quality, and adherence to the Mediterranean diet became the second most important in the model, followed by psychosocial health and cell phone use. Time spent on WhatsApp was associated with sleep quality only among girls and was the most important variable in the model along with diet and psychosocial health.
Conclusions: Our results suggest a strong relationship between cell phones, video games and social networks with sleep quality and time.
... This instrument contains questions that evaluate sleep-related areas such as bedtime problems (e.g., difficulties for going to bed and falling asleep), excessive daytime sleepiness (e.g., behaviors usually related to somnolence during the day), awakening during the night, regularity and duration of sleep, and snoring. A previous study showed the concurrent validity of the Spanish translation of the BEARS to screen sleep disorders in pediatric evaluations [85]. ...
Background: Childhood obesity is one of the greatest public health concerns facing advanced societies, Spain being one of the countries with the highest incidence. In this sense, the Region of Murcia has been pointed out as the Spanish autonomous community with the highest prevalence of excess weight among young people. More specifically, the Valle de Ricote has shown an even greater proportion of excess weight among young people. Several sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors are related to excess weight. Based on the lack of information, this research project will try to provide relevant information to design intervention programs, as well as to implement effective public policies to try and reverse this alarming situation. Therefore, this research project aims (1) to obtain cross-sectional and longitudinal data on the excess weight and their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated among adolescents from the Valle de Ricote (Region of Murcia, Spain) (aged 12–17 years), and (2) to examine the association between excess weight and their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated among this population. Methods: A cross-sectional study and follow-up study will be performed. This research project will involve adolescents using a simple random sampling technique. A total of three secondary schools from the Valle de Ricote (Region of Murcia, Spain) will be included in this project. The minimum sample size will be 1138, establishing a 95% confidence interval, a 40% prevalence of excess weight, a 3% margin of error, and a non-response rate of 10%. Primary outcome measures will be: (1) anthropometric measurements, (2) sociodemographic factors, (3) environmental factors, (4) lifestyle factors, (5) health-related factors, (6) cognitive factors, and (7) psychological factors. Conclusion: This research project will aim to determine the prevalence of excess weight and interrelate their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated. The obtained results will help to manage and propose possible multidisciplinary interventions and strategies in order to prevent and reduce the excess weight in adolescents from the Valle de Ricote. Furthermore, orientations will be given to transfer the obtained results to the public sector to evaluate or change the adopted policies.
... In addition, a study conducted to confirm the validity of the Spanish version of BEARS using CSHQ as a comparison instrument revealed that children with sleep problems obtained scores that are significantly higher than children who did not have a sleep problem on the CSHQ-related subscales. 24 Moreover, several studies that used BEARS revealed its effectiveness in detecting sleep problems among children. 17,18 In our study, more than one-third of the children did not have regular bedtime or wake time, and bedtime was at about 10:00 PM. ...
Objective: Sleep problems are common among preschoolers. We conducted this study to investigate sleep problems in a sample of Egyptian preschoolers attending pediatric outpatient clinics and examine the relationship between their sleep problems, patterns, and hygiene.
Methods: The parents of 319 preschoolers, aged 2-5 years, completed the BEARS(which represent the fve major sleep domains, i.e., bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, and snoring) questionnaire in Arabic and a short survey on their educational status, significant medical problems and/or their child’s medications , and sleeping habits.
Results: The frequency of bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity of sleep, and snoring were 58.9%, 17.9%, 31%, 60.5%, and 20.4%, respectively. More than a third of the samples had poor sleep hygiene practices, ranging from 41.7% to 70.5%. Multivariate analyses revealed that age and body mass index (BMI) are predictors of bedtime problems.
Conclusions: Our fndings indicate that sleep problems and poor sleep hygiene are common among this sample of preschoolers. This study also suggests an association between age and BMI and sleep disturbances.
... Finalmente, la versión China (Li et al., 2007), aplicada en 20.457 infantes, mostró un alfa de Cronbach de 0,73 (rango entre 0,42-0,89). Otro trabajo español, realizado por Bastida-Pozuelo et al. (2016), se encontró un coeficiente alfa de 0,73. ...
El sueño juega un papel fundamental en muchas esferas del desarrollo de los infantes en etapa escolar. El objetivo de este estudio fue determinar la confiabilidad y validez de contenido del cuestionario BEARS en niños y adolescentes de 9 a 17 años. La muestra estuvo compuesta por 8.862 niños y adolescentes pertenecientes a 24 instituciones educativas oficiales de Bogotá, Colombia. Se aplicó el cuestionario BEARS, de manera auto-diligenciada por formulario estructurado. Una sub-muestra de 246 participantes se utilizó para los análisis de fiabilidad. La consistencia del instrumento se analizó mediante el coeficiente alfa de Cronbach, la validez de constructo a través del análisis factorial exploratorio (AFE), y la fiabilidad mediante el coeficiente Kappa ponderado. Los resultados mostraron adecuada consistencia (Cronbach global de 0,732; rango 0,706 a 0,769) y moderada fiabilidad (kappa de 0,665; rango 0,378 a 0,629). El AFE determinó un solo factor (ítem 1: problemas a la hora de dormir), explicaba el 61,4% de la varianza, agrupando dos interacciones χ2/gl=2690,817; p=0,001. El cuestionario BEARS mostró una adecuada consistencia interna, fiabilidad y validez. A partir de estos resultados, se recomienda este instrumento principalmente en el contexto de atención primaria, para el estudio y cribado de las alteraciones del sueño en población escolarizada de Bogotá, Colombia.Abstract. Sleep plays a vital role in good health and well-being in school-age children. The aim of this study was to determine the reliability and content validity of the BEARS questionnaire in children and adolescents from 9 to 17 years of age. The sample comprised 8,862 children and adolescents belonging to 24 official education institutions from Bogotá, Colombia. The BEARS questionnaire was applied through self-completion manner, with a structured form. A sub-sample of 246 participants was used for reliability analyses. Consistency of the instrument was analyzed through Cronbach’s alpha coefficient, construct validity through exploratory factor analysis (EFA), and reliability through the weighted Kappa coefficient. Results showed adequate consistency (global Cronbach of 0.732; range 0.706 to 0.769) and moderate reliability (Kappa of 0.665; range 0.706 to 0.769). The EFA determined a single factor (item 1: problems when going to sleep), which explained 61.4% of the variance, grouping two interactions χ2/gl = 2690.817; p = 0.001. The BEARS questionnaire showed adequate internal consistency, reliability, and validity. From these results, this instrument is recommended principally within the context of primary care for the study and screening of sleep alterations in school-aged populations from Bogotá, Colombia.
... We searched for questionnaires that could be used for children with CP across all ability levels. The following questionnaires were identified: the BEARS sleep screening tool, 18,19 the Sleep Disturbance Scale for Children, 20 the Paediatric Sleep Questionnaire, 21 and the Children's Sleep Habits Questionnaire. 22 These questionnaires have all been previously used in a variety of children with CP, and some have been validated in typically developing paediatric populations against objective measures, such as polysomnography. ...
The association between physical activity and health has been clearly established, and the promotion of physical activity should be viewed as a cost‐effective approach that is universally prescribed as a first‐line treatment for nearly every chronic disease. Health care providers involved in the care for individuals with cerebral palsy (CP) are encouraged to take an active role in promoting their health and well‐being. Balancing activity behaviours across the whole day, with improved physical activity, reduced sedentary time, and healthy sleep behaviours, can set up infants, preschool‐, and school‐aged children with CP for a healthy trajectory across their lifetime. However, most clinicians do not apply a systematic surveillance, assessment, and management approach to detect problems with physical activity or sleep in children with CP. Consequently, many children with CP miss out on an important first line of treatment. This article presents an evidence‐informed clinical practice guide with practical pointers to help practitioners in detecting 24‐hour activity problems as a critical step towards adoption of healthy lifestyle behaviours for children with CP that provide long‐term health benefits.
... The lesser frequent combinations of age ranges for which tools were assessed in these studies, ranged from 0.7-7.6% per combination. As for the sample size, this ranged between 20 and 11,626 children inclusive of adult (6)(7)(8)(9)(10)(11)(12)(13) participants across all publications, where 15.6% of all studies used a sample size >1,000 participants large ( Table 2). Of these study samples, approximately 46.5% of respondents were parents, 41% were self-report, and 11.1% either a combination of experts, children, mothers, and parents. ...
Since a thorough review in 2011 by Spruyt, into the integral pitfalls of pediatric questionnaires in sleep, sleep researchers worldwide have further evaluated many existing tools. This systematic review aims to comprehensively evaluate and summarize the tools currently in circulation and provide recommendations for potential evolving avenues of pediatric sleep interest. 144 “tool”-studies (70 tools) have been published aiming at investigating sleep in primarily 6–18 years old per parental report. Although 27 new tools were discovered, most of the studies translated or evaluated the psychometric properties of existing tools. Some form of normative values has been established in 18 studies. More than half of the tools queried general sleep problems. Extra efforts in tool development are still needed for tools that assess children outside the 6-to-12-year-old age range, as well as for tools examining sleep-related aspects beyond sleep problems/disorders. Especially assessing the validity of tools has been pursued vis-à-vis fulfillment of psychometric criteria. While the Spruyt et al. review provided a rigorous step-by-step guide into the development and validation of such tools, a pattern of steps continue to be overlooked. As these instruments are potentially valuable in assisting in the development of a clinical diagnosis into pediatric sleep pathologies, it is required that while they are primary subjective measures, they behave as objective measures. More tools for specific populations (e.g., in terms of ages, developmental disabilities, and sleep pathologies) are still needed.
... Finalmente, la versión China (Li et al., 2007), aplicada en 20.457 infantes, mostró un alfa de Cronbach de 0,73 (rango entre 0,42-0,89). Otro trabajo español, realizado por Bastida-Pozuelo et al. (2016), se encontró un coeficiente alfa de 0,73. ...
Sleep plays a vital role in good health and well-being in school-age children. The aim of this study was to determine the reliability and content validity of the BEARS questionnaire in children and adolescents from 9 to 17 years of age. The sample comprised 8,862 children and adolescents belonging to 24 official education institutions from Bogotá, Colombia. The BEARS questionnaire was applied through self-completion manner, with a structured form. A sub-sample of 246 participants was used for reliability analyses. Consistency of the instrument was analyzed through Cronbach’s alpha coefficient, construct validity through exploratory factor analysis (EFA), and reliability through the weighted Kappa coefficient. Results showed adequate consistency (global Cronbach of 0.732; range 0.706 to 0.769) and moderate reliability (Kappa of 0.665; range 0.706 to 0.769). The EFA determined a single factor (item 1: problems when going to sleep), which explained 61.4% of the variance, grouping two interactions ÷²/gl = 2690.817; p = 0.001. The BEARS questionnaire showed adequate internal consistency, reliability, and validity. From these results, this instrument is recommended principally within the context of primary care for the study and screening of sleep alterations in school-aged populations from Bogotá, Colombia. © Copyright: Federación Española de Asociaciones de Docentes de Educación Física (FEADEF)
... Finalmente, la versión China (Li et al., 2007), aplicada en 20.457 infantes, mostró un alfa de Cronbach de 0,73 (rango entre 0,42-0,89). Otro trabajo español, realizado por Bastida-Pozuelo et al. (2016), se encontró un coeficiente alfa de 0,73. ...
El sueño juega un papel fundamental en muchas esferas del desarrollo de los infantes en etapa escolar. El objetivo de este estudio fue determinar la confiabilidad y validez de contenido del cuestionario BEARS en niños y adolescentes de 9 a 17 años. La muestra estuvo compuesta por 8.862 niños y adolescentes pertenecientes a 24 instituciones educativas oficiales de Bogotá, Colombia. Se administró el cuestionario BEARS, de manera auto-diligenciada por formulario estructurado. Una sub-muestra de 246 participantes se utilizó para los análisis de fiabilidad. La consistencia del instrumento se analizó mediante el coeficiente alfa de Cronbach, la validez de constructo a través del análisis factorial exploratorio (AFE), y la fiabilidad mediante el coeficiente Kappa ponderado. Los resultados mostraron adecuada consistencia (Cronbach global de 0,732; rango 0,706 a 0,769) y moderada fiabilidad (kappa de 0,665; rango 0,378 a 0,629). El AFE determinó un solo factor (ítem 1: problemas a la hora de dormir), explicaba el 61,4% de la varianza, agrupando dos interacciones χ 2/gl=2690,817; p=0,001. El cuestionario BEARS mostró una adecuada consistencia interna, fiabilidad y validez. A partir de estos resultados, se recomienda este instrumento principalmente en el contexto de atención primaria, para el estudio y cribado de las alteraciones del sueño en población escolarizada de Bogotá, Colombia
... (28) Notably, a recent paper employed the Spanish version as the gold standard for determining the validity of the shorter BEARS screener, in primary care practice. (29) The current study aims to provide preliminary validity for a shortened version of the CSHQ (SF-CSHQ), exclusive of its parasomnia and SDB items. Such a tool would be specific to BSPs, thus identifying common sleep problems that are responsive to behavioral interventions delivered to (and administered by) parents. ...
Objectives
Behavioral sleep problems (BSPs) are prevalent and consequential in young children. There is a need for screening tools that identify BSPs—which are often rooted in the parent-young child relationship—and typically respond to behavior management. Such a tool would increase capacity to identify and treat BSPs. We sought to validate a short-form version of the widely used Children's Sleep Habits Questionnaire (SF-CSHQ) that omitted items that would not be responsive to behavioral strategies.
Methods
The original 33-item CSHQ elicits parent report of “behaviorally-based” and “medically-based” sleep items (eg, parasomnias and sleep disordered breathing). We conducted analyses to develop a SF-CSHQ that excludes its “medically-based” items, to determine (a) the SF-CSHQ threshold score corresponding to the full CSHQ clinical cut-off score (≥41), and (b) preliminary validity of this SF-CSHQ. Data were re-analyzed from the original data that established the CSHQ's psychometric properties in 4–10 year olds, and a second dataset that established its validity in 24–66 month olds.
Results
In both datasets, a threshold score of 30 had correlations of 0.90–0.94 with the original cut-off. This 23-item SF-CSHQ cut-off functioned as well as the full CSHQ cut-off in discriminating between children with vs without a parent-reported behavioral sleep problem, and with vs without prolonged sleep latency (per actigraphy).
Conclusion
We established preliminary validity of modified version of the widely-used CSHQ. This SF-CSHQ may be useful for widening screening and first-line guidance for behavioral sleep problems in young children, among professionals who are not sleep medicine specialists.
Background: A lifestyle including poor diet, physical inactivity, excessive gaming and inadequate sleep hygiene is frequently seen among Dutch children. These lifestyle behaviors can cause long-term health problems later in life. Unhealthy lifestyle and poor physical health are even more prevalent among children with mental illness (MI) such as autism, attention-deficit/hyperactivity disorder, depression, and anxiety. However, research on lifestyle interventions among children with MI is lacking. As a result, there are currently no guidelines, or treatment programs where children with MI and poor lifestyle can receive effective support. To address these issues and to provide insight into the effectiveness of lifestyle interventions in children with MI and their families, the Movementss study was designed. This paper describes the rationale, study design, and methods of an ongoing randomized controlled trial (RCT) comparing the short-term (12 weeks) and long-term (1 year) effects of a lifestyle intervention with care as usual (CAU) in children with MI and an unhealthy lifestyle.
Methods: A total of 80 children (6-12 years) with MI according to DSM-V and an unhealthy lifestyle are randomized to the lifestyle intervention group or CAU at a specialized child and adolescent mental hospital. The primary outcome measure is quality of life measured with the KIDSCREEN. Secondary outcomes include emotional and behavior symptoms, lifestyle parameters regarding diet, physical activity, sleep, and screen time, cognitive assessment (intelligence and executive functions), physical measurements (e.g., BMI), parenting styles, and family functioning, prior beliefs, adherence, satisfaction, and cost-effectiveness. Assessments will take place at the start of the study (T0), after 12 weeks (T1), six months (T2), and 12 months of baseline (T3) to measure long-term effects.
Discussion: This RCT will likely contribute to the currently lacking knowledge on lifestyle interventions in children with MI.
Trial registration: trialsearch.who.int/ NL9822. Registered at November 2nd, 2021
Introduction:
There is little information on the impact of mobile phone overuse (MPO) in areas in need of social transformation (ANST). Our objective was to estimate the prevalence of MPO in an ANST and its association with sleep disorders, academic performance and obesity.
Patients and methods:
Consecutive sampling of patients aged 10-17 years who visited a primary care centre in an ARST between October 2019 and March 2020. The study involved performance of a clinical interview with collection of anthropometric, sociodemographic, mobile phone use and sleep data.
Results:
The analysis included 214 participants. The prevalence of MPO during weekdays (more than 2 h a day) was 37.5% in children aged 10-12 years and 65.2% in 13- to 17-year-olds; in the weekend, the prevalence increased to 66.6% and 81.3%, respectively. In weekdays, MPO was associated with an increased prevalence of obesity, lower maternal educational attainment, greater difficulty waking up, daytime sleepiness and higher frequency of school failure. The adjusted risk was double for excess weight (odds ratio [OR] 1.90, 95% confidence interval [95% CI] 1.04-3.47), obesity (OR 2.45, 95% CI 1.23-4.89) and sleep disorders or sleep duration of less than 7 h (OR 2.26; 95% CI 1.31-3.92). Weekend MPO was associated with sleep disorders or sleep duration of less than 7 h (OR 2.68; 95% CI 1.40-5.11).
Conclusions:
The prevalence of mobile phone overuse is high in areas of social exclusion and is associated with sleep disorders, school failure and obesity.
The incidence of overweight and obesity is alarming worldwide. In Argentina, multifactorial studies are scarce despite the high rates of childhood overweight and obesity (OW/OB). In this study we assessed the prevalence of childhood OW/OB and the associated risk factors from a multicausal perspective: we analyzed sleep habits, screen use, chronic stress in children and their caregivers, social relationship problems, eating habits, and physical activity. Of the 397 first and seventh graders who completed the questionnaires, 41% had childhood OW/OB. In children with obesity, a lower level of physical activity, a lower consumption of protective foods, a higher risk for sleep disorders, higher levels of chronic stress (in both children and their caregivers), and higher rates of peer rejection were observed. Widespread use of screens before bedtime was noted in most children. This study evidences the diversity of factors associated with childhood OW/OB and highlights the convenience of a multidimensional approach to address it. In addition, the results of this study suggest the need to consider lifestyle habits as a preventive and therapeutic strategy for the management of OW/OB from early stages.
Introducción.
La higiene y la calidad del sueño se ha relacionado con el funcionamiento cognitivo en la adolescencia. El creciente uso de dispositivos tecnológicos puede afectar negativamente su sueño y rendimiento académico.
Objetivo.
Estudiar algunas variables que pueden estar implicadas en la higiene o alteraciones del sueño, uso de dispositivos tecnológicos y rendimiento académico, para detectar diferencias y asociaciones según edad y sexo.
Metodología.
Estudio descriptivo transversal en el que participaron 53 estudiantes entre 13-16 años que responden sobre su higiene de sueño y su uso de dispositivos tecnológicos. También se les aplicó el cribado de BEARS y la “Escala breve de ajuste escolar''. Sus padres informaron sobre calificaciones escolares y ejercicio físico de sus hijos.
Resultados.
Los principales resultados se observaron en adolescentes de 13-14 años, quienes presentaron más estrés (M = 4,33), consumo de bebidas estimulantes (M = 2,89) y problemas para dormir (50%). En general, hubo desfase significativo entre horas de dormir días escolares y fines de semana, acentuándose la diferencia con la edad. La somnolencia fue la alteración del sueño más referida (47%) y se asoció con desconexión más tardía de dispositivos electrónicos y menor duración del sueño. Las calificaciones, mejores en mujeres, correlacionaron con ajuste.
Conclusiones.
Las implicaciones teóricas del estudio podrían ser útiles para construir un modelo que aúne estas variables y las implicaciones prácticas para desarrollar propuestas de intervención socioeducativa enfocadas en mejorar la higiene del sueño y el uso a los dispositivos tecnológicos, a fin de minimizar su impacto negativo sobre el rendimiento académico.
We know that sleep problems affect 20–30% of all children during childhood and that disturbed or poor sleep affects many aspects of daytime functioning. Poor sleep is known to affect memory consolidation, cognitive function, academic achievement, daytime behaviour and even levels of obesity [1]. This section briefly describes the physiology of sleep, a guide to considerations to include when undertaking sleep work, gives information about good sleep hygiene and suggests behavioural approaches to sleep relevant for children with FASD.
A questionnaire is an instrument that consists of sets of open- and closed-ended questions with the aim to gather information from respondents. It can be used in clinical and research setting. In sleep medicine, as in other medical branches, questionnaires are used for different reasons. They give the sleep specialist an accurate and quick way to screen for different sleep problems which even the patient may not pay attention to. Questionnaires can also be used as a reference point to measure a patient’s progress. Furthermore, they can facilitate parents and caregiver’s verbalization of their child’s sleep difficulties. It is important to note that the number of pediatric sleep questionnaires is fewer compared to that available for adults. The limited number of pediatric sleep questionnaires might be due to difficulty in designing scales that can be used for a range of ages. This chapter reviews 19 sleep questionnaires in details that can be used to address a wide range of sleep difficulties. Those questionnaires are used widely in sleep clinics.
l-Carnosine is an amino acid that acts as an anti-oxidant, anti-toxic and neuroprotective agent. There is a paucity of data about the effectiveness of l-Carnosine in the management of autism spectrum disorder (ASD) in children. This study aimed at investigating the effectiveness of l-Carnosine as adjunctive therapy in the management of ASD. This was a randomized controlled trial. Children aged 3–6 years with a diagnosis of mild to moderate ASD were assigned to standard care arm (occupational and speech therapy) and intervention care arm (l-Carnosine, 10–15 mg/kg in 2 divided doses) plus standard care treatment. The children were assessed at the baseline and the end of 2 months for the scores of Childhood Autism Rating Scale, Second Edition—Standard Version (CARS2-ST), Autism Treatment Evaluation Checklist (ATEC), BEARS sleep screening tool and 6-item Gastrointestinal Severity Index (6-GSI). Of the sixty-seven children enrolled, sixty-three children had completed the study. No statistically significant difference (p > 0.05) was observed for any of the outcome measures assessed. Supplementation of l-Carnosine did not improve the total score of CARS2-ST, ATEC, BEARS sleep screening tool and 6-GSI scores of children with ASD. Further investigations are needed with more objective assessments to critically validate the effectiveness of l-Carnosine on ASD children for more decisive results.
Purpose
To test the effects of a single‐session parent sleep educational intervention, led by a pediatric nurse, on sleep in a group of school‐aged children attending a National Health Service mental health clinic in Murcia, Spain.
Design and Methods
Parents/caregivers of 26 children (mean age = 8.58 years; standard deviation = 0.58; 80.8% male) with neurodevelopmental or mental health disorders (84.6% pervasive developmental disorder), and with a suspicion of a behavioral sleep problem, participated in a 45‐min group educational session about healthy sleep practices, supplemented by a written handout. The main outcome measures were derived from items of the Pediatric Sleep Questionnaire and included an insomnia composite score, a daytime sleepiness composite score, average sleep onset latency, and sleep duration on both weekdays and weekends. Outcome variables were assessed before and 3 months after the intervention.
Results
After the educational intervention, the insomnia and daytime composite scores decreased significantly (ps < 0.03). Weekday and weekend sleep duration significantly increased ( ps < 0.01). No statistically significant difference was observed in sleep onset latency before and after the intervention.
Practice Implications
A brief and relatively inexpensive single sleep educational session can positively impact sleep in children with neurodevelopmental and mental health disorders. Thus, this intervention meets the characteristics of a successful “entry level” treatment in a stepped‐care approach. The stepped‐care model places nurses in a pivotal position to ensure that their patients will receive the least complex and most accessible intervention, from which they are likely to get some benefit, and that a sizeable number of patients who need treatment may receive it. Thus, it is important for nurses in all types of practice settings to have an understanding of healthy sleep patterns, as well as sleep disorders in children. Pediatric nurses, regardless of their setting, are in a unique position to screen children and adolescents for sleep behavior problems or sleep disorders, to educate families about healthy sleep practices, provide guidance and feedback, and recommend referral to pediatric specialized care for more complex assessment and management.
Study Objectives
To present psychometric data on a comprehensive, parent-report sleep screening instrument designed for school-aged children, the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ yields both a total score and eight subscale scores, reflecting key sleep domains that encompass the major medical and behavioral sleep disorders in this age group.
Design
Cross-sectional survey.
Setting
Three elementary schools in New England, a pediatric sleep disorders clinic in a children's teaching hospital.
Participants
Parents of 469 school-aged children, aged 4 through 10 years (community sample), and parents of 154 patients diagnosed with sleep disorders in a pediatric sleep clinic completed the CSHQ.
Interventions
N/A
Measurements and Results
The CSHQ showed adequate internal consistency for both the community sample (=0.68) and the clinical sample (=0.78); alpha coefficients for the various subscales of the CSHQ ranged from 0.36 (Parasomnias) to 0.70 (Bedtime Resistance) for the community sample, and from 0.56 (Parasomnias) to 0.93 (Sleep-Disordered Breathing) for the sleep clinic group. Test-retest reliability was acceptable (range 0.62 to 0.79). CSHQ individual items, as well as the subscale and total scores were able to consistently differentiate the community group from the sleep-disordered group, demonstrating validity. A cut-off total CSHQ score of 41 generated by analysis of the Receiver Operator Characteristic Curve (ROC) correctly yielded a sensitivity of 0.80 and specificity of 0.72.
Conclusions
The CSHQ appears to be a useful sleep screening instrument to identify both behaviorally based and medically-based sleep problems in school-aged children.
An approximate test and confidence interval for coefficient alpha are derived. The approximate test and confidence interval are then used to derive closed-form sample size formulas. The sample size formulas can be used to determine the sample size needed to test coefficient alpha with desired power or to estimate coefficient alpha with desired precision. The sample size formulas closely approximate the sample size requirements for an exact confidence interval or an exact test.
Infant mental health problems include difficulties to regulate emotions or attention, crying, sleeping or feeding problems as well as aggressive behavior. Early identifications of these problems help to change developmental trajectories and improve developmental outcomes. Psychiatric assessment and classification have to take into account the rapid processes of development as well as the inseparable linkage between symptoms of the infant, psychosocial risks in the family environment, and parent-child relations. The proposed DSM-5 classification system presents a systematic description of mental health disorders which are relevant for infant psychiatry. However, the proposal has provided rather limited attention to developmental differences and parent-infant relations. Therefore, additional classification systems, like the Zero-to-Three (DC: 0-3R), are strongly recommended. In terms of assessment and in accordance with the guidelines of the American Academy of Child and Adolescent Psychiatry, infant psychiatrists have to consider the close relation between somatic and mental health and the interplay between behaviors of the caregiver and the infant. Therefore, the assessment has to be multidisciplinary and relationship based. A standard assessment in infancy includes a clinical interview, behavior observations, caregiver questionnaires, and a pediatric screening. All assessments should pay attention to motor, cognitive, language, and social-emotional development. Because infant development is embedded in the family context, socio-economic factors, parents' mental problems, including drug abuse, domestic violence, and trauma history should be assessed. The treatment has to be oriented toward symptoms and development and has to address underlying medical conditions. The focus should be on parent-child interactions. Evidence-based interventions are based on attachment theory, use social-learning perspectives, and behavioral approaches.
Objectives. Obstructive sleep apnea (OSA) and habitual snoring are highly prevalent childhood conditions and have been associated with a large array of negative health outcomes. Although guidelines were published by the American Academy of Pediatrics (AAP) a decade ago recommending routine screening of sleep-disordered breathing (SDB) in primary care settings, it remains unclear to what extent such guidelines have been implemented and resulted in effective SDB screening. The aim of this study was to determine if AAP guidelines are adhered to in pediatric primary care. Study design. In all, 1032 electronic charts of children 4 to 17 years old presenting for well-child visits to 17 pediatricians between January 1 and December 31, 2010, were manually reviewed. Abstracted data included demographic variables and documentation of snoring as well as other sleep-related complaints. Results. The mean age was 8.5 ± 3.9 years (mean ± standard deviation), 49.9% were male, and 79.7% were Hispanic; 24.4% (n = 252) were screened for snoring. Of the children screened for sleep-related issues, 34.1% (n = 86) snored, but the majority of them (61.6%, n = 53) received no further evaluation. In the present sample, 0.5% (n = 5) had a diagnosis of OSA. Conclusions. The low prevalence of OSA may be explained by the relatively low frequency of sleep-related problem screening by pediatricians and thus the inordinately low adherence to the AAP guidelines. Modification and transition to electronic medical records as well as expanded efforts to educate health care providers and caregivers may improve detection and timely treatment of children at risk for SDB.
Examine the prevalence, patterns, and persistence of parent-reported sleep problems during the first 3 years of life.
Three hundred fifty-nine mother/child pairs participated in a prospective birth cohort study. Sleep questionnaires were administered to mothers when children were 6, 12, 24, and 36 months old. Sleep variables included parent response to a nonspecific query about the presence/absence of a sleep problem and 8 specific sleep outcome domains: sleep onset latency, sleep maintenance, 24-hour sleep duration, daytime sleep/naps, sleep location, restlessness/vocalization, nightmares/night terrors, and snoring.
Prevalence of a parent-reported sleep problem was 10% at all assessment intervals. Night wakings and shorter sleep duration were associated with a parent-reported sleep problem during infancy and early toddlerhood (6-24 months), whereas nightmares and restless sleep emerged as associations with report of a sleep problem in later developmental periods (24-36 months). Prolonged sleep latency was associated with parent report of a sleep problem throughout the study period. In contrast, napping, sleep location, and snoring were not associated with parent-reported sleep problems. Twenty-one percent of children with sleep problems in infancy (compared with 6% of those without) had sleep problems in the third year of life.
Ten percent of children are reported to have a sleep problem at any given point during early childhood, and these problems persist in a significant minority of children throughout early development. Parent response to a single-item nonspecific sleep query may overlook relevant sleep behaviors and symptoms associated with clinical morbidity.
Sleep problems occur in 20% to 30% of young children. Although behaviorally based interventions are highly efficacious, most existing interventions require personal contact with a trained professional, and unfortunately many children remain untreated. However, the use of an internet-based intervention could provide widespread access. Thus, the purpose of this study was to examine the efficacy of an internet-based intervention for infant and toddler sleep disturbances, as well as to assess any indirect benefits to maternal sleep, mood, and confidence.
264 mothers and their infant or toddler (ages 6-36 months) participated in a 3-week study. Families were randomly assigned to one of 2 intervention groups (algorithmic internet-based intervention alone or in combination with a prescribed bedtime routine) or a control group. After a one-week baseline (usual routine), the intervention groups followed personalized recommendations during weeks 2 and 3. All mothers completed the Brief Infant Sleep Questionnaire, the Pittsburgh Sleep Quality Index, and the Profile of Mood States weekly.
Both internet-based interventions resulted in significant reductions in problematic sleep behaviors. Significant improvements were seen in latency to sleep onset and in number/duration of night wakings, P<0.001. Sleep continuity increased as well as mothers' confidence in managing their child's sleep. Improvements were seen by one week, with additional benefits by week two. Maternal sleep and mood were also significantly improved.
This internet-based intervention (with and without routine) is beneficial in improving multiple aspects of infant and toddler sleep, especially wakefulness after sleep onset and sleep continuity, as well as improving maternal sleep and mood.
Sleep disorders can lead to significant morbidity. Information on sleep in healthy children is necessary to evaluate sleep disorders in clinical practice, but data from different societies cannot be simply generalized. The aims of this study were to (1) assess the prevalence of sleep disturbances in Dutch healthy children, (2) describe sleep habits and problems in this population, (3) collect Dutch norm data for future reference, and (4) compare sleep in children from different cultural backgrounds. A population-based descriptive study was conducted using the Children's sleep habits questionnaire and the sleep self-report. One thousand five hundred seven proxy-reports and 262 self-reports were analyzed. Mean age was 8.5 years (95% confidence interval, 8.4-8.6), 52% were boys. Sleep problems in Dutch children were present in 25%, i.e., comparable to other populations. Sleep habits were age-related. Problem sleepers scored significantly higher on all scales. Correlations between parental and self-assessments were low to moderate. Dutch children had significantly more sleep disturbances than children from the USA and less than Chinese children. Cognitions and attitudes towards what is considered normal sleep seem to affect the appraisal of sleep, this probably accounts partly for cultural differences. For a better understanding of cultural influences on sleep, more information on these determinants and the establishment of cultural norms are mandatory.
Relatively little is known about sleep habits, sleep disturbances, and the consequences of disordered sleep in school-aged children. This descriptive study examined a variety of common sleep behaviors in a group of 494 elementary school children, grades kindergarten through fourth, using a battery of sleep questionnaires that included parent, teacher, and self-report surveys. The prevalence of parent-defined sleep problems ranged from 3.7% (Sleep-Disordered Breathing) to 15.1% (Bedtime Resistance), with 37% of the overall sample described as having significant sleep problems in at least one sleep domain. Younger children were more likely than older children to have sleep problems noted by parents (particularly bedtime struggles and night wakings), as well as by teacher and self-report. Children tended to identify more sleep problems by self-report, particularly sleep-onset delay and night wakings, than did their parents. Overall, approximately 10% of the sample was identified by all three measures as having significant problems with daytime sleepiness. The results of this study emphasize the importance of screening for sleep disorders in this age group in the clinical setting. The need for consensus regarding the use of sleep screening instruments and the definition of "problem" sleep in school-aged children is also discussed.
To present psychometric data on a comprehensive, parent-report sleep screening instrument designed for school-aged children, the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ yields both a total score and eight subscale scores, reflecting key sleep domains that encompass the major medical and behavioral sleep disorders in this age group.
Cross-sectional survey.
Three elementary schools in New England, a pediatric sleep disorders clinic in a children's teaching hospital.
Parents of 469 school-aged children, aged 4 through 10 years (community sample), and parents of 154 patients diagnosed with sleep disorders in a pediatric sleep clinic completed the CSHQ.
N/A.
The CSHQ showed adequate internal consistency for both the community sample (p=0.68) and the clinical sample (p=0.78); alpha coefficients for the various subscales of the CSHQ ranged from 0.36 (Parasomnias) to 0.70 (Bedtime Resistance) for the community sample, and from 0.56 (Parasomnias) to 0.93 (Sleep-Disordered Breathing) for the sleep clinic group. Test-retest reliability was acceptable (range 0.62 to 0.79). CSHQ individual items, as well as the subscale and total scores were able to consistently differentiate the community group from the sleep-disordered group, demonstrating validity. A cut-off total CSHQ score of 41 generated by analysis of the Receiver Operator Characteristic Curve (ROC) correctly yielded a sensitivity of 0.80 and specificity of 0.72.
The CSHQ appears to be a useful sleep screening instrument to identify both behaviorally based and medically-based sleep problems in school-aged children.
Sleep and Sleep Disorders in Adolescents: This volume of Adolescent Medicine: State of the Art Reviews (AM:STARs) examines the complex spectrum of normal sleep and sleep disorders in adolescents. It is the first compendium of its kind from some of the leading national and international researchers and experts on sleep in children and adolescents. These articles will provide the reader with a greater understanding of the physiology of normal sleep during adolescence, the pathophysiology and management of common medically based and behaviorally based sleep disorders and the significant public health factors that both contribute to sleep disorders during adolescence and threaten the safety and wellness of adolescents who suffer from sleep disorders.
Objective To evaluate and quantify the evidence for behavioral interventions for pediatric insomnia. Methods Meta-analysis of 16 controlled trials and qualitative analysis of 12 within-subject studies were conducted (total n = 2,560). Results Meta-analysis found significant effects for four specified sleep outcomes: sleep-onset latency, number of night wakings,
and duration of night wakings, and sleep efficiency, with small to large effect sizes across the controlled clinical trials
involving typical children. No significant effects were found for the two studies conducted with special needs populations.
Finally, within-subjects studies demonstrated significant effects for all sleep outcomes with large effect sizes. Risk of
bias assessment and GRADE ratings of the quality of the evidence are described. Conclusion Moderate-level evidence supports behavioral interventions for pediatric insomnia in young children. However, low evidence
for children, adolescents, and those with special needs (due to a lack of studies that met inclusion criteria) highlights
the need for future research.
CME Educational Objectives
1. Review new 2012 American Academy of Pediatrics guidelines for the diagnosis and management of childhood obstructive sleep apnea syndrome (OSA).
2. Outline the differences between the previous 2002 guidelines and the most recent guidelines.
3. Highlight controversies and challenges in the diagnosis and management of pediatric OSA.
On a busy day at the pediatric office, child health care practitioners may see children of different ages present with symptoms such as inattentiveness, hyperactivity, aggression, behavioral problems, excessive sleepiness, difficulty waking up in the morning, learning problems, frequent awakening at night, restless sleep, morning headaches, and nocturnal enuresis. Children with these symptoms may be underweight or morbidly obese; healthy; or suffering from asthma, seasonal allergies, or other ailments. What they will likely have in common is a fairly well-known and yet under-recognized condition — obstructive sleep apnea syndrome (OSA).
The American Academy of Pediatrics first published “Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome” in 2002. However, with the increase in obstructive sleep apnea syndrome research, they revised these guidelines in 2012. These new guidelines evaluate obstructive sleep apnea syndrome diagnostic techniques, describe available treatment options, and provide follow-up recommendations. This article explores those revisions.
Sleep disorders are common in children and adolescents, their incidence is estimated to be within 25-40%. Among children with psychiatric disorders, sleep problems often arise. Sleep disorders are a symptom of many mental illnesses, they have a major impact on the severity of other symptoms of the disease and the treatment is often difficult. Epidemiological and clinical studies have shown that children in this group often suffer from chronic insomnia, but also relatively frequently are seen in them primary sleep disorders such as restless legs syndrome or obstructive sleep apnea. On the other hand, there is evidence that primary insomnia may be a risk factor for many psychiatric diseases especially depression and anxiety disturbances, and may even produce symptoms of mental illness. Researches regarding pharmacotherapy in pediatric sleep disorders are limited. As a first-line treatment nonpharmacologic strategies are usually recommended.
Objective:
The aim of the present school-based questionnaire was to analyze the sleep problems of children with developmental disorders, such as pervasive developmental disorder and attention deficit hyperactivity disorder.
Methods:
The sleep problems of 43 children with developmental disorders were compared with those of 372 healthy children (control group). All children attended one public elementary school in Kurume, Japan; thus, the study avoided the potential bias associated with hospital-based surveys (i.e. a high prevalence of sleep disturbance) and provided a more complete picture of the children's academic performance and family situation compared with a control group under identical conditions. Children's sleep problems were measured with the Japanese version of the Children's Sleep Habits Questionnaire (CSHQ).
Results:
Children with developmental disorders had significantly higher total CSHQ scores, as well as mean scores on the parasomnias and sleep breathing subscales, than children in the control group. The total CSHQ score, bedtime resistance, sleep onset delay, and daytime sleepiness worsened with increasing age in children with developmental disorders; in contrast, these parameters were unchanged or became better with age in the control group. In children with developmental disorders, there was a significant association between a higher total CSHQ score and lower academic performance, but no such association was found in the control group. For both groups, children's sleep problems affected their parents' quality of sleep. There were no significant differences in physical, lifestyle, and sleep environmental factors, or in sleep/wake patterns, between the two groups.
Conclusions:
Children with developmental disorders have poor sleep quality, which may affect academic performance. It is important for physicians to be aware of age-related differences in sleep problems in children with developmental disorders. Further studies are needed to identify the association between sleep quality and school behavioral performance.
The purpose of this study was to review evidence from the last 5 years (2006-2011) regarding a relationship between sleep duration and childhood overweight/obesity.
Among the 25 studies selected from PubMed and Web of Knowledge databases, all indicated significant associations between short sleep duration and childhood overweight/obesity. Studies explored a range of pediatric populations, methodologies, and potential contributing factors.
Childhood sleep duration may be a modifiable risk factor in preventing obesity. In addition to identifying and assessing patients' sleep habits, nurses play important roles as educators regarding the importance of adequate sleep and promoting it in children.
Parenting stress is an aspect of parent functioning relevant in clinical settings. Within the context of behavioral sleep medicine, the role of parenting stress is not well understood.
Prospective evaluation of patients 1.5-10 years old with insomnia. Subjects were 156 primary caregiver-child pairs who completed the Parenting Stress Index-Short Form (PSI-SF), Child Sleep Habits Questionnaire (CSHQ) and Child Behavior Checklist (CBCL). Aims: (1) determine prevalence of clinically significant parenting stress in primary caregivers of children clinically referred for insomnia; (2) identify childhood sleep problems that play a role in parenting stress; (3) identify relevant correlates of parenting stress within the context of a behavioral sleep medicine clinic; and (4) identify the most salient child sleep and behavioral variables associated with parenting stress.
Forty-seven percent of primary caregivers had clinically significant parenting stress. When examining the relationship between child sleep problems and parenting stress, bedtime resistance (p=0.030) and daytime sleepiness (p=0.0003) stood alone as having the most salient associations with parenting stress. When considering a broader range of covariates (child age and child gender) and clinically relevant variables (parent history of sleep problems, parent history of psychiatric conditions, child behavior problems and child sleep problems) in a single regression equation, both child externalizing behavior problems (β=0.570, p<0.0001) and child daytime sleepiness (β=0.152, p=0.028) independently explained significant variability in parenting stress.
Many primary caregivers of children clinically-referred for insomnia evaluation and treatment have significant parenting stress. Parenting stress is associated with daytime behavioral problems and sleepiness in children with insomnia. Clinicians working with pediatric insomnia patients should carefully evaluate parenting stress and child daytime behavior as these aspects of functioning may have an impact on service delivery and treatment outcomes.
Sleep disorders are highly prevalent during childhood and adolescence. It is known that if left untreated, these problems can have significant impact on daytime function, including learning, memory, attention, and behavior. The approach to the treatment of these disorders (whether with or without pharmacotherapy) is dependent on a thorough evaluation of the sleep complaint and determination of an accurate diagnosis. Many pediatric sleep problems are due to insomnia. There is good evidence that young children with behaviorally based insomnia respond to appropriate behavioral interventions. There is less research evidence of the efficacy of these interventions in children who are either school age or adolescents; however, nonpharmacologic strategies are usually indicated initially in the approach to treatment. The indication for the use of pharmacotherapy in pediatric insomnia is not well understood; however, some general principles are described when medications may be considered. There are specific sleep disorders (other than insomnia) for which pharmacotherapy plus behavioral strategies are warranted. The research regarding pharmacotherapy in pediatric sleep disorders is limited; often, medications are used "off label" based on data extrapolated from adult studies. Clinicians who suggest over-the-counter treatments or prescribe medications for pediatric patients with sleep disorders should have an understanding of the classification of sleep disorders and the role of pharmacotherapy in the treatment of these disorders. In this chapter, the emphasis is on the pharmacologic treatment of sleep disorders in typically developing children and adolescents.
The sleep habits and the prevalence of sleep problems have been poorly evaluated globally in Spain. The objective is to find out the opinions of the paediatric population in of an autonomous community as a whole (Comunidad Valenciana) on sleep and its difficulties, and to analyse their distribution by age, sex and geographical origin.
An observational, descriptive epidemiological study of prevalence. The Children Sleep Habits Questionnaire was used. The sample was obtained proportionally to the population of the three provinces of the Community of Valencia and depending on the place of residence: urban and rural, coastal zone/Interior. We evaluated the responses of 1507 questionnaires.
Between 91.2% and 76.1% believed that they have problems sleeping with a relationship of dependency with age. Fifteen percent of the sample lack a regular sleep schedule during school days and 19.7% of the 9-11 years themselves decided their own sleep schedules during school days. A majority (53.9% of the 12-15 years had nightmares more than once per week and 37.4% (6-8 years), 25.3% (9-11 years) and 31.8% (12-15 years) never woke up tired or did so only once per week.
Poor sleep habits are prevalent. It is necessary to increase the educational measures and explain the importance of sleep. Teenagers are a particularly sensitive to poor sleep habits group. Environmental factors (place of residence) should be taken into account when assessing sleep.
Behavioral insomnia of childhood (BIC; more commonly known as bedtime problems and night wakings) commonly occurs in young children (<or=5 years). If left untreated, bedtime problems and night wakings can result in impairments in behavior, emotion regulation, and academic performance. Yet, treatments for bedtime problems and night wakings have been found to be efficacious and durable. This article begins with a review of the diagnostic criteria and clinical presentation of BIC. This is followed by a brief review of how operant theory is applied to behavioral interventions for BIC and a detailed discussion of how to apply these treatments for bedtime problems and night wakings in young children.
Although sleep problems often comprise core features of psychiatric disorders, inadequate attention has been paid to the complex, reciprocal relationships involved in the early regulation of sleep, emotion, and behavior. In this paper, we review the pediatric literature examining sleep in children with primary psychiatric disorders as well as evidence for the role of early sleep problems as a risk factor for the development of psychopathology. Based on these cumulative data, possible mechanisms and implications of early sleep disruption are considered. Finally, assessment recommendations for mental health clinicians working with children and adolescents are provided toward reducing the risk of and improving treatments for sleep disorders and psychopathology in children and adolescents.
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.
Parasomnias have been little studied in prepubertal age children. When it happens often they can alter the continuity of the sleep and reduce the value restorer of this affecting the academic functioning and daytime behavioural in younger children. We study the total frequency of the parasomnias, the individual frequency of every parasomnia and the association between them in primary education children.
We distribute to children's parents (358) of third through sixth grade of Primary Education of one college of Alcoy the Owens Children's Sleep Habits Questionnaire of for parents to answer.
Rate of response was 58 %. Total frequency of the parasomnias was 6.2 %. The most frequent parasomnia of the research was the periodic limb movements (PLM) (7.7 %) followed of bruxism (6.7%), nightmares (1.9%), enuresis (1.9%) and sleepwalking (1.4%). We did not find any case of night terror. There is a major frequency of enuresis, sleepwalking and nightmares in male children and of PLM in the girls though we have not obtained statistical significance. The PLM associated with nightmares (75%, p < 0.005), sleepwalking (66%, p < 0.05) and bruxism (40%, p < 0.005).
Parasomnias happen with a frequency raised in the children in prepubertal age. Following the repercussion that a parasomnia can suppose to the child as well as to his environment, it is important to detect it as soon as possible in order to prevent its consequences and not let them continua once the child gets older.
Sleep problems in a pediatric practice: clinical issues for the pediatric nurse practitioner
- Mindell J.A.
Situación actual de los trastornos del sueño en niños
- Estivill E.
Sleep duration and overweight/obesity in children: implication for pediatric nursing
- Liu
- Streiner