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Sleep problems seldom addressed at two general pediatric clinics
R D Chervin1, K H Archbold, P Panahi
1Department of Neurology, Sleep Disorders Center, University Hospital, 0117, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0117, USA. chervin@umich.edu
Insights
Pediatric sleep problems identified by questionnaire are rarely addressed in primary care. Most children with sleep issues had their sleep mentioned in charts, but these discussions seldom led to diagnosis or effective treatment.
Area of Science:
- Pediatric Sleep Medicine
- General Pediatrics
- Clinical Research
Background:
- Sleep disorders are common in children and can lead to significant health issues.
- Undiagnosed sleep problems in pediatric populations represent a critical gap in healthcare.
- Early identification and management of childhood sleep disorders are essential for overall well-being.
Purpose of the Study:
- To evaluate the frequency of addressing, diagnosing, and treating sleep problems in children presenting to general pediatric clinics.
- To assess the correlation between identified sleep issues via the Pediatric Sleep Questionnaire (PSQ) and clinical documentation.
- To highlight the need for improved recognition and management of pediatric sleep disorders in primary care settings.
Main Methods:
- An observational study conducted in two community-based general pediatrics clinics.
- Utilized the validated Pediatric Sleep Questionnaire (PSQ) to screen children (ages 2.0-13.9 years) for various sleep disorders.
- Reviewed medical chart notes from the previous two years for mentions of sleep-related symptoms, diagnoses, or treatments.
Main Results:
- Out of 830 completed questionnaires, 103 sleep problems were identified in 86 symptomatic children.
- Fewer than 15% of patients had current chart notes mentioning PSQ-defined sleep problems; only 2 diagnoses and no treatments were documented.
- Only 16 of the 103 identified sleep problems were mentioned in any chart notes, with limited diagnosis and effective treatment recorded.
Conclusions:
- Children with questionnaire-identified sleep problems are seldom adequately addressed, diagnosed, or treated in general pediatric clinics.
- Despite frequent mentions of sleep in patient charts, these discussions rarely align with specific sleep disorder concerns identified by the PSQ.
- Findings underscore the necessity for enhanced education for clinicians and parents regarding pediatric sleep disorders and their management.
Objective:
Sleep disorders can cause substantial morbidity but often remain undiagnosed among adults. We identified a series of children with sleep-related symptoms and reviewed medical chart notes for the previous 2 years to determine how often sleep problems had been addressed.
Design:
Observational. Setting. Two university-affiliated but community-based general pediatrics clinics.
Patients:
Children, ages 2.0 to 13.9 years, with clinic appointments.
Measures:
Parental and child responses to a validated Pediatric Sleep Questionnaire (PSQ) were used to identify patients at risk for chronic sleep-disordered breathing, periodic leg movements during sleep, insomnia, or excessive daytime sleepiness. Chart notes written within the previous 2 years were searched for sleep-related symptoms, diagnoses, or treatments.
Results:
A total of 830 questionnaires were completed; 1395 chart notes of 86 symptomatic participants (mean age: 6.6 +/- 3.1 years; 51% male) with 103 identified sleep problems were reviewed. Fewer than 15% of patients had current chart notes that mentioned any of the PSQ-defined sleep problems; diagnoses were mentioned for 2 of 86 patients and no treatments were discussed. Among the 103 sleep problems, only 16 received mention in any past or current note; 10 had led to a diagnosis; 4 had led to intervention; and 3 were treated in a manner likely to be effective. Seventy-four of the sleep problems (72%) occurred in children whose charts did mention something about sleep, but such notations rarely related to concerns uncovered by the PSQ.
Conclusions:
Children with PSQ-identified sleep problems at 2 general pediatrics clinics seldom had these problems addressed, diagnosed, or treated, despite discussions about some aspect of their sleep in the large majority of cases. These findings support expansion of clinician and parent education about sleep disorders in children.