Screening for Problematic Sleep in a Diverse Sample of Infants

Area of Science:

• Pediatrics
• Sleep Medicine
• Public Health

Background:

• Problematic infant sleep affects development and family well-being.
• Effective screening tools are crucial for early identification and intervention in primary care settings.
• Diverse infant populations present unique challenges for sleep assessment.

Purpose of the Study:

• To evaluate the effectiveness of different screening strategies for identifying problematic infant sleep.
• To compare the performance of various screening items against a validated measure (Infant Sleep Questionnaire).
• To analyze the prevalence and demographic correlates of problematic sleep in a diverse infant sample.

Main Methods:

• A cohort of 3,271 infants (5-19 months) in primary care completed five screening items and the Infant Sleep Questionnaire (ISQ).
• Screening item endorsement and criterion-related validity with the ISQ were examined.
• Prevalence, validity, and demographic associations were analyzed for conceptual composites of night waking and sleep difficulty.

Main Results:

• Prevalence rates for problematic sleep varied significantly based on the screening item, from 7.4% (parental perception) to 74.0% (night wakings).
• Sleep difficulty items showed high agreement (95.0-97.8%) for identifying infants *without* sleep problems but low agreement (24.9-34.0%) for those *with* problems.
• Night waking items identified 91.0-94.6% of infants *with* sleep problems but only 31.8-46.9% of those *without*.

Conclusions:

• Screening strategies for infant sleep problems yield variable results depending on whether they focus on perceived difficulty or night wakings.
• The choice of screening strategy should align with the specific goals of the healthcare system or clinical setting.
• No single screening approach is universally optimal; tailored strategies are necessary for effective identification.