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Screening for Problematic Sleep in a Diverse Sample of Infants
Sarah M Honaker1, Maureen E McQuillan1, Jodi A Mindell2,3
1Department of Pediatrics, Indiana University School of Medicine.
Insights
Screening infants for sleep problems depends on the strategy used. Night waking items effectively identify infants with issues, while sleep difficulty items better identify those without. The best approach depends on clinical goals.
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.
Objective:
To examine screening strategies for identifying problematic sleep in a diverse sample of infants.
Methods:
Parents of infants (5-19 months; N = 3,271) presenting for a primary care visit responded to five screening items and the Infant Sleep Questionnaire (ISQ), a validated measure of problematic infant sleep. If parents responded affirmatively to any screening item, primary care providers received a prompt to evaluate. For each of the screening questions, we examined differences in item endorsement and criterion related validity with the ISQ. Using conceptual composites of night waking and sleep difficulty, prevalence, criterion-related validity, and concurrent demographic correlates were analyzed.
Results:
Infants were primarily of Black race (50.1%) or Hispanic ethnicity (31.7%), with the majority (63.3%) living in economically distressed communities. Rates of problematic sleep ranged from 7.4%, for a single item assessing parental perception of an infant having a sleep problem, to 74.0%, for a single item assessing night wakings requiring adult intervention. Items assessing sleep difficulty had high (95.0-97.8%) agreement with the ISQ in identifying infants without problematic sleep, but low agreement (24.9-34.0%) in identifying those with problematic sleep. The opposite was true for items assessing night waking, which identified 91.0-94.6% of those with sleep problems but only 31.8-46.9% of those without.
Conclusions:
Screening strategies for identifying problematic infant sleep yielded highly variable prevalence rates and associated factors, depending on whether the strategy emphasized parent-perceived sleep difficulty or night wakings. The strategy that is most appropriate will depend on the system's goals.
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