Owens J A
Division of Pediatric Ambulatory Medicine, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
Pediatrics. 2001 Sep;108(3):E51. doi: 10.1542/peds.108.3.e51.
To assess knowledge, screening, evaluation, treatment practices, and attitudes regarding sleep disorders in children and adolescents in a large sample of community-based and academic pediatricians.
Cross-sectional survey.
Six hundred twenty-six pediatricians in Rhode Island, Massachusetts, and Connecticut. INTRUMENT: The Pediatric Sleep Survey, a 42-item questionnaire assessing general and specific sleep knowledge categories; clinical screening, diagnostic, and treatment practices for common pediatric sleep disorders; and practitioner attitudes regarding the impact of sleep disorders in the clinical setting and as a public health issue.
On the knowledge section, the mean Total Knowledge score for the respondents was 18.1 +/- 3.5 out of 30 items, with 23.5% of the sample responding correctly on half or less of the items. Pediatricians scored highest on items relating to developmental and behavioral aspects of sleep and parasomnias, whereas the mean percentage of correct responses was <50% for items relating to sleep disordered breathing, excessive daytime sleepiness, and sleep movement disorders. Although only 16.5% and 18.2% of the sample reported not screening routinely for sleep disorders in infants and toddlers, this percentage rose to 43.9% in adolescents. Furthermore, only 38.3% regularly question the adolescents themselves about their sleep. Only about one quarter of the respondents screen toddlers and school-aged children for snoring. In evaluating and treating pediatric sleep problems, 53.2% of the sample never or rarely order overnight sleep studies to assess for obstructive sleep apnea and few use alternative treatment strategies, such as continuous positive airway pressure. A quarter of the sample at least occasionally recommends diphenhydramine and almost half suggests a psychological evaluation for children with night terrors. Finally, the percent of pediatricians rating the impact on children of sleep problems in a variety of domains as important or very important ranged from 49.7% (nonintentional injuries) to 92.6% (academic performance). However, only 46% of the sample felt confident or very confident about their own ability to screen for sleep problems, whereas 34.2% and 25.3% similarly rated their ability to evaluate and treat sleep problems in children.
The results of this survey suggest that there are still significant gaps among practicing pediatricians both in basic knowledge about pediatric sleep disorders, and in the translation of that knowledge into clinical practice. Despite their acknowledgment of the importance of sleep problems, many pediatricians fail to screen adequately for them, especially in older children and adolescents. Additional educational efforts regarding pediatric sleep issues are warranted, and should be targeted at the medical school, postgraduate training, and continuing medical education levels.
在大量社区及学术型儿科医生样本中，评估关于儿童和青少年睡眠障碍的知识、筛查、评估、治疗实践及态度。
横断面调查。
罗德岛、马萨诸塞州和康涅狄格州的626名儿科医生。
儿科睡眠调查问卷，这是一份包含42个条目的问卷，用于评估一般和特定的睡眠知识类别；常见儿科睡眠障碍的临床筛查、诊断和治疗实践；以及从业者对睡眠障碍在临床环境及作为公共卫生问题方面影响的态度。
在知识部分，受访者的平均总知识得分在30个条目中为18.1±3.5分，23.5%的样本在半数或更少条目上回答正确。儿科医生在与睡眠的发育和行为方面以及异态睡眠相关的条目上得分最高，而与睡眠呼吸障碍、日间过度嗜睡和睡眠运动障碍相关的条目，正确回答的平均百分比<50%。尽管只有16.5%和18.2%的样本报告未对婴儿和幼儿进行睡眠障碍的常规筛查，但在青少年中这一比例升至43.9%。此外，只有38.3%的医生会定期询问青少年自身的睡眠情况。只有约四分之一的受访者会对幼儿和学龄儿童进行打鼾筛查。在评估和治疗儿科睡眠问题时，53.2%的样本从未或很少安排夜间睡眠研究以评估阻塞性睡眠呼吸暂停，且很少使用替代治疗策略，如持续气道正压通气。四分之一的样本至少偶尔会推荐苯海拉明，近一半的样本建议对夜惊儿童进行心理评估。最后，将睡眠问题在各个领域对儿童的影响评为重要或非常重要的儿科医生比例，从49.7%（非故意伤害）到92.6%（学业成绩）不等。然而，只有46%的样本对自己筛查睡眠问题的能力有信心或非常有信心，而分别有34.2%和25.3%的样本对自己评估和治疗儿童睡眠问题的能力有类似评价。
本次调查结果表明，执业儿科医生在儿科睡眠障碍的基础知识以及将这些知识转化为临床实践方面仍存在显著差距。尽管他们认识到睡眠问题的重要性，但许多儿科医生未能对其进行充分筛查，尤其是在大龄儿童和青少年中。有必要针对儿科睡眠问题开展更多教育工作，且应针对医学院校、毕业后培训和继续医学教育阶段。
