照料者报告的幼儿睡眠问题与临床医生记录和转介之间的差异。
Discrepancies Between Caregiver Reported Early Childhood Sleep Problems and Clinician Documentation and Referral.
机构信息
Saint Joseph's University (M Carson and JA Mindell), Philadelphia, Pa.
Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa.
出版信息
Acad Pediatr. 2023 Aug;23(6):1234-1241. doi: 10.1016/j.acap.2023.02.001. Epub 2023 Feb 9.
OBJECTIVE
The American Academy of Pediatrics recommends routine sleep problem screenings during child well-visits. However, studies suggest a discrepancy between caregiver- and clinician-reported child sleep problems. The present study examines whether caregiver-reported child sleep problems (ie, habitual snoring, insomnia symptoms, poor sleep health) and clinician-documented child sleep problems and management are congruent.
METHODS
The sample included 170 caregiver-child dyads (child M = 3.3 years, range = 2-5 years; 56.5% girls; 64.1% Black, 20.0% non-Latinx White, and 4.1% Latinx; 86.5% maternal caregiver reporter). Caregivers' questionnaire-based reports of habitual snoring, insomnia symptoms, and sleep health behaviors (nighttime electronics, caffeine intake, insufficient sleep) were compared with clinician documentation in the electronic health record.
RESULTS
About 92.3% of children had at least 1 caregiver-reported sleep problem (66% insomnia symptoms, 64% electronics, 38% insufficient sleep, 21% caffeine, 17% snoring). In contrast, a substantially lower percent of children had a clinician documented sleep problem (20% overall; 10% insomnia symptoms, 7% electronics, 0% insufficient sleep, 3% caffeine, 4% snoring), sleep-related referral (1% overall; 0.6% Otolaryngology, 0.6% polysomnogram, 0% sleep clinic), or recommendation (12% overall; 8% insomnia symptoms, 4% electronics, 0% insufficient sleep, 1% caffeine).
CONCLUSIONS
There is a vast discrepancy between caregiver-reported child sleep problems and clinician-documented sleep problems and management, with a higher proportion of caregiver reports. To benefit overall child health and well-being, future research and quality improvement initiatives should focus on enhancing screening tools and educational opportunities to improve clinician documentation and enhance family conversations about early childhood sleep problems.
目的
美国儿科学会建议在儿童健康检查期间进行常规睡眠问题筛查。然而，研究表明，照顾者报告的儿童睡眠问题与临床医生记录的儿童睡眠问题和管理之间存在差异。本研究旨在检查照顾者报告的儿童睡眠问题（即习惯性打鼾、失眠症状、睡眠健康状况不佳）和临床医生记录的儿童睡眠问题和管理是否一致。
方法
本研究样本包括 170 对照顾者-儿童对（儿童 M = 3.3 岁，范围为 2-5 岁；56.5%为女孩；64.1%为黑人，20.0%为非拉丁裔白人，4.1%为拉丁裔；86.5%为母亲照顾者报告）。通过问卷，照顾者报告了习惯性打鼾、失眠症状和睡眠健康行为（夜间电子设备使用、咖啡因摄入、睡眠不足），并与电子健康记录中的临床医生记录进行了比较。
结果
约 92.3%的儿童存在至少 1 种照顾者报告的睡眠问题（66%的儿童存在失眠症状，64%的儿童使用电子设备，38%的儿童睡眠不足，21%的儿童摄入咖啡因，17%的儿童打鼾）。相比之下，儿童的临床医生记录的睡眠问题比例要低得多（总体为 20%；失眠症状为 10%，电子设备使用为 7%，睡眠不足为 0%，咖啡因摄入为 3%，打鼾为 4%），睡眠相关转诊率（总体为 1%；耳鼻喉科为 0.6%，多导睡眠图为 0.6%，睡眠诊所为 0%）和推荐率（总体为 12%；失眠症状为 8%，电子设备使用为 4%，睡眠不足为 0%，咖啡因摄入为 1%）也较低。
结论
照顾者报告的儿童睡眠问题与临床医生记录的睡眠问题和管理之间存在很大差异，照顾者报告的比例更高。为了提高儿童整体健康和幸福感，未来的研究和质量改进举措应重点关注加强筛查工具和教育机会，以提高临床医生的记录并加强家庭关于幼儿睡眠问题的讨论。
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