Department of Psychology, Loma Linda University, Loma Linda, California.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Clin Sleep Med. 2024 Nov 1;20(11):1727-1738. doi: 10.5664/jcsm.11232.
The current study aimed to examine clinically relevant psychiatric and sociodemographic predictors of insomnia treatment outcomes in pediatric patients clinically referred for insomnia.
Pediatric patients (n = 1,428; ages 1.5-18 years) presenting for insomnia evaluation in a medical/sleep center-based behavioral sleep clinic were followed for treatment as clinically indicated. According to patient age, parents/patients completed validated measures of insomnia severity, psychiatric symptoms, and sociodemographic measures. Patients were also categorized by treatment outcome status (ie, not recommended to follow-up after initial evaluation and treatment session, successful treatment completion, lost to follow-up after initial evaluation and treatment session, and early termination) according to the clinically indicated treatment recommended and dose of treatment received.
Youth had elevated scores on psychiatric screening indexes and affective problems were highest for all age groups. Other comorbid sleep disorders were present in nearly 25% of patients with insomnia and use of sleep aids (melatonin or hypnotics) was commonplace. Baseline insomnia severity significantly predicted sleep treatment trajectories and posttreatment insomnia severity with large effects for all age groups. Other clinically relevant predictors of insomnia treatment outcomes included medication use and externalizing mental health concerns in younger patients and internalizing mental health concerns and chronological age in older patients. Lack of treatment follow-up and premature treatment termination was observed for patients with the worst insomnia symptoms at time of initial evaluation.
Pediatric health providers delivering insomnia treatment should take a developmentally sensitive approach that is proactive with regards to managing treatment barriers that are likely influenced by severity of insomnia and comorbid mental health concerns.
Van Dyk TR, Simmons DM, Durracio K, Becker SP, Byars KC. The role of psychiatric symptoms, sociodemographic factors, and baseline sleep variables on pediatric insomnia treatment outcomes in a clinically referred population. 2024;20(11):1727-1738.
本研究旨在探讨儿科患者临床转介失眠患者的临床相关精神科和社会人口统计学预测因素对失眠治疗结果的影响。
在以医疗/睡眠为基础的行为睡眠诊所就诊的儿科患者（n=1428；年龄 1.5-18 岁）中，根据患者的年龄，由父母/患者完成失眠严重程度、精神症状和社会人口统计学的有效评估。根据临床推荐的治疗方法和治疗剂量，根据患者的治疗结果状态（即初始评估和治疗后不建议随访、成功完成治疗、初始评估和治疗后失访、早期终止）对患者进行分类。
青少年在精神科筛查指标上的得分较高，所有年龄组的情绪问题得分最高。近 25%的失眠患者存在其他共患睡眠障碍，且使用睡眠辅助剂（褪黑素或催眠药）很常见。基线失眠严重程度显著预测睡眠治疗轨迹和治疗后失眠严重程度，所有年龄组均有较大影响。失眠治疗结果的其他临床相关预测因素包括药物使用和年轻患者的外化精神健康问题，以及老年患者的内化精神健康问题和实际年龄。在初始评估时，有最严重失眠症状的患者出现缺乏治疗随访和过早终止治疗的情况。
提供失眠治疗的儿科健康提供者应采取一种发展敏感的方法，对管理可能因失眠严重程度和共患精神健康问题而受到影响的治疗障碍采取积极主动的态度。
Van Dyk TR, Simmons DM, Durracio K, Becker SP, Byars KC. 儿科临床转介人群中精神症状、社会人口学因素和基线睡眠变量对儿童失眠治疗结果的作用。2024；20(11)：1727-1738.
