Elsevier

Sleep Medicine

Volume 6, Issue 1, January 2005, Pages 63-69
Sleep Medicine

Special Section: Sleep Medicine Education based on NIH Sleep Academic Award Program
Use of the ‘BEARS’ sleep screening tool in a pediatric residents' continuity clinic: a pilot study

https://doi.org/10.1016/j.sleep.2004.07.015Get rights and content

Abstract

Objective: To assess the effectiveness of a simple, 5‐item pediatric sleep screening instrument, the BEARS (B=Bedtime Issues, E=Excessive Daytime Sleepiness, A=Night Awakenings, R=Regularity and Duration of Sleep, S=Snoring) in obtaining sleep-related information and identifying sleep problems in the primary care setting.

Setting: Pediatric residents' continuity clinic in a tertiary care children's hospital.

Methods: BEARS forms were placed in the medical records of a convenience sample of 2 to 12 year old children presenting for well child visits over the 5 month study period. Sleep-related information recorded in the BEARS visit and in the pre-BEARS visit, which was the subject's most recent previous well child check (WCC), was coded with respect to whether or not a sleep problem was indicated, and whether sleep issues were addressed.

Results: A total of 195 children had both a documented pre-BEARS and BEARS WCC visit. BEARS visits were significantly more likely than the pre-BEARS visits to have any sleep information recorded (98.5% vs. 87.7%, p<0.001), and to have information recorded about bedtime issues (93.3% vs. 7.7%, p<0.001), excessive daytime sleepiness (93.9% vs. 5.6%, p<0.001), snoring (92.8% vs. 7.2%, p<0.001), nighttime awakenings (91.3% vs. 29.2%, p<0.001), and regularity and duration of sleep (65.3% vs. 31.5%, p<0.001). Significantly more sleep problems were identified during the BEARS visits in the domains of bedtime issues (16.3% vs. 4.1%, p<0.001), nighttime awakenings (18.4% vs. 6.8%, p<0.001) and snoring (10.7% vs. 4.6%, p=0.012). Finally, almost twice as many BEARS charts had sleep mentioned in the Impression and Plan (13.1% vs. 7.3%), which approached significance (p=0.07).

Conclusions: The BEARS appears to be a user-friendly pediatric sleep screening tool which significantly increases the amount of sleep information recorded as well as the likelihood of identifying sleep problems in the primary care setting.

Section snippets

Subjects

This study was conducted in a pediatric residents' continuity clinic in a children's teaching hospital in Rhode Island, which serves a multi-ethnic, primarily low-income population. The clinic has approximately 21,000 primary care visits per year. Patients are primarily seen for clinic visits by pediatric residents, as well as by pediatric nurse practitioners on the clinic staff and occasionally by pediatric attending faculty. Because of resident turnover and scheduling considerations, patients

Results

A total of 195 children had both a documented pre-BEARS and BEARS WCC visit. As expected, the average age at the BEARS visit was significantly older at 5.60 SD 2.85 years than the average age at the pre-BEARS visit of 4.35 SD 2.77 years (t=−20.586, P<0.001). Half (52%) of the sample was male, 44% was Hispanic, 27% was African-American, 16% Caucasian, 1% Asian, and 12% other. Eighty percent was at poverty or low-income level, based on Rhode Island zip code information.

Table 1 compares pre-BEARS

Discussion

The results of this study suggest that the use of a simple 5-question screening tool for pediatric sleep problems is significantly more likely than the use of a standard single chart prompt to yield sleep information in general, as well to yield information about specific sleep domains. There was a 2–ten-fold difference in the amount of information recorded during the BEARS visits in each of the five sleep domains and parasomnias. In addition, the information obtained with the BEARS screen was

Acknowledgements

This project was supported by the Sleep Academic Award grant program of the National Heart, Lung, and Blood Institute of the National Institute of Health.

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