Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study.
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.


METHODS
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.
Owens
Judith A
JA
Division of Pediatric Ambulatory Medicine, Brown University School of Medicine, Rhode Island Hospital, 593 Eddy St., Potter Building, Suite 200, Providence, RI 02903, USA. owensleep@aol.com
Dalzell
Victoria
V
D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000379:methods*; D010865:Pilot Projects; D012890:Sleep; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000503:physiopathology; D012913:Snoring / Q000175:diagnosis; D013997:Time Factors; D014851:Wakefulness