(82) Screening for Sleep Disorders in Pediatric Patients with Cystic Fibrosis: Improved Knowledge and Early intervention

Background: SDs in pediatric Cystic Fibrosis are under-appreciated and under-diagnosed. Children with CF are four times more likely to have a sleep-disorder (SD) and three times more likely to have moderate-severe SDs. [1-3] SDs are associated with psychological/cognitive comorbidities such as anxiety, depression, and attention deficits. Additional risks include obesity, immune dysfunction, and cardiovascular disease. Given advances in CF survival and to further optimize patient long-term outcomes, systematic screening for SDs was integrated as a part of routine CF care at Duke University Pediatric CF Center.

Methods: We implemented the BEARS questionnaire, a sleep screening instrument (B=Bedtime Issues, E=Excessive Daytime Sleepiness, A=Night Awakenings, R=Regularity and Duration of Sleep, S=Snoring) in CF patients aged 2 to 18 years [4] starting January, 2022 to March, 2022 with plans to reassess process and outcome measures every 3 months for 1 year. Primary measures included the proportion of eligible patients screened using the BEARS questionnaire and the rate of referrals for evaluation/intervention at our sleep clinic. Secondary measures included wait time for sleep clinic evaluation and, if needed, polysomnography (PSG) scheduling. As a part of this improvement process, effort was made to identify barriers to screening and referral completion.

Results: Seventy-seven percent (40/52) of patients were eligible for screening. None had documentation of SD screening on previous visits. Twenty-three (58%) completed screening of which 6/23 (26%) reported variable sleep issues. These six questionnaires were reviewed by our sleep specialist. All six were referred for a telehealth sleep clinic evaluation and 50% were referred for PSG (Image 1). Barriers identified included: lack of prioritization of the screening on busy clinic days, parental disinterest in screening and undermining its value, extended wait time for sleep clinic and PSG scheduling leading to appointment cancellations.

Conclusions: Formal screening for SDs in our Pediatric CF population identified sleep issues in more than a quarter of those screened. Sleep issues were captured as a problem during routine care prior to this systematic screening. However, screening resulted in the identification of concerns with potential solutions. Screening increased family and CF team awareness of sleep issues and anticipated intervention using sleep hygiene plans. Our process and outcomes will be tracked through December 2022 with stratification by age, race, and type of sleep disturbance. Identifying a point person to facilitate sleep visit scheduling is planned.

Acknowledgements:

References: [1] Shakkottai A, Nasr SZ, Hassan F, Irani S, O'Brien LM, Chervin RD. Sleep-disordered breathing in cystic fibrosis. Sleep Med. 2020;74:57-65.

[2] Reiter J, Gileles-Hillel A, Cohen-Cymberknoh M, Rosen D, Kerem E, Gozal D, et al. Sleep disorders in cystic fibrosis: A systematic review and meta-analysis. Sleep Med Rev. 2020;51:101279.

[3] De Sousa LP, Liberato FMG, Vendrusculo FM, Donadio MVF, Barbosa RRB. Obstructive sleep apnea in children and adolescents with cystic fibrosis and preserved lung function or mild impairment: a systematic review and meta-analysis of prevalence. Sleep Med. 2021;88:36-43.

[4] Owens JA, Dalzell V. Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study. Sleep Med. 2005;6(1):63-9.