What was the research about?
Healthy sleep is important for a child’s well-being, school performance, and mood. Doctors can ask children about their sleep health to identify and treat sleep problems. However, few reliable surveys are available for doctors to use to ask children about their sleep.
In this study, the research team created sets of survey questions that asked children or their parents about sleep health. The team interviewed children and their parents to make sure they could understand the questions and that the questions included sleep health topics important to them.
What were the results?
The research team created two sets of survey questions to measure important aspects of children’s sleep health. One set asked about common problems that disturb a child’s sleep and cause trouble falling or staying asleep. The other set asked about ways that sleep problems affect a child’s ability to function during the day, such as problems staying awake or changes in mood. Each set of questions had two versions. In one version, children answered questions about their own sleep. In the other version, parents answered questions about their children’s sleep. Tests showed that the question sets provide a good measure of children’s sleep health.
Who was in the study?
Children with sleep problems, parents of children with sleep problems, and sleep health experts helped the study team decide on the types of questions to include in the survey. The research team also had children and parents check the questions for understanding. Then, the team tested the surveys with 2,676 children ages five to seven and 3,197 parents across the United States, including
- Children without sleep problems and their parents
- Children with sleep problems and their parents
- Children with chronic illnesses that may cause sleep problems and their parents
What did the research team do?
Using a set of questions designed for adults, the research team developed sets of questions for children and their parents to answer to describe the children’s sleep. The team then interviewed 28 children with sleep problems, 33 parents of children with sleep problems, and 8 sleep experts. The team asked whether there were other important questions to add about sleep health. To find more questions about children’s sleep, the team also looked at other surveys.
Next, 32 children and 21 parents read and responded to the new sets of sleep questions. Their answers helped the research team see how well the parents and children understood the questions. The team then changed or removed survey questions that weren’t clear.
Finally, the research team created two surveys with the sleep questions. One survey asked children about their sleep. The other survey asked parents about their children’s sleep. The team used the survey responses to identify the most accurate questions to measure the quality and effects of children’s sleep.
What were the limits of the study?
The survey questions didn’t ask about everything that may affect children’s sleep health. For example, the survey didn’t include other factors that may prevent healthy sleep, such as the level of noise from neighbors.
Future research could translate the survey questions from English into other languages so more people could use the survey. Researchers could also use the survey questions to study how a change in a child’s health affects sleep.
How can people use the results?
Doctors can use some or all of the survey questions to see whether children have sleep problems and how serious those sleep problems are. The results may also help doctors to guide treatment for sleep problems.
To use qualitative and quantitative methods to develop survey questions and to evaluate the reliability and validity of Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks that measure children’s sleep health
Item bank and survey question development and testing
|Data Sources and Data Sets||
Item bank and survey question development: literature review; interviews with 33 parents of children with sleep problems, 28 children with sleep problems, and 8 sleep medicine experts; review of survey questions by 21 parents and 32 children
Survey testing: 3,197 parents and 2,676 children ages 5–17
Qualitative analysis of interview data, exploratory factor analysis, item response theory analysis
Item banks measuring 2 domains of pediatric sleep health
Although substantial evidence supports the importance of sleep to children’s health, there are no widely used measures of sleep health based on self-report by children or reports from parents. In this study, the research team developed item banks of survey questions to measure children’s sleep health. An item bank is a collection of survey questions about a specific topic. During the development process, the team collaborated with children with sleep problems, their parents, sleep-medicine clinicians, sleep-health advocates, and measure-development researchers.
The research team took questions from two PROMIS® item banks that measure adults’ sleep disturbance and sleep-related impairment. The team then adapted the questions for children and parents. To identify any important sleep concepts missing from the adapted questions, the team interviewed 33 parents of children with sleep problems, 28 children with sleep problems, and 8 sleep-medicine experts. The team also reviewed the literature to find other patient-reported outcome survey questions that measure children’s sleep health.
Next, the team asked 21 parents and 32 children to review the survey questions in the item banks. If survey questions were confusing or not interpreted as intended, the team revised or deleted the questions from the item banks. Then the team created two versions of each item bank, one with questions for children about their own sleep and one with questions for parents about their children’s sleep.
Using the questions from the item banks, the research team developed a survey and administered it to 2,676 children ages 5–17 and 3,197 parents. These children and parents were from a national online panel that included a general population of children and their parents, children with sleep problems and their parents, and children with chronic conditions that might affect their sleep health and their parents.
To identify the best questions to measure sleep health and to evaluate the questions’ validity and reliability, the research team used item-response theory. The team also evaluated the validity of the item banks by comparing the sleep scores that resulted with other indicators of patients’ sleep quality in patients known to have sleep problems. To further evaluate the validity of the measures, the team compared sleep scores for the general population with scores for children with sleep problems and children with chronic conditions, which can cause sleep problems.
Results showed that the item banks developed and validated in this study produced reliable and valid data to describe children’s sleep health.
The study did not test the validity of the sleep measures in describing changes in sleep over time. Also, the survey questions do not assess all factors potentially affecting children’s sleep health, such as environmental conditions that promote or prevent healthy sleep.
Conclusions and Relevance
This study produced reliable and valid measures of children’s sleep health based on child self-report and parent-proxy report. Clinicians can use these measures to determine the presence and severity of sleep problems in children. The results can also help clinicians guide the treatment of children’s sleep problems.
Future Research Needs
Future research could translate the survey questions into other languages and test their effectiveness. Researchers could also use the survey questions to examine sleep health and its relationship to changes in health status in children with sleep problems.
Final Research Report
View this project's final research report.
Related Journal Citations
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
The awardee made the following revisions in response to peer review:
- The awardee reorganized the methods section sequentially, so the awardee could describe the methods for each aim separately. The awardee did this to address reviewers’ concerns about difficulty following the progression of the study.
- The awardee responded to reviewer questions about a study eligibility requirement that a child be able to self-report outcomes. In doing so, the awardee added more information to the methods section indicating that the awardee asked parents during study enrollment whether their children had any intellectual or developmental disabilities that would prevent their children from completing a study questionnaire. As a result, only a few intellectually disabled children with a rare genetic disorder participated in the study.
- The awardee underscored that the sleep measure focused on insomnia in children. Further, the awardee pointed out that the measure did not evaluate other pediatric sleep disorders, such as periodic limb movements or hypersomnia.
Conflict of Interest Disclosures
Study Registration Information
Final Research Report
View this project's final research report.
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