A Sleep Questionnaire for Children with Severe Psychomotor Impairment (SNAKE)—Concordance with a Global Rating of Sleep Quality

Abstract

Sleep problems are a common and serious issue in children with life-limiting conditions (LLCs) and severe psychomotor impairment (SPMI). The “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen, SNAKE) was developed for this unique patient group. In a proxy rating, the SNAKE assesses five different dimensions of sleep(-associated) problems (disturbances going to sleep, disturbances remaining asleep, arousal and breathing disorders, daytime sleepiness, and daytime behavior disorders). It has been tested with respect to construct validity and some aspects of criterion validity. The present study examined whether the five SNAKE scales are consistent with parents’ or other caregivers’ global ratings of a child’s sleep quality. Data from a comprehensive dataset of children and adolescents with LLCs and SPMI were analyzed through correlation coefficients and Mann–Whitney U testing. The results confirmed the consistency of both sources of information. The highest levels of agreements with the global rating were achieved for disturbances in terms of going to sleep and disturbances with respect to remaining asleep. The results demonstrate that the scales and therefore the SNAKE itself is well-suited for gathering information on different sleep(-associated) problems in this vulnerable population.

Assessment of Sleep-Related Problems in Children with Cerebral Palsy Using the SNAKE Sleep Questionnaire

“…The SNAKE assesses children’s sleep behavior during the past 4 weeks. It is based on parent’s or caregiver’s proxy reporting and includes five scales oriented on the International Classification of Sleep Disorders-2 [ 44 ]: (1) disturbances going to sleep (value range: 5–20; normal range: 6–14, T-score: 40–60), (2) disturbances remaining asleep (value range: 5–20; normal range: 8–17 points, T-score: 41–60), (3) arousal and breathing disorders (value range: 6–24; normal range: 7–16, T-score: 41–60), (4) daytime sleepiness (value range: 3–12; normal range: 4–9, T-score: 41–58), and (5) daytime behaviour disorders (value range: 4–16; normal range: 4–12, T-score: 36–59; [ 26 , 36 , 37 , 45 ]. In addition, a global rating of the child’s sleep during the reference period can be made (4-point Likert scale; very well, well, satisfactory, poor).…”

“…In our study, some children also scored outside the normal range of the SNAKE, which may tend to indicate abnormal sleep behavior and fits with the numerous existing studies, which ascribed sleep disturbances to children with CP [ 17 , 21 , 25 , 54 , 57 , 58 ]. Nevertheless, as the greatest limitation of the study, it must be stressed at this point that the SNAKE defines no cut-off values that determine at what point a child’s sleep behavior is clinically relevant and thus potentially requiring special attention or treatment [ 37 , 45 ]. In order for the SNAKE to be fully applicable to complex samples, such as the one studied, and also to have relevance as a diagnostic tool for everyday clinical practice, the definition of cut-off values, for example, as part of a revision of the SNAKE, should definitely be sought.…”

“…The “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen, SNAKE) was specifically developed for children with psychomotor impairments and complex (neurological) conditions and was confirmed to show a good reliability and validity [ 26 ]. It comprises items that are disregarded in other frequently used questionnaires, such as the “Sleep Disturbance Scale for Children” (SDSC; [ 21 , 27 ]), the “Children’s Sleep Habits Questionnaire” (CSHQ; [ 28 , 29 , 30 , 31 , 32 ]), or the “Sleep Behavior Questionnaire” (SBQ; [ 33 , 34 ]), that have been applied in different studies [ 35 ] but, however, were developed per se for healthy persons [ 26 , 36 , 37 ]. Although the potential utility of the SNAKE for examining sleep in children with CP has been pointed out [ 38 ], it has not yet been used in a systematic study with this particular population.…”

The Unfavorable Alliance of Pain and Poor Sleep in Children with Life-Limiting Conditions and Severe Psychomotor Impairment

“…The data from each patient were based on a proxy report of parents or caregivers assessed through the SNAKE [ 4 ]. More detailed information on children’s recruitment can be found in studies based on the same dataset but with different questions that have been published previously [ 4 , 34 , 35 , 36 ].…”

Disturbi del sonno. Consigli pratici di gestione nei pazienti eleggibili alle cure palliative pediatriche

“…È importante valutare il percepito del paziente e del caregirver sulla qualità del sonno. Per questo esistono delle scale di valutazione validate che possono aiutare il clinico nell'inquadramento del sintomo: tra quelli usati e validati troviamo: la Sleep Disturbance Scale (SDSC), validata in età pedia-SAPER FARE trica [5], la scala PROMIS [6] nel paziente oncologico, la scala SNAKE [7], rivolta a indagare la qualità del sonno nei bambini con compromissione neurologica. Tutte queste scale valutano aspetti sia qualitativi sia quantitativi del sonno con la differenza che le scale SDSC e SNAKE vengono compilate unicamente dal caregiver, mentre la PROMIS viene proposta sia al caregiver sia direttamente al paziente se di età superiore agli 8 anni.…”