Evaluation of an Internet-Based Behavioral Intervention to Improve Psychosocial Health Outcomes in Children With Insomnia (Better Nights, Better Days): Protocol for a Randomized Controlled Trial

Abstract

The author-made SQ is a screening instrument comprised of 12 items to assess whether participants meet study inclusion criteria and do not meet any of the exclusion criteria. A specific item addressing co-sleeping is modelled conceptually on Ramos and colleagues' [63] study examining parental perceptions of sleep problems. The questionnaire requires approximately 5 minutes to complete. Eligibility Measures Behavioural Insomnia Questionnaire (BIQ)The BIQ is adapted by the authors based on the insomnia diagnosis criteria for children reported by Anders and Dahl [62]. The BIQ is comprised of 4 items to assess sleep onset disturbance and 4 items to assess night waking dyssomnia. An additional 9 items are included to capture sleep habits modelled from the ICSD-3/DSM-5 insomnia criteria. An evidence-based review [74] reported that the criteria, identified by Anders and Dahl, is one of few well-reported scales/assessments to evaluate insomnia symptoms in children. Only sleep onset items 1-4 are used to assess eligibility in this study. Children are determined to meet sleep onset disturbance criteria if two of the following three conditions are fulfilled for at least one month: 1) more than three parental reunions occur per night for children ages 12-14 months, or more than two reunions for children older than 24 months; 2) sleep onset latency is greater than 30 minutes for children ages 12-24 months, or greater than 20 minutes for children older than 24 months; and 3) parental presence is required for sleep onset for two or more nights per week. The BIQ requires approximately 5 minutes to complete. Pediatric Sleep Questionnaire (PSQ)The PSQ developed by Chervin and colleagues [64] is a 22-item questionnaire which measures features of the presence of pediatric sleep related breathing disorders (SRBD), including snoring, daytime sleepiness, and behavioural disturbance. Response options to each item are 1 "Yes," 0 "No," or excluded "Don't know." The PSQ includes 3 subscales: snoring (4 items), sleepiness (4 items), and inattentive/hyperactivity behaviour (6 items). Responses to all non-excluded items are averaged to obtain a total score between 0.00 and 1.00. Scores with a cut off value of 0.33 indicate the presence of an SRBD. The PSQ demonstrates strong association with diagnosis of an SRBD (P<0.0001); diagnosis is also reported to be strongly associated across the 3 subscales [74]. The PSQ has been validated for use in children aged 2-18 years, and yields a sensitivity of (α=.81-.85), a specificity of (α=.87) and correct diagnostic classification for 85-86% of subjects. It also demonstrates good internal consistency (α=.89) and good test-retest stability (r=.92) [63]. The average of the first 6 items of the PSQ related to snoring and sleep disrupted breathing are used to assess eligibility criteria in this study. A score of 0.33 and greater does not meet inclusion criteria. The PSQ requires approximately 5 minutes to complete.

Children’s Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families

“…This study included parents of children, now aged 4–14 years, who previously met research criteria for insomnia and participated in the BNBD pan-Canadian RCT 3.5 years prior ( Corkum et al, 2018 ). All parents who consented to participate in the BNBD RCT and consented to be contacted for future research ( n = 524) were eligible to participate.…”

“…This intervention offered evidence-based strategies for establishing a bedtime routine, creating a healthy sleep environment, stress reduction techniques, learning to fall asleep independently (i.e., modified extinction-based strategies), and using a reward system. Conducting a mixed-methods follow-up study with this cohort provided an opportunity to understand sleep during the first wave of the COVID-19 pandemic in children who had well-characterized sleep concerns and a comprehensive assessment of relevant psychosocial variables prior to the pandemic ( Corkum et al, 2018 ). An explanatory sequential mixed-methods approach was taken, a method by which quantitative data are collected and explored in-depth using qualitative data ( Creswell & Plano Clark, 2017 ).…”

Pediatric Insomnia: Update and Future Directions

“…In addition, web-based interventions are also gaining popularity in light of their relative success. [55][56][57] A Committee focused on Practice Parameters from the American Academy of Sleep Medicine reviewed 52 treatment studies pertaining to behavioral treatments of pediatric insomnia. They found that 94% of studies showed clinically significant improvements in the context of behavioral interventions.…”

A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study

“…AYAs are drawn to technology; therefore, technology provides an opportunity to directly reach this large invisible at-risk cohort for whom sleep disorders contribute to psychopathology and vice versa [ 34 , 35 ]. Although there are web-based programs for infant (aged 6-36 months) [ 36 ], pediatric (aged 1-8 years) [ 37 , 38 ], adolescent [ 39 - 41 ], and adult sleep disturbances [ 42 ], there are no evidence-based transdiagnostic programs that adequately address the multitude of sleep problems observed in AYAs and that span both adolescence and young adulthood. Put differently, as some of the sleep problems of AYAs are unique and go beyond insomnia (eg, voluntary sleep restriction, circadian phase delay, and poor sleep hygiene), pediatric and adult programs are not suitable for this age group.…”