[:en]The impact of introduction the sleep diaries and a sleep evaluation questionnaire in the clinical practice of a PPC service[:ro]Impactul introducerii „jurnalelor de somn” și a chestionarelor SNAKE în practica clinică a Hospice ‘’Casa Speranței’’ Brașov[:]

[:en]Delia M Birtar, pediatrician, competence in paliative care, Hospice ”Casa Speranței”, Braşov, Romania

Address for correspondence: e-mail: birtardelia@yahoo.com

Abstract

Background:
The majority of children with severe disabilities present sleep disturbances (SD). This is often the most distressing complaint. However, the insomnia is not well studied and managed by professionals partly because the lack of suitable measurement methods.

Recently a team from Germany has developed and validated a questionnaire to assess different aspects of the SD and we have welcomed it in the clinical practice.

Objective:
To evaluate the impact of implementing the sleep diaries and the sleep evaluation questionnaire (SNAKE) on assessment and management of SD in a service of paediatric palliative care (PPC).

Methods:
Our unit contains an in-patient unit, a day centre and a home PPC team. From 149 children in our care, 83 have severe psychomotor impairment (55.7%). We have introduced the sleep diaries in our practice since 2012.

After the SNAKE questionnaire was published, we introduced it to all children with severe disabilities whose parents were willing and able to understand and respond to it.

As a follow up: 1. We did chart review looking for changes in the diagnosis and in the treatment of SD after the introduction of the new tools. 2. We asked parents about the usefulness of these methods. 3. We have inquired the staff about their perceptions on SD in children prior to and three months after the introduction of the SNAKE.

Results:
From 68 eligible patients, 52 had both the sleep diary and the SNAKE completed. In the in-patient unit there were prompt changes in the treatment plan as a result of better evaluation of the sleep. We received positive feed-back from the parents who were content that more attention was given to this often neglected symptom. The staff became more aware of the importance of evaluation and management of sleep problems.

Conclusions:
Keeping a sleep diary is a good start in the evaluation of the sleep; a more complex tool (such as the SNAKE) can give a better assessment of the symptom resulting in better treatment and improving the QOL of these patients.

Key words: children, sleep disturbances, sleep diary, sleep evaluation questionnaire, SNAKE, paediatric palliative care

(Full text in Romanian)

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