Understanding patient characteristics and medication prescriptions in children with mental health and neurodevelopmental disorders referred to a sleep clinic-A quality improvement/quality assurance analysis

Osman S Ipsiroglu; Juhi Bhathella; Renee Paula Boldut; Dean Elbe; Olivia Hill; Elizabeth Keys; Scout McWilliams; Rosalia Silvestri; David F Wensley

doi:10.3389/fpsyt.2022.878356

Understanding patient characteristics and medication prescriptions in children with mental health and neurodevelopmental disorders referred to a sleep clinic-A quality improvement/quality assurance analysis

Front Psychiatry. 2022 Nov 10:13:878356. doi: 10.3389/fpsyt.2022.878356. eCollection 2022.

Authors

Osman S Ipsiroglu^{1

2}, Juhi Bhathella¹, Renee Paula Boldut¹, Dean Elbe^{3

4

5}, Olivia Hill^{1

2}, Elizabeth Keys^{6

7

8}, Scout McWilliams¹, Rosalia Silvestri^{9

10}, David F Wensley¹¹

Affiliations

¹ H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children's Hospital Research Institute, Vancouver, BC, Canada.
² Interdisciplinary Sleep Program, Divisions of Developmental Pediatrics, Respirology, and Child & Adolescent Psychiatry, Departments of Pediatrics and Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
³ Healthy Minds Centre, BC Children's Hospital, Vancouver, BC, Canada.
⁴ Department of Pharmacy, Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada.
⁵ Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
⁶ Faculty of Health and Social Development, School of Nursing, The University of British Columbia, Kelowna, BC, Canada.
⁷ Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
⁸ School of Nursing, Dalhousie University, Halifax, NS, Canada.
⁹ Centro Interdipartimentale per la Medicina del Sonno UOSD di Neurofisiopatologia e Disordini del Movimento, Messina, Italy.
¹⁰ Dipartimento di Medicina Clinica e Sperimentale, AOU Messina, Messina, Italy.
¹¹ Interdisciplinary Sleep Program, Division of Respirology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.

Abstract

Introduction: Motivated by challenges faced in outpatient sleep services for mental health and neurodevelopmental disorders (MHNDD) during the COVID-19 clinical shutdown, a pan-Canadian/international working group of clinicians and social scientists developed a concept for capturing challenging sleep and wake behaviours already at the referral stage in the community setting.

Methods: In a quality improvement/quality assurance (QIQA) project, a visual logic model was the framework for identifying the multiple causes and possible interventions for sleep disturbances. Intake forms informed clinicians about situational experiences, goals/concerns, in addition to the questions from the Sleep Disturbances Scale for Children (SDSC), the ADHD Rating Scale-IV and medication history. Descriptive statistics were used to describe the sample.

Results: 66% of the pilot study patients (n = 41) scored in the SDSC red domains (highest scoring) with highest sub-scores for insomnia (falling asleep 73%; staying asleep: 51%) and daytime somnolence (27%). A total of 90% of patients were taking at least one medication; 59% sleep initiation/sleep medications, 41% in combination with further non-stimulant medications, 9% with stimulants, 27% with antidepressants and 18% with antipsychotics. Polypharmacy was observed in 62% of all patients and in 73% of the ones medicated for sleep disturbances. Qualitative information supported individualisation of assessments.

Conclusion: Our intake process enabled a comprehensive understanding of patients' sleep and wake profiles prior to assessment, at the referral stage. The high prevalence of insomnia in patients, combined with polypharmacy, requires special attention in the triaging process at the community level.

Keywords: disruptive behaviour; medications; mental health; neurodevelopmental disorders (NDDs); pandemic; polypharmacy; sleep disorders; waitlist.