Commentary:Beta‐blockers and sleep problems

Frost et al10 designed a prospective study using a validated questionnaire, Brief Infant Sleep Questionnaire (BISQ), and a bracelet actigraph (measuring movement as a surrogate marker of wakefulness) 1 week before propranolol initiation and 5 weeks after. They concluded that there was no evidence of increased sleep disturbance in patients treated with propranolol. While on the surface, their conclusion is reassuring, the study had limitations well acknowledged by the authors such as very small sample size, very few patients participating in the actigraphy portion (10/55), and very short duration of follow‐up (5 weeks). Additionally, the BISQ questionnaire lacks granularity and tends to emphasize sleeping issues that are in the normal variant range of developmental problems (“Is the sleep problem a small problem or none at all?”).