The complexities of defining optimal sleep: empirical and theoretical considerations with a special emphasis on children

Subjective sleep measures for adolescents: a systematic review

BACKGROUND

Sleep disturbances in adolescents have received significant attention because of their high prevalence and the negative health outcomes. Relative to objective measures, subjective sleep instruments have been the most practical tools used to identify sleep problems and assess responses to interventions in research and clinical settings. This systematic review aims to examine the psychometric properties of subjective measures that are used to assess sleep quality and disturbances among adolescents, identify the strength and limitation of each measurement and inform recommendations for practice.

METHODS

PubMed, Embase and PsycInfo were searched from 2000 through May 2016. The reference lists of important articles were included if they met the inclusion criteria. The available measures were evaluated and classified as positive, intermediate or poor according to the quality criteria for health status questionnaires.

RESULTS

Thirteen self-reported or parent-reported sleep measures met the inclusion criteria. Of the measurements reviewed, six were generic instruments assessing overall sleep quality and disturbances; five were dimension-specific instruments measuring daytime sleepiness, sleep insufficiency and sleep hygiene; and two were condition-specific instruments for insomnia. None of the subjective sleep measures for adolescents has a psychometric profile with all essential measurement properties. Specifically, the generic sleep measurements capture multiple dimensions but face issues of participant burden and compatibility. Among the domain-specific tools, the Cleveland Adolescent Sleepiness Questionnaire and the Chronic Sleep Reduction Questionnaire have achieved good psychometric merits but need further evaluation for responsiveness. Likewise, essential measurement properties of condition-specific tools for insomnia have yet to be established.

CONCLUSIONS

Because of the limited evidence, no definite recommendations can be made at this point. However, each available measurement has its own uniqueness and strength despite the limitations. Future research on measurement development and evaluation for adolescent sleep is needed to ensure the relevance and suitability to different stages of adolescence and social contexts.

Circadian preferences and sleep in 15- to 20-year old Finnish students

Purpose

Despite progress in research concerning adolescent and young adult sleep and circadian preferences, several aspects have remained unexamined. This study explored gender and diurnal rhythms in relation to several sleep-related factors: sleep duration, bedtime, wake-up time, tiredness, sleepiness, and optimal subjective sleep duration

Methods

Circadian preferences and sleep were investigated in 555 (Females N=247) Finnish students aged 15–20. The self-report measures included a shortened version of the Horne-Östberg Morningness-Eveningness Scale, the Epworth Sleepiness Scale as well as items probing feelings of tiredness, optimal subjective sleep durations, and bedtime and wake-up time on the most recent day and a typical weekend. Data were collected from Tuesday to Thursday during an ordinary school week.

Results and conclusion

The most frequent chronotype was the intermediate type (54%), and compared to previous studies, the prevalence of evening-oriented individuals was high (37%), whereas only 9% of the participants were classified as morning oriented. No gender-specific or chronotype-specific differences in sleep durations were observed, but girls/women and evening-orientated individuals reported suffering more from sleepiness, compared to boys/men and more morning-typed participants, respectively. About 20% of the total sample indicated that their subjective need for sleep was not satisfied during the weekdays nor the weekend, indicating chronic sleep deprivation. Among girls/women and evening-oriented individuals, the subjective sleep need was greater for weekday nights.

Putting Children's Sleep Problems to Bed: Using Behavior Change Theory to Increase the Success of Children's Sleep Education Programs and Contribute to Healthy Development

Sleep is critical for the healthy development of children, yet most children simply don’t get enough. Whilst school based sleep education programs have been developed for parents and their children, they have had mixed success. We consider how existing school-based sleep education programs can be improved by applying a broader model to behaviour change theory. We find that the mixed success of school-based sleep education programs may be due to a plausible but misleading assumption that simply increasing information about the importance of sleep and the risks of insufficient and/or inefficient sleep, will necessarily result in improved sleep behaviours. We identify the potential benefits of using a more inclusive behavior change theory in the development of sleep education programs with a particular need for theories that incorporate the multiple biological, environmental and social impacts on children’s sleep. Bronfenbrenner’s Bioecological model is presented to illustrate how one such inclusive behavior change theory could significantly improve the success of sleep education programs and ultimately support the healthy development of children.

Characteristics Associated with Sleep Duration, Chronotype, and Social Jet Lag in Adolescents

Sleep is a complex behavior with numerous health implications. Identifying sociodemographic and behavioral characteristics of sleep is important for determining those at greatest risk for sleep-related health disparities. In this cross-sectional study, general linear models were used to examine sociodemographic and behavioral characteristics associated with sleep duration, chronotype, and social jet lag in adolescents. One hundred and fifteen participants completed Phase I (self-reported sleep measures), and 69 of these participants completed Phase II (actigraphy-estimated sleep measures). Black adolescents had shorter free night sleep than Hispanics. Youth with later chronotypes ate fewer fruits and vegetables, drank more soda, were less physically active, and took more daytime naps. Based on these findings, recommendations for individual support and school policies are provided.

ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations

The ABCs of SLEEPING mnemonic was developed to serve as an organizing framework for common pediatric sleep recommendations. The mnemonic stands for 1) age appropriate bedtimes and wake-times with consistency, 2) schedules and routines, 3) location, 4) exercise and diet, 5) no electronics in the bedroom or before bed, 6) positivity 7) independence when falling asleep and 8) needs of child met during the day, 9) equal great sleep. This review examines the empirical evidence behind the practices and recommendations captured by the ABCs of SLEEPING mnemonic for children aged 1 to 12. A search was conducted of key electronic databases (PubMed, PsycINFO, CINAHL, & EMBASE) to identify English articles that included the concepts of sleep, insomnia, and/or bedtime. 77 articles were eligible for inclusion and were coded to extract key details and findings regarding the relations between sleep practices identified in the ABCs of SLEEPING mnemonic and sleep outcomes. Findings provided preliminary support for many of the recommendations that are commonly made to families regarding healthy sleep practices. However, more robust investigations are needed to better understand the causal contributions of healthy sleep practices to the onset and maintenance of children's sleep problems.

High cardiac vagal control is related to better subjective and objective sleep quality

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Cardiac vagal control (CVC) was measured during an extended standardized baseline.

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Subjective and polysomnographic variables of sleep quality were assessed.

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Higher CVC was found to be associated with better subjective and objective sleep quality.

Cardiac vagal control (CVC) has been linked to both physical and mental health. One critical aspect of health, that has not received much attention, is sleep. We hypothesized that adults with higher CVC – operationalized by high-frequency heart rate variability (HF-HRV) – will exhibit better sleep quality assessed both subjectively (i.e., with Pittsburgh Sleep Quality Index) and objectively (i.e., with polysomnography). HF-HRV was measured in 29 healthy young women during an extended neutral film clip. Participants then underwent full polysomnography to obtain objective measures of sleep quality and HF-HRV during a night of sleep. As expected, higher resting HF-HRV was associated with higher subjective and objective sleep quality (i.e., shorter sleep latency and fewer arousals). HF-HRV during sleep (overall or separated by sleep phases) showed less consistent relationships with sleep quality. These findings indicate that high waking CVC may be a key predictor of healthy sleep.