Delayed benefit of naps on motor learning in preschool children

A Matter of Time: A Web-Based Investigation of Rest and Sleep Effects on Speech Motor Learning

PURPOSE

Here, we examine the possibility that memory consolidation during a period of postpractice rest or nocturnal sleep can bolster speech motor learning in the absence of additional practice or effort.

METHOD

Using web-administered experiments, 74 typical, American English talkers trained in a nonnative vowel contrast then had a 12-hr delay with (SLEEP) or without nocturnal sleep (REST) or proceeded immediately (IMMEDIATE) to a posttraining production assessment. For ecological validity, 51 native Danish talkers perceptually identified the American English talkers' productions.

RESULTS

We observed that practice resulted in productions that were more acoustically similar to the Danish target. In addition, we found that rest in the absence of further practice reduced the token-to-token variability of the productions. Last, for vowels produced immediately following training, listeners more accurately identified vowels in the trained context, whereas in the untrained context, listener accuracy improved only for vowels produced by talkers who slept.

CONCLUSIONS

A single session of speech motor training promotes observable change to speech production behavior. Specifically, practice facilitates acoustic similarity to the target. Moreover, although a 12-hr postpractice period of rest appears to promote productions that are less variable, only the productions of those who slept are perceived as more accurate by listeners. This may point to sleep's role in contextualizing the acoustic goal of the production to the learner's own vocal tract and its role as a protective mechanism during learning. These results are unaccounted for under existing models and offer potential for future educational and clinical applications to maximize speech motor learning.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24707442.

Developmental changes in retention and generalization of nonadjacent dependencies over a period containing sleep in 18-mo-old infants

Sleep promotes the stabilization of memories in adulthood, with a growing literature on the benefits of sleep for memory in infants and children. In two studies, we examined the role of sleep in the retention and generalization of nonadjacent dependencies (NADs; e.g., a-X-b/c-X-d phrases) in an artificial language. Previously, a study demonstrated that over a delay of 4 h, 15 mo olds who nap after training retain a general memory of the NAD rule instead of memory for specific NADs heard during training. In experiment 1, we designed a replication of the nap condition used in the earlier study but tested 18-mo-old infants. Infants of this age retained veridical memory for specific NADs over a delay containing sleep, providing preliminary evidence of the development of memory processes (experiment 1). In experiment 2, we tested 18 mo olds' ability to generalize the NAD to new vocabulary, finding only infants who napped after training generalized their knowledge of the pattern to completely novel phrases. Overall, by 18 mo of age, children retain specific memories over a period containing sleep, and sleep promotes abstract memories to a greater extent than wakefulness.

Associations between parental relationship dissolution and child sleep: A systematic review

Parental relationship dissolution is considered one of the most common adverse childhood experiences. Although sleep is crucial for healthy development of children and very sensitive to environmental changes, it is poorly studied in the context of parental relationship dissolution. The aim of the current study was to systematically review and critically assess the existing literature on the associations between parental relationship dissolution and child sleep (0-18 years old; registered on PROSPERO (CRD42021272720)). PsycInfo, MEDLINE, Scopus, ProQuest Dissertations and Theses Global, Social Work abstracts, and Web of Science Core Collection were searched. Published empirical quantitative studies were included if they reported statistics regarding the association between parental relationship dissolution and any child sleep variable. Out of the 358 articles screened, 14 articles met inclusion criteria and reported on several sleep dimensions: sleep quality, dreams and nightmares, and sleep disorders (enuresis, night terrors, and bruxism). Out of the 14 articles, six were longitudinal studies and eight were cross-sectional studies. While most studies found that parental relationship dissolution was associated with some indices of poorer child sleep, studies were generally of low to moderate quality. Health professionals should assess child sleep in the context of a parental relationship dissolution.

Associations of activity, sedentary, and sleep behaviors with cognitive and social-emotional health in early childhood

Background

Early childhood is important for cognitive and social-emotional development, and a time in which to promote healthy movement behaviors (sedentary behavior, physical activity, and sleep). Movement behaviors may have interactive influences on cognition and social-emotional factors in young children, but most previous research has explored them independently. The purpose of this study was to determine if movement behaviors are associated with measures of cognitive and social-emotional health in young children and if so, to describe optimal compositions of movement behaviors of a daily cycle for such outcomes.

Methods

Children (n = 388, 33 to 70 months, 44.6% female) from a clinical trial (ClinicalTrials.gov ID: NCT03285880, first posted September 18, 2017) wore accelerometers on their wrists for 24-h for 9.56 ± 3.3 days. Movement behavior compositions consisted of time spent in sedentary behaviors, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sleep. Outcomes were cognitive (receptive vocabulary, declarative and procedural memory, and executive attention) and social-emotional measures (temperament and behavioral problems). Compositional linear regression models with isometric log ratios were used to investigate the relations between the movement behavior composition and the cognitive and social-emotional health measures. If a significant association was found between the composition and an outcome, we further explored the "optimal" 24-h time-use for said outcome.

Results

Movement behavior compositions were associated with receptive vocabulary. The composition associated with the predicted top five percent of vocabulary scores consisted of 12.1 h of sleep, 4.7 h of sedentary time, 5.6 h of light physical activity, and 1.7 h of MVPA.

Conclusions

While behavior compositions are related to vocabulary ability in early childhood, our findings align with the inconclusiveness of the current evidence regarding other developmental outcomes. Future research exploring activities within these four movement behaviors, that are meaningful to cognitive and social-emotional development, may be warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-023-00016-6.

The unique contributions of day and night sleep to infant motor problem solving

The current study sought to tease apart the unique contributions of napping and nighttime sleep to infant learning, specifically in the context of motor problem solving. We challenged 54 walking infants to solve a novel locomotor problem at three time points-training, test, and follow-up the next morning. One group of infants napped during the delay between training and test. Another group did not sleep during the delay. A third group received the test immediately after training with no delay. Only the Nap group's strategy choices continued to improve through the follow-up session, suggesting that daytime sleep has an active role in strengthening otherwise fragile memory. Although group did not affect strategy maintenance, walk experience did, suggesting that task difficulty may shape the impact of sleep on learning. Thus, day sleep and night sleep make independent contributions to the consolidation of motor problem-solving strategies during infancy.

Systematic review and meta-analyses on the effects of afternoon napping on cognition

Naps are increasingly considered a means to boost cognitive performance. We quantified the cognitive effects of napping in 60 samples from 54 studies. 52 samples evaluated memory. We first evaluated effect sizes for all tests together, before separately assessing their effects on memory, vigilance, speed of processing and executive function. We next examined whether nap effects were moderated by study features of age, nap length, nap start time, habituality and prior sleep restriction. Naps showed significant benefits for the total aggregate of cognitive tests (Cohen's d = 0.379, CI₉₅ = 0.296-0.462). Significant domain specific effects were present for declarative (Cohen's d = 0.376, CI₉₅ = 0.269-0.482) and procedural memory (Cohen's d = 0.494, CI₉₅ = 0.301-0.686), vigilance (Cohen's d = 0.610, CI₉₅ = 0.291-0.929) and speed of processing (Cohen's d = 0.211, CI₉₅ = 0.052-0.369). There were no significant moderation effects of any of the study features. Nap effects were of comparable magnitude across subgroups of each of the 5 moderators (Q values = 0.009 to 8.572, p values > 0.116). Afternoon naps have a small to medium benefit over multiple cognitive tests. These effects transcend age, nap duration and tentatively, habituality and prior nocturnal sleep.

Motor memory consolidation in children: The role of awareness and sleep on offline general and sequence-specific learning

Study aim: The purpose of this study was to investigate the role of sleep and awareness on consolidation of general and Sequence-Specific learning in children.

Material and methods: Male participants (n = 48, 10 to 12 years old) were assigned to one of four groups based on awareness and sleep. Acquisition phase took place in the morning (wake groups, 8 ± am) or in the evening (sleep groups, 8 ± pm) followed by a 12 hours retention interval and a subsequent delayed retention test (1 week). Children in the explicit groups were informed about the presence of the sequence, while in the implicit groups were not informed about it. For data analysis in consolidation of general sequence learning and Sequence-Specific Consolidation phases, 2 × 2 × 2 and 2 × 2 × 3 ANOVA with repeated measures on block tests were used respectively.

Results: The data provides evidence of offline enhancement of general motor learning after 12 hours which was dependent on sleep and awareness. Moreover, the information persistence after 1-week was significant only in sleep groups. The results also indicated that consolidation of sequence-specific learning was only observed after 12 hours in element duration and it was related to sleep and awareness.

Conclusions: The results revealed that sleep wasn’t only an essential factor in enhancement of off-line sequence learning task after 12 hours in children, but performance of the children was dependent on awareness and sleep.

A case for the role of memory consolidation in speech-motor learning

This review will explore the role of memory consolidation in speech-motor learning. Existing frameworks of speech-motor control account for the protracted time course of building the speech-motor representation. These perspectives converge on the speech-motor representation as a multimodal unit that is comprised of auditory, motor, and linguistic information. Less is known regarding the memory mechanisms that support the emergence of a generalized speech-motor unit from instances of speech production. Here, we consider the broader learning and memory consolidation literature and how it may apply to speech-motor learning. We discuss findings from relevant domains on the stabilization, enhancement, and generalization of learned information. Based on this literature, we provide our predictions for the division of labor between conscious and unconscious memory systems in speech-motor learning, and the subsequent effects of time and sleep to memory consolidation. We identify both the methodological challenges, as well as the practical importance, of advancing this work empirically. This discussion provides a foundation for building a memory-based framework for speech-motor learning.

Role of Napping for Learning across the Lifespan

Purpose of review

Napping is a common behavior across age groups. While studies have shown a benefit of overnight sleep on memory consolidation, given differences in nap frequency, composition, and intent, it is important to consider whether naps serve a memory function across development and aging.

Recent findings

We review studies of the role of naps in declarative, emotional, and motor procedural memory consolidation across age groups. Recent findings in both developmental and aging populations find that naps benefit learning of many tasks but may require additional learning or sleep bouts compared to young adult populations. These studies have also identified variations in nap physiology based on the purpose of the nap, timing of the nap, or age.

Summary

These studies lend to our understanding of the function of sleep, and the potential for naps as an intervention for those with reduced nighttime sleep or learning impairments.

Sleep and human cognitive development

Emerging studies across learning domains have shed light on mechanisms underlying sleep's benefits during numerous developmental periods. In this conceptual review, we survey recent studies of sleep and cognition across infancy, childhood, and adolescence. By summarizing recent findings and integrating across studies with disparate approaches, we provide a novel understanding of sleep's role in human cognitive function. Collectively, these studies point to an interrelation between brain development, sleep, and cognition. Moreover, we point to gaps in our understanding, which inform the agenda for future research in developmental and sleep science.

The role of naps in memory and executive functioning in early childhood

While sleep, including naps, has been shown to benefit many cognitive functions in adults, understanding whether naps are beneficial in early childhood has important translational implications. Here we review recent studies which, collectively, suggest that naps indeed benefit cognition at this age. Specifically, declarative, motor, and emotional memory are better if a nap follows learning. Executive functions such as attention and emotion processing are likewise better following sleep. However, a better understanding of the mechanism supporting these benefits and the generalizability to other forms of learning and executive functions is necessary. It is important for future research to extend such findings, which may promote the use of naps to support early education, particularly for learning-impaired children.

Slow wave sleep in naps supports episodic memories in early childhood

Naps have been shown to benefit visuospatial learning in early childhood. This benefit has been associated with sleep spindles during the nap. However, whether young children's naps and their accompanying physiology benefit other forms of declarative learning is unknown. Using a novel storybook task, we found performance in children (N = 22, mean age = 51.23 months) was better following a nap compared to performance following an equivalent interval spent awake. Moreover, performance remained better the following day if a nap followed learning. Change in post-nap performance was positively associated with the amount of time spent in slow wave sleep during the nap. This suggests that slow wave sleep in naps may support episodic memory consolidation in early childhood. Taken in conjunction with prior work, these results suggest that multiple features of brain physiology during naps may contribute to declarative memory processing in early childhood.

Longitudinal correlates of sleep duration in young children

OBJECTIVE

The primary aim of this study was to longitudinally examine potential demographic and screen time correlates of nap duration, nighttime sleep duration, and total sleep duration in young children over two time points.

METHODS

Data from the supporting Healthy physical AcTive Childcare setting (HATCH) study were analyzed. Participants were 206 toddlers (19-35 months) and preschoolers (36-60 months) in Alberta and Ontario, Canada. Child age, screen time (television, video games), and sleep duration (nap, nighttime) were measured at baseline and six-month follow-up, while other demographic variables were assessed at baseline only using the HATCH parental questionnaire. Mixed models were performed to examine the associations between potential correlates and sleep duration over time.

RESULTS

In the multiple regression models, significant correlates of total sleep duration (min/d) were child age (months; B = -3.03; 95%CI:-3.88,-2.19) and parental education (bachelor's degree vs. below bachelor level; B = 29.74, 95%CI:7.43,52.06). Significant correlates of nighttime sleep duration (min/d) included child age (B = -0.81; 95CI%:-1.53,-0.10), child race/ethnicity (Caucasian vs. non-Caucasian; B = 15.31; 95%CI:0.38,30.25), household income (>$150,000 vs. <$50,000; B = 32.93, 95%CI:9.80,56.06), television time (B = -0.19, 95%CI:-0.32,-0.05), video games time (B = -0.19, 95%CI: -0.38, -0.01) and total screen time (B = -0.19; 95%CI:-0.29,-0.08). Significant correlates of nap duration (min/d) were child age (B = -2.10; 95%CI:-2.68,-1.51) and race/ethnicity (Caucasian vs. non-Caucasian; B = -13.73; 95%CI:-25.78,-1.68).

CONCLUSION

Young children who were non-Caucasian, from lower income families, who had less-educated parents, or who had more screen time tended to have shorter sleep duration. Targeting these demographic groups and screen time appears important for promoting adequate sleep duration in early childhood.

Habitual sleep is associated with both source memory and hippocampal subfield volume during early childhood

Previous research has established important developmental changes in sleep and memory during early childhood. These changes have been linked separately to brain development, yet few studies have explored their interrelations during this developmental period. The goal of this report was to explore these associations in 200 (100 female) typically developing 4- to 8-year-old children. We examined whether habitual sleep patterns (24-h sleep duration, nap status) were related to children’s performance on a source memory task and hippocampal subfield volumes. Results revealed that, across all participants, after controlling for age, habitual sleep duration was positively related to source memory performance. In addition, in younger (4–6 years, n = 67), but not older (6–8 years, n = 70) children, habitual sleep duration was related to hippocampal head subfield volume (CA2-4/DG). Moreover, within younger children, volume of hippocampal subfields varied as a function of nap status; children who were still napping (n = 28) had larger CA1 volumes in the body compared to children who had transitioned out of napping (n = 39). Together, these findings are consistent with the hypothesis that habitually napping children may have more immature cognitive networks, as indexed by hippocampal integrity. Furthermore, these results shed additional light on why sleep is important during early childhood, a period of substantial brain development.

Neuroimaging the sleeping brain: Insight on memory functioning in infants and toddlers

Episodic memory, or the ability to remember past events with specific detail, is central to the human experience and is related to learning and adaptive functioning in a variety of domains. In typically developing children, episodic memory emerges during infancy and improves during early childhood and beyond. Developmental processes within the hippocampus are hypothesized to be primarily responsible for both the early emergence and persistence of episodic memory in late infancy and early childhood. However, these hypotheses are based on non-human models. In-vivo investigations in early human development of hippocampal processes have been significantly limited by methodological challenges in acquiring neuroimaging data, particularly task-related functional neuroimaging data, from infants and toddlers. Recent studies in adults have shown neural activity in the brain regions supporting episodic memory during slow-wave sleep using functional magnetic resonance imaging (fMRI), and fMRI has been increasingly utilized in infancy and early childhood to address other research questions. We review initial evidence and present preliminary data showing the promise of this approach for examining hippocampal contribution to how infants and toddlers remember individual events, and their association with information about the context in which the event occurred. Overall, our review, integrated with the presentation of some preliminary data provides insight on leveraging sleep to gain new perspectives on early memory functioning.

The cross-sectional and prospective associations between sleep characteristics and adiposity in toddlers: Results from the GET UP! Study

BACKGROUND

The associations between sleep characteristics and adiposity in children under three years are not fully understood yet.

OBJECTIVE

The objective of the study is to examine the cross-sectional and prospective associations between sleep characteristics and adiposity in toddlers over a 12-month period.

METHODS

Participants were 202 toddlers from the GET-UP!

STUDY

Sleep duration, sleep timing, and sleep variability were assessed using 24-hour accelerometry for seven consecutive days. Height and weight were measured, and BMI z scores were calculated. Linear mixed models were performed to examine the cross-sectional and prospective associations between sleep characteristics and adiposity, with adjustments for clustering effects and demographic factors.

RESULTS

Total sleep duration was negatively associated with higher adiposity cross-sectionally (B = -0.12; 95% CI: -0.23, -0.01; .033) but not prospectively (B = 0.01; 95% CI: -0.13, 0.10; .843). Nap duration was prospectively associated with higher levels of adiposity (B = 0.41; 95% CI: 0.14, 0.68; .003). Sleep variability and sleep timing were not associated with concurrent or subsequent adiposity.

CONCLUSION

Although sleep duration is an important factor associated with obesity in toddlerhood, the potential effects of different types of sleep duration may vary. While longer total sleep duration may protect children from increasing adiposity, longer nap duration seems to be risk factor. As evidence in this age group is scarce, more research is needed to confirm this finding.

Measuring Neural Mechanisms Underlying Sleep-Dependent Memory Consolidation During Naps in Early Childhood

Sleep is critical for daily functioning. One important function of sleep is the consolidation of memories, a process that makes them stronger and less vulnerable to interference. The neural mechanisms underlying the benefit of sleep for memory can be investigated using polysomnography (PSG). PSG is a combination of physiological recordings including signals from the brain (EEG), eyes (EOG), and muscles (EMG) that are used to classify sleep stages. In this protocol, we describe how PSG can be used in conjunction with behavioral memory assessments, actigraphy, and parent-report to examine sleep-dependent memory consolidation. The focus of this protocol is on early childhood, a period of significance as children transition from biphasic sleep (consisting of a nap and overnight sleep) to monophasic sleep (overnight sleep only). The effects of sleep on memory performance are measured using a visuospatial memory assessment across periods of sleep and wakeful-rest. A combination of actigraphy and parent report is used to assess sleep rhythms (i.e., characterizing children as habitual or non-habitual nappers). Finally, PSG is used to characterize sleep stages and qualities of those stages (such as frequencies and the presence of spindles) during naps. The advantage of using PSG is that it is the only tool currently available to assess sleep quality and sleep architecture, pointing to the relevant brain state that supports memory consolidation. The main limitations of PSG are the length of time it takes to prepare the recording montage and that recordings are typically taken over one sleep bought. These limitations can be overcome by engaging young participants in distracting tasks during application and combining PSG with actigraphy and self/parent-report measures to characterize sleep cycles. Together, this unique combination of methods allows for investigations into how naps support learning in preschool children.

Television use and its effects on sleep in early childhood

OBJECTIVES

The purpose of this study was to investigate the impacts of television (TV) viewing and bedroom TV presence on young children's sleep as measured by actigraphy.

DESIGN

Analyses of covariance were run to examine differences in sleep duration and quality among children based on the presence of TVs in their bedrooms and the amount of TV watched.

SETTING

Recruited in preschools in Massachusetts; recorded ambulatory (in home, environs).

PARTICIPANTS

Participants were 470 children between 33 and 71 months of age (M = 51.02).

MEASUREMENTS

Children were instructed to wear an actigraph watch for 16 days. Caregivers reported demographic information, completed behavior questionnaires, and answered questions regarding their child's TV use.

RESULTS

Children who watched more TV and had TVs in their bedroom displayed significantly shorter sleep duration and worse sleep, but they also napped significantly longer in the daytime. Nonetheless, total 24-hour sleep was shorter for those who watched more TV and had TVs in their bedroom compared to those who did not have TVs in their bedrooms or watch TV frequently. Children who had TVs in their bedrooms watched TV later at night, watched more adult TV programs, and had higher negative affect than children without TVs in their bedrooms.

CONCLUSIONS

These findings suggest that TV use in young children does impact sleep duration and quality as measured by actigraphy, and daytime napping does not offset these negative impacts.

Different post-training processes in children's and adults' motor skill learning

Do young children and adults share similar underlying motor skill learning mechanisms? Past studies have shown that school-aged children's speed of performance developed over wake periods of a few hours post-training. Such training-dependent gains were not found in adults. In the current study of children as young as 5-years-old and young adults who practiced a simple grapho-motor task, this finding was replicated only by the children that showed faster performance a few hours post-training. These positive gains in performance speed were retained two weeks later. Furthermore, among the children, variations in gains attained a few hours post-training were associated with initial performance level. These behavioral findings indicate different underlying post-training processes in children's and adults' motor skill learning thus, supporting differential tutoring of skills.

The impact of sleep on complex gross-motor adaptation in adolescents

Sleep has been shown to facilitate the consolidation of newly acquired motor memories in adults. However, the role of sleep in motor memory consolidation is less clear in children and adolescents, especially concerning real‐life gross‐motor skills. Therefore, we investigated the effects of sleep and wakefulness on a complex gross‐motor adaptation task by using a bicycle with an inverse steering device. A total of 29 healthy adolescents aged between 11 and 14 years (five female) were either trained to ride an inverse steering bicycle (learning condition) or a stationary bicycle (control condition). Training took place in the morning (wake, n = 14) or in the evening (sleep, n = 15) followed by a 9‐hr retention interval and a subsequent re‐test session. Slalom cycling performance was assessed by speed (riding time) and accuracy (standard deviation of steering angle) measures. Behavioural results showed no evidence for sleep‐dependent memory consolidation. However, overnight gains in accuracy were associated with an increase in left hemispheric N2 slow sleep spindle activity from control to learning night. Furthermore, decreases in REM and tonic REM duration were related to higher overnight improvements in accuracy. Regarding speed, an increase in REM and tonic REM duration was favourable for higher overnight gains in riding time. Thus, although not yet detectable on a behavioural level, sleep seemed to play a role in the acquisition of gross‐motor skills. A promising direction for future research is to focus on the possibility of delayed performance gains in adolescent populations.

Sleep-dependent enhancement of emotional memory in early childhood

Naps in early childhood support declarative memory consolidation. However, emotional memories are unique in the neural basis of encoding as well as the sleep physiology underlying consolidation. Specifically, while consolidation of declarative memories has been associated with slow wave sleep, a prevailing theory suggests that REM sleep is necessary for consolidation of memories with emotional valence. Thus, we presented children (34-64 months) with faces paired with mean or nice descriptions. There were no significant main effects of emotional valence on recognition memory. Change in memory accuracy also did not differ when probed after a nap compared to the change in memory accuracy after an interval awake. However, when memory was probed again following overnight sleep, the change in memory accuracy was greater if the child napped the previous day. Greater nap slow wave activity was associated with greater memory decay during the nap. Yet nap slow wave activity also predicted greater overnight improvement in memory. These results suggest that sleep bouts can interact to benefit memory in early childhood.

Nocturnal sleep mediates the relationship between morningness-eveningness preference and the sleep architecture of afternoon naps in university students

The present study investigated the parameters of nocturnal sleep that mediate the relationship between morningness-eveningness preference and the sleep architecture of naps in university students. This study had a cross-sectional, descriptive correlational design. The sleep architecture of 52 students invited to take an afternoon nap in the laboratory was recorded. The morningness-eveningness questionnaire (MEQ) was used to evaluate morningness-eveningness preference. An actigraph was used to collect students' nighttime sleep data in the week preceding the study. Polysomnography was used to measure the sleep architecture of the participants' naps. After adjustments for potential factors, although the MEQ did not directly correlate with the percentage of sleep stages in naps, the effects of the MEQ on the percentage of Stage 1 sleep, slow-wave sleep, and rapid eye movement sleep; sleep duration; and sleep efficiency of naps were mediated by the total sleep time in the preceding week. This preliminary study suggests that nap quality was affected by morningness-eveningness preference through the mediation of total nocturnal sleep time. Therefore, future studies should be carefully designed to consider nighttime sleep patterns when analyzing the effects of chronotypes on daytime sleep.

Exploring the nap paradox: are mid-day sleep bouts a friend or foe?

The mid-day nap, sometimes called a siesta, is a ubiquitous occurrence across the lifespan. It is well established that in addition to reducing sleepiness, mid-day naps offer a variety of benefits: memory consolidation, preparation for subsequent learning, executive functioning enhancement, and a boost in emotional stability. These benefits are present even if a sufficient amount of sleep is obtained during the night prior. However, we present a paradox: in spite of these reported benefits of naps, frequent napping has also been associated with numerous negative outcomes (eg, cognitive decline, hypertension, diabetes), particularly in older populations. This association exists even when statistically controlling for relevant health- and sleep-affecting determinants. An emerging hypothesis suggests inflammation is a mediator between mid-day naps and poor health outcomes, yet further research is necessary. Given this, it may be premature to 'prescribe' naps as a health enhancer. Herein, we aggregate findings from several branches of sleep research (eg, developmental neuroscience, cognitive neuroscience, sleep medicine) to critically examine the paradoxical role of naps in cognitive and somatic health. This review uncovers gaps in the literature to guide research opportunities in the field.

Naps Enhance Executive Attention in Preschool-Aged Children

Objective

Executive attention is impaired following sleep loss in school-aged children, adolescents, and adults. Whether naps improve attention relative to nap deprivation in preschool-aged children is unknown. The aim of this study was to compare executive attention in preschool children following a nap and an interval of wake.

Method

Sixty-nine children, 35-70 months of age, completed a Flanker task to assess executive attention following a nap and an equivalent interval of wake.

Results

Overall, accuracy was greater after the nap compared with the wake interval. Reaction time(s) did not differ between the nap and wake intervals. Results did not differ between children who napped consistently and those who napped inconsistently, suggesting that naps benefit executive attention of preschoolers regardless of nap habituality.

Conclusions

These results indicate that naps enhance attention in preschool children. As executive attention supports executive functioning and learning, nap promotion may improve early education outcomes.

Children benefit differently from night- and day-time sleep in motor learning

Motor skill acquisition occurs while practicing (on-line) and when asleep or awake (off-line). However, developmental questions still remain about whether children of various ages benefit similarly or differentially from night- and day-time sleeping. The likely circadian effects (time-of-day) and the possible between-test-interference (order effects) associated with children's off-line motor learning are currently unknown. Therefore, this study examines the contributions of over-night sleeping and mid-day napping to procedural skill learning. One hundred and eight children were instructed to practice a finger sequence task using computer keyboards. After an equivalent 11-h interval in one of the three states (sleep, nap, wakefulness), children performed the same sequence in retention tests and a novel sequence in transfer tests. Changes in the movement time and sequence accuracy were evaluated between ages (6-7, 8-9, 10-11years) during practice, and from skill training to retrievals across three states. Results suggest that night-time sleeping and day-time napping improved the tapping speed, especially for the 6-year-olds. The circadian factor did not affect off-line motor learning in children. The interference between the two counter-balanced retrieval tests was not found for the off-line motor learning. This research offers possible evidence about the age-related motor learning characteristics in children and a potential means for enhancing developmental motor skills. The dynamics between age, experience, memory formation, and the theoretical implications of motor skill acquisition are discussed.

Napping: A public health issue. From epidemiological to laboratory studies

Sleep specialists have proposed measures to counteract the negative short- and long-term consequences of sleep debt, and some have suggested the nap as a potential and powerful "public health tool". Here, we address this countermeasure aspect of napping viewed as an action against sleep deprivation rather than an action associated with poor health. We review the physiological functions that have been associated positively with napping in both public health and clinical settings (sleep-related accidents, work and school, and cardiovascular risk) and in laboratory-based studies with potential public health issues (cognitive performance, stress, immune function and pain sensitivity). We also discuss the circumstances in which napping-depending on several factors, including nap duration, frequency, and age-could be a potential public health tool and a countermeasure for sleep loss in terms of reducing accidents and cardiovascular events and improving sleep-restriction-sensitive working performance. However, the impact of napping and the nature of the sleep stage(s) involved still need to be evaluated, especially from the perspective of coping strategies in populations with chronic sleep debt, such as night and shift workers.