Sleep Habits and Sleep Problems in Healthy Preschoolers

Parental sleep-related practices and sleep in children aged 1-3 years: a systematic review

The current systematic review sought to identify the relationship between the range of different parental sleep-related practices that had been explored in relations to child sleep outcomes in children aged 1-3 years. A systematic literature review was carried out in CINAHL, The Cochrane Library, PsycArticles, PsycInfo, PubMed and Web of Science, as well as relevant grey literature in August 2022 using the terms; population (children, aged 1-3 years), exposure (parental sleep-related practice) and outcome (child sleep). Any quantitative study published between 2010 and 2022 that explored the relationship between parental sleep-related practices and the sleep of children aged 1-3 years were included. The Mixed Methods Appraisal Tool was employed to quality appraise included studies and results were narratively synthesised. In all, 16 longitudinal and cross-sectional quantitative studies met inclusion criteria. Parental presence or physical involvement, as well as broader parental practices including using screens or devices at bedtime and night-time breastfeeding were all related to poorer child sleep outcomes. Consistent and relaxing routines, sleeping in a cot, and spending all night in their own sleep location were associated with better child sleep outcomes. Acknowledging the plethora of diverse parental sleep-related practices, which may have varying relationships with child sleep outcomes, could be usefully considered in theoretical models and to inform clinical practice. Issues of definitional and measurement ambiguity are highlighted and discussed.

Compliance with the 24-h movement behaviors guidelines among urban and rural Brazilian preschoolers

BACKGROUND

The importance of movement behaviors for health is well-known, although few studies have examined the compliance with movement guidelines in preschoolers from different living contexts. This study reported the compliance with the 24-h movement behaviors guidelines among low-income Brazilian preschoolers from rural and urban areas, according to age.

METHODS

A total of 453 preschoolers (n = 222 urban), aged between 3 and 5 years, provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, and screen time were parent-reported. Preschoolers were classified as compliant/non- compliant with the 24-h movement guidelines, according to age. The association between prevalence of compliance with the recommendations and the children's living setting were estimated (SPSS; 27.0).

RESULTS

Preschoolers were active (mean = 299.19 ± 76.42; and 369.76 ± 95.56 min/day in urban and rural areas, respectively), though moderate-to-vigorous physical activity (MVPA) time was below the 60 daily minutes recommended in both urban and rural settings (mean = 38.39 ± 21.36; and 47.32 ± 24.28, respectively). None of the urban children complied with the three recommendations simultaneously, while in the rural area, only 2.6% were compliant. Single movement behaviors compliances in the urban setting were 6.8%, 28.8% and 5.4% for PA, sleep, and screen time, respectively; while for rural settings were 16.5%, 21.2%, and 7.4%. Living in the rural area was related to the compliance with PA recommendation for the 5-year-old preschoolers.

CONCLUSION

In both urban and rural Brazilian areas, very few preschoolers are compliant with the guidelines, and more than one third of the children do not comply with any of the recommendations. Strategies and programs to promote compliance with movement behaviors guidelines should consider children's living setting and their age groups.

Sleep and behavioral problems in preschool-age children with Down syndrome

Sleep is a major concern, especially in people with Down Syndrome (DS). Beyond Obstructive Sleep Apnea, a number of other sleep difficulties have been reported in children with DS, such as delayed sleep onset, night-time awakenings, and early morning awakenings. The detrimental effect of sleep difficulties seems to contribute to and exacerbate the cognitive and behavioral outcomes of DS. Although the screening for sleep disorders is recommended early in age in DS, only a few studies have evaluated the sleep profile in preschool-age children with DS. The aim of the current study was to assess the association between sleep disturbances and behavioral problems in a group of preschool-age children with DS, by means of a feasible and easy-to-administer parent-report questionnaires. Seventy-one preschool-age children with DS, ranging in age from 3 to 5.11 years, were included in this retrospective study. Sleep disturbances were evaluated by means of the Sleep Disturbance Scale for Children, while emotional and behavioral problems by means of the Child Behavior Checklist. Sleep breathing disorders were the most frequent sleep difficulties reported by parents. Moreover, children with clinical scores in total sleep problems exhibited elevation of psychopathological symptoms, namely Total problems, Affective problems, Anxiety problems, Pervasive Developmental Problems, and Attention Deficit/Hyperactivity Problems. The identification of the broader connection between sleep difficulties and emotional and behavioral problems in preschool-age children with DS leads to important considerations for intervention.

Effect of sleep habits on academic performance in schoolchildren age 6 to 12 years: a cross-sectional observation study

STUDY OBJECTIVES

Sleep plays a vital role in the cognitive and neurodevelopmental outcome of children; therefore, adequate sleep is needed to improve academic performance. The primary objective of this study was determine the prevalence of sleep behaviors and their effect on academic performance in schoolchildren age 6-12 years and to translate the findings into greater opportunity for healthy development and academic success.

METHODS

Our study included 791 healthy children between ages 6 and 12 years from schools that are parts of the Central Board of Secondary Education in the South Indian urban population. Pro forma and The Children's Sleep Habits Questionnaire (CSHQ in local language translation) was given to the parents, and any doubts regarding the questionnaire were clarified during parent-teacher meetings. The previous 2 cycles of academic grades for these children were collected and categorized into A, B, and C grades accordingly. Then a statistical analysis of the completed CSHQ questionnaires was performed.

RESULTS

On analyzing the CSHQ questionnaire, 71.9% of the children studied had a score higher than 41, which is in the clinical range indicating a significant prevalence of altered sleep habits. Other risk factors included nocturnal enuresis (3.5%), snoring (10.6%), night terrors (8%), and teeth grinding (6.4%).

CONCLUSIONS

Altered sleep habits have a major effect on the academic performance of the school-age children. Assessment of sleep habits should be included in routine pediatric office visits.

CITATION

Sivakumar CT, Rajan M, Pasupathy U, Chidambaram S, Baskar N. Effect of sleep habits on academic performance in schoolchildren age 6 to 12 years: a cross-sectional observation study. J Clin Sleep Med. 2022;18(1):145-149.

Movement behaviors in short versus adequate nocturnal sleepers: A compositional analysis of preschoolers

BACKGROUND

Accruing adequate daily amounts of time spent on movement behaviors (physical activity (PA), sedentary behavior (SB), and sleep) in childhood has been associated with positive short and long-term health outcomes. Nonetheless, how waking time is distributed across PA and SB among preschoolers who are short and adequate sleepers at night is unknown.

AIM

This study investigated: (1) if there are differences in a movement behaviors composition among adequate and short nocturnal sleepers; and (2) the association between preschoolers' time spent in PA, SB, and sleep among adequate and short nocturnal sleepers.

METHODS

A total of 270 preschoolers (132 boys; 3.97 ± 0.81 years old; 15.48 ± 1.62 kg/m² ) participated in this study. PA and SB were assessed using accelerometry (model wGT3X). Sleep duration was assessed through a parental-proxy interview, and preschoolers were stratified as short and adequate sleepers, according to attendance to international sleep duration guidelines. Compositional data analysis was used to explore the time-use patterns of behaviors among adequate and short sleepers.

RESULTS

Short sleepers spent 64 min less time asleep, accumulated 32 min in more sedentary time (p = .005, Cohen's d = 0.36, Bayes Factor: 6.17), and 24 min more in light PA (p = .0005, Cohen's d = 0.44, Bayes Factor: 46.37) compared to adequate sleepers.

CONCLUSIONS

Being a short sleeper was associated with greater time spent in SB and light PA during their waking hours. The health implications of movement behaviors composition among short sleep preschoolers should be further investigated.

Sleep habits and weight status in Brazilian children aged 4-6 years of age: the PREDI study

OBJECTIVES

To evaluate the association of sleep habits with the weight status of children aged 4-6 years.

METHODS

Data were obtained from the PREDI Study, a Brazilian birth cohort study. The current study was carried out in the homes of the participants during two follow-ups: 2016/17 and 2018. The participants were submitted to anthropometric assessment and demographic, socioeconomic and sleep data were obtained. The child's sleep habits were self-reported by the mother or caregiver on the day of the visit and included information on the following sleep habits during the past week: bedtime routine, rhythmicity, and separation affect determined with the Sleep Habits Inventory for Preschool Children and the Sleep Habits Inventory. Logistic regression and gamma-log regression analyses were used to examine the association of sleep habits with excess body weight of children in the two follow-ups according to sex.

RESULTS

Of the 217 and 185 children included in 2016/17 and 2018, respectively, 66 (30.6%) and 48 (25.9%) had a BMI >85th percentile at 4-6 years, respectively. The median rhythmicity score was higher in children with excess body weight (p = 0.05). Adjusted analysis showed that rhythmicity was associated with excess body weight of girls at ages 4-5 years (OR = 1.42, 95% CI: 1.09-1.86, p = 0.009) and 6 years (OR = 1.32, 95% CI: 1.06-1.65, p = 0.015), even after adjustment for other important covariates. Additionally, the sleep habit "separation affect" was inversely associated with the child's BMI in boys (β = -0.005, 95% CI: -0.010-0.000, p = 0.037).

CONCLUSIONS

In the present study, rhythmicity problems were associated with increased odds of girls aged 4-6 years having excess body weight. These results are important from a public health perspective since strategies aimed at preventing excess body weight in children need to consider the child's sleep quality as a potential risk factor, especially rhythmicity.

The effect of the indoor environment on wheeze- and sleep-related symptoms in young Indian children

Background

Environmental exposures have a significant effect on respiratory and sleep symptoms in young children. Although the effect of air pollution on the respiratory symptoms in young children is well-established, less is known about the effect of household environmental characteristics and practices on wheeze and sleep concerns.

Aims

The aim of this pilot study is to explore the association between household environmental characteristics and practices with the symptoms of wheezing and sleep concerns in the past year in a convenience sample of young Indian children.

Materials and Methods

A detailed questionnaire about the child's home environment and respiratory and sleep symptoms was administered to the caregivers of 190 outpatients aged between 6 months and 5 years old at a teaching hospital.

Results

Indoor environmental characteristics and cleaning techniques were analyzed for the association with wheeze and sleep disorders. Half (50%) of the cohort had the symptoms of wheezing and 21% had occasional or frequent sleep concerns. Sleeping with a stuffed toy was significantly associated with both wheezing and sleep concerns (P = 0.05).

Conclusions

: Sleeping with a stuffed toy was a risk factor for wheeze and a risk factor for sleep disorders independent of wheeze.

Is using nanosilver mattresses/pillows safe? A review of potential health implications of silver nanoparticles on human health

Human exposure to engineered nanoparticles has become inevitable in today's extensive commercial use and large-scale production of engineered nanoparticles. Even though several studies have characterised the exposure to nanomaterials during wakeful state (related to occupational exposures and exposures from commercially available particles), very few studies on human exposure during sleep exist. As the study of exposure to all possible nanomaterials during sleep is extensive, this study focuses on exposure to specifically silver nanoparticles which are present in beddings and mattresses. The reasoning behind the use of silver nanoparticles in bedding and related materials, possible routes of entry to various population groups in several sleep positions, exposure characterisation and toxicity potential of such silver nanoparticles are reviewed in this study. The toxicity potential of silver nanoparticles in vivo tests with relation to mammals and in vitro tests on human cells has been tabulated to understand the risks associated during oral, dermal and inhalation exposure to silver nanoparticles. The exposure to humans with regard to dermal absorption and oral intake has been summarised. Although potential inhalation exposure to silver nanoparticles is increasing, only a few studies address the possible toxic effect of inhaled silver particles. Determination of exposure to silver nanoparticles in beddings is a topic that has been less researched, and this review aims to provide background information for future research and help establish a comprehensive risk assessment during sleep in the times of increasing usage of nanoparticles in our daily activities. Despite the current limitations of our understanding, risk assessments must utilise the available data and apply extrapolation procedures in the face of uncertainty, in order to address the needs of regulatory programs. This would enable safe use of the antimicrobial properties of silver nanoparticles without negatively impacting human health. Until then, it would be better to adopt a conservative approach on the usage of silver nanoparticles in daily used commercial items.

Study of Sleep Disorders among Young Children Using Hindi Translated and Validated Version of Pediatric Sleep Questionnaire

OBJECTIVE

The objective of this study is to assess the prevalence of sleep disorders among children aging between 4 and 9 years using Hindi version of Pediatric Sleep Questionnaire (PSQ).

METHODS

This study had two parts first, translation and validation of PSQ into Hindi language, and second, assessment of the prevalence of sleep disorders using PSQ Hindi version. Hindi PSQ was distributed in randomly chosen primary schools in a semi-urban area. The children were requested to get them filled by their parents. When the questionnaires were returned, responses were analyzed.

RESULTS

Most of the items of the Hindi version had perfect agreement with original questionnaire in a bilingual population (κ =1). Totally, 435 children were included in the field study having average age of 6.3 years. Obstructive sleep apnea was reported in 7.5% children; symptoms suggestive of restless legs syndrome were reported by 2%-3%; teeth grinding by 13.9% and sleep talking by 22.6% children.

CONCLUSION

PSQ Hindi version is a validated tool to screen for sleep disorders among children. Sleep disorders are fairly prevalent among young children in India.

Prevalence of Sleep Disorders Among Primary School Children

OBJECTIVE

To screen symptoms of sleep disorders among primary school children.

METHODS

Four schools from urban area and four rural schools were included in this study. Symptoms of sleep disorders were assessed using the validated Hindi version of Childhood Sleep Habit Questionnaire in 8-13 y old children. Comparison was made between urban and rural group and between boys and girls. Descriptive statistics was calculated.

RESULTS

Mean age of the subjects included in this study was 8.9 ± 1.5 y. Boys and girls were equally distributed, however, rural sample was smaller. More than one awakening each night was found in 12.2 % children. In the whole group, prevalence of bed-wetting was 8.7 %, sleep-talking 20.9 %, sleep-walking 3.2 %, teeth grinding 15.4 % and night terrors 8.4 %. Daytime sleepiness was reported by 25.5 % and napping by 56.4 %. 17.3 % used to fall asleep in unusual circumstances and the teacher or the friend in 6.9 % students noticed it. Snoring was reported by 11.4 % children, and 6.3 % reportedly struggled to breathe during sleep. Domicile and gender did not affect prevalence of parasomnia, however, symptoms of sleep apnea were more frequent among rural children. Daytime sleepiness was more common among rural children as compared to urban.

CONCLUSIONS

Symptoms of sleep disorders are prevalent among primary school children. Common disorders are parasomnia, sleep apnea and daytime sleepiness.

Parent-child bed-sharing: The good, the bad, and the burden of evidence

The practice of parent and child sharing a sleeping surface, or 'bed-sharing', is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on 98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - anthropology, psychology/psychiatry, and pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children's social, emotional, and physical development.