Intrinsic and extrinsic factors predicting infant sleep: Moving beyond main effects

Impact of a structured sleep education program on mothers' knowledge and attitudes toward infant sleeping

Introduction

Sleeping is necessary for the infant growth and development. Sufficient and quality of sleep can have an impact on physical, cognitive, and emotional functioning. Infancy is a critical time for establishing healthy habits and routines. However, many infants were suffering from sleeping issues that impact their health.

Objectives

This study aims to evaluate the effect of educational programs given to mothers regarding their infants' sleep on mothers' knowledge and attitudes toward infant's sleeping.

Method

A quasi-experimental design for nonequivalent groups was used, and data was collected from 208 mothers with infants aged 5-12 months from all Jordanian governorates who had not been exposed to educational programs prior to this study. Data was collected in two stages: pre-test and post-test, with two weeks in between for both groups.

Results

The final results indicated that the educational intervention had a significant impact on mothers' knowledge over time. It was found that mothers in the intervention group had significantly higher mean of infant sleep health knowledge at follow up time compared to their baseline time (B = 0.236, P 0.001). Also, the yielded analysis showed that there was no significant change in mothers' mean attitudes toward infants sleeping over time (P = 0.011). The mothers' measured sleep health knowledge correlated positively and significantly statistically with their sleep health attitudes score (r = 0.436, P 0.010).

Shorter night-time sleep duration and later sleep timing from infancy to adolescence

BACKGROUND

Here, we (a) examined the trajectories of night-time sleep duration, bedtime and midpoint of night-time sleep (MPS) from infancy to adolescence, and (b) explored perinatal risk factors for persistent poor sleep health.

METHODS

This study used data from 12,962 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Parent or self-reported night-time sleep duration, bedtime and wake-up time were collected from questionnaires at 6, 18 and 30 months, and at 3.5, 4-5, 5-6, 6-7, 9, 11 and 15-16 years. Child's sex, birth weight, gestational age, health and temperament, together with mother's family adversity index (FAI), age at birth, prenatal socioeconomic status and postnatal anxiety and depression, were included as risk factors for persistent poor sleep health. Latent class growth analyses were applied first to detect trajectories of night-time sleep duration, bedtime and MPS, and we then applied logistic regressions for the longitudinal associations between risk factors and persistent poor sleep health domains.

RESULTS

We obtained four trajectories for each of the three sleep domains. In particular, we identified a trajectory characterized by persistent shorter sleep, a trajectory of persistent later bedtime and a trajectory of persistent later MPS. Two risk factors were associated with the three poor sleep health domains: higher FAI with increased risk of persistent shorter sleep (OR = 1.20, 95% CI = 1.11-1.30, p < .001), persistent later bedtime (OR = 1.28, 95% CI = 1.19-1.39, p < .001) and persistent later MPS (OR = 1.30, 95% CI = 1.22-1.38, p < .001); and higher maternal socioeconomic status with reduced risk of persistent shorter sleep (OR = 0.99, 95% CI = 0.98-1.00, p = .048), persistent later bedtime (OR = 0.98, 95% CI = 0.97-0.99, p < .001) and persistent later MPS (OR = 0.99, 95% CI = 0.98-0.99, p < .001).

CONCLUSIONS

We detected trajectories of persistent poor sleep health (i.e. shorter sleep duration, later bedtime and later MPS) from infancy to adolescence, and specific perinatal risk factors linked to persistent poor sleep health domains.

Sleep and depression in couples during the transition to parenthood

OBJECTIVES

The objectives were to: (1) investigate the prevalence, differences and changes in sleep quality over time among Chinese couples during pregnancy and at 6 weeks and 6 months postpartum and (2) examine the association between sleep quality and depressive symptoms.

METHOD

This study was part of an intervention study for postnatal depression. Childbearing couples were recruited from antenatal clinics. Data on sleep and depression during pregnancy and at 6 weeks and 6 months postpartum were collected using the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale, respectively.

RESULTS

The prevalence of sleep disturbance (PSQI score > 5) during pregnancy and at 6 weeks and 6 months postpartum was 45.0%, 62.8% and 36.8%, respectively, among women and 26.4%, 36.4% and 27.3%, respectively, among men. Sleep quality declined significantly in both partners from pregnancy to 6 weeks postpartum, followed by a significant improvement by 6 months postpartum. The results revealed significant correlations between partners' scores on sleep quality across the perinatal period, with women experiencing poorer sleep quality than men. Poor sleep was associated with depressive symptoms across the perinatal period for both partners.

CONCLUSIONS

This study highlights the importance of screening couples for sleep disturbances throughout pregnancy and the postnatal period and assisting them to develop strategies to improve sleep quality during the transition to parenthood.

A preliminary study on the performance of the Nanit auto-videosomnography scoring system against observed video scoring and actigraphy to estimate sleep-wake states in infants

GOAL AND AIMS

To examine the performance of the Nanit auto-videosomnography scoring system as a measure of sleep-wake states in infants compared to observed video scoring and actigraphy.

FOCUS TECHNOLOGY

Nanit's auto-videosomnography scoring system.

REFERENCE

Observed video scoring and actigraphy.

SAMPLE

Sixteen U.S. infants (age: 4-8 months).

DESIGN

Infants' sleep was assessed with the Nanit camera and actigraphy (micromotion logger sleep watch). Fifty nights were included in the analyses. Nanit's videos were processed via a computer vision algorithm and were scored by trained observers. Actigraphic data were scored with the validated Sadeh algorithm.

CORE ANALYTICS

Bland-Altman plots and epoch-by-epoch analyses (sensitivity, specificity, and total accuracy).

ADDITIONAL ANALYTICS

Specificity values for each night separately.

CORE OUTCOMES

Nanit estimates of sleep minute were not significantly different from observed sleep minute, but Nanit overestimated sleep minute relative to actigraphy by 17 minutes. Nanit overestimated wake minutes (wake after sleep onset by 5.3 minutes relative to observed scoring and underestimated wake after sleep onset by 19.1 minutes relative to actigraphy. The epoch-by-epoch analyses revealed that Nanit reached 97.8% sensitivity in classifying sleep and 60.4% specificity in classifying wake compared to observed scoring. The rates compared to actigraphy were 99.3% for sensitivity and 51.7% for specificity.

IMPORTANT ADDITIONAL OUTCOMES

Specificity values were lower for infants with lower wake after sleep onset.

CORE CONCLUSION

This preliminary study suggests that Nanit is highly accurate in detecting infant sleep compared to observed scoring and actigraphy. Specificity values are within the range of those reported previously for actigraphy devices that are commonly used in pediatric sleep research.

Contextual considerations in infant sleep: Offering alternative interventions to families

Infant sleep problems are one of the commonly reported reasons parents seek professional help, yet what constitutes a "sleep problem" depends on the models used to explain the development of infant sleep. The current models are based on research conducted in the western context where infant solitary sleeping is the norm. Parent-child co-sleeping is the norm in many cultures around the world. We argue that the primary focus of current research on parent-child interactions as the mediating context for the development of infant sleep problems has inherently made these models and ensuing interventions less sensitive and applicable to infant sleep problems in the context of co-sleeping families. When families present for help with infant sleep difficulties, extinction based behavioral interventions or interventions focused on reducing parental presence at bedtime are commonly recommended. These recommendations may not always align with cultural values and parenting practices of all families, therefore precluding these families from getting necessary help. In attempting to provide families with choices that depart from behavioral based interventions, this paper draws on research and adapts current models to propose an alternative to conceptualize perceptions of infant sleep problems that may be sensitive to and applied across various cultural and personal contexts. We attempt to provide a rationale for interventions that are inclusive and sensitive to families where reduced parental nighttime responsiveness may not be a preferred choice.

Fetal SSRI antidepressant exposure and infant sleep: Findings from the MPEWS pregnancy cohort study

This longitudinal study examines the association between fetal Selective Serotonergic Reuptake Inhibitor antidepressant exposure and infant sleep behaviours at six and 12 months of age and focus on three of the most commonly prescribed antidepressants in pregnancy. This study utilises data on 698 women recruited at less than 20 weeks of pregnancy and are followed up at six and 12 months postpartum. Women were recruited into one of three groups: those taking either sertraline, citalopram or escitalopram antidepressants in pregnancy (n = 85); women with a depressive disorder who were not taking antidepressants (non-medicated depressed, NMD; n = 82); and, and a control group of women (n = 531). At six and 12 months, data were collected on breastfeeding and sleep location and infant sleep was measured using the Brief Infant Sleep Questionnaire. Antidepressants sertraline, escitalopram and citalopram were not associated with increased infant waking or time awake. However, sertraline was associated with longer time for an infant to go to sleep. This study provides reassurance that SSRI antidepressants and, in particular, sertraline, escitalopram and citalopram are not associated with infant sleep behaviours that are commonly regarded as problematic including night waking. Further replication of these findings, including with direct measures of infant sleep, are recommended.

Associations between demographic and parental factors and infant sleep characteristics

Although sleep problems are highly prevalent in infants, the intrinsic and extrinsic factors that influence sleep consolidation and regulation in this age group are not well understood. This study aimed to examine the cross-sectional associations of demographic and parental factors with infant sleep characteristics. Participants were 97 Canadian mother-infant dyads primarily from Edmonton, Alberta. Demographic factors (e.g., infant age), parenting practices (e.g., sleep position, sleep initiation methods), and infants sleep characteristics (e.g., the frequency of nighttime awakenings) were assessed using the Brief Infant Sleep Questionnaire. Maternal sleep characteristics (e.g., nighttime sleep duration) were assessed using Actigraph accelerometers. Infant age (mean = 4.24 ± 2.90) was associated with most infant sleep characteristics. In multiple regression models for infant nighttime sleep duration, after removing influential observations, a negative association for side (vs. prone) sleep position was, respectively, observed. In multiple regression models for the frequency of nighttime awakenings in infants, positive associations for infants falling asleep while feeding (vs. in bed alone) and side (vs. prone) sleep position were consistently observed after removing influential observations. Lower nighttime sleep efficiency (B =  - 0.08, 95%CI: - 0.13, - 0.02) and longer nighttime wake after sleep onset (B = 1.03, 95%CI: 0.41, 1.65) in mothers were associated with more frequent nighttime awakenings in infants. After removing influential observations, more frequent nighttime awakenings (B = 0.35; 95%CI: 0.09, 0.61) and longer total sleep duration (B = 0.33, 95%CI: 0.11, 0.55) in mothers were also associated with more frequent nighttime awakenings in infants. Sleep initiation methods with less parental involvement, and more continuous and efficient maternal nighttime sleep, tended to be associated with less interrupted infant sleep.

Maternal Differentiation of Self and Toddlers' Sleep: The Mediating Role of Nighttime Involvement

Good sleep is essential for optimal development and adaptive functioning. Hence, identifying the factors that shape sleep quality is important. Based on the transactional model of sleep development and drawing on Bowen's concept of differentiation of self (DoS), the present study examined the interrelations between sleep-related parental behavior, child's sleep quality, and mothers' DoS. A community sample of 130 mothers of 24- to 36-month-old children completed the DoS instrument and sleep questionnaires. Lower maternal DoS levels were associated with higher parental sleep-related involvement, both at bedtime and through the course of the night. Using structural equation modeling (SEM), a path analysis model indicates that maternal sleep-related involvement functions as a mediator through which the differentiation of self is related to the sleep characteristics of toddlers. As the links between parenting practices and child sleep reflect bi-directional associations, the conclusion that can be drawn from the present data is that relational aspects, such as those defined and measured by the construct of DoS, contribute to sleep-wake regulation beyond infancy. The data suggest that this construct should be considered in intervention research.

Links between Daytime Napping, Night-Time Sleep Quality and Infant Attention: An Eye-Tracking, Actigraphy and Parent-Report Study

The current study explored the potential influence of infant sleep, measured by parental report and actigraphy, and family functioning on attention development using eye tracking. The use of actigraphy in parallel with parental report, has the advantage of measuring participant’s sleep throughout the night without parental observation and the ability to objectively assess sleep quality. An eye-tracking version of the Gap-Overlap task was used to measure visual attention. Questionnaires and behavioural assessment were used to assess family function, and general cognitive development. Fifty infants (Mean age = 13.44 months, SD = 3.10) participated in the study, 23 of which had full final datasets. Results show that daytime sleep duration, as measured by parental report, and proportion of light sleep at night, as measured by actigraphy, are linked to visual attention. A higher proportion of light sleep, a marker of poorer sleep quality, and less daytime sleep were negatively linked with facilitation and disengagement on the Gap-Overlap task. Family functioning was not associated with attention. The results provide initial evidence that in addition to the amount of daytime sleep; quality of night-time sleep as measured by proportion of light sleep, is a potentially useful sleep variable which requires further focus in the study of attention development.

Infant sleep arrangements, infant-parent sleep, and parenting during the first six months post-partum

The present study of 124 families examined linkages between patterns of sleep arrangement use across the first 6 months post-partum and (a) family socio-demographics, (b) nighttime sleep of infants, mothers, and fathers, and (c) coparenting distress, and mothers' emotional availability with infants and bedtime. Families were recruited when infants were 1-month-old, and infants were classified, from video data available at 3 and 6 months post-partum, into one of three sleep arrangement pattern groups: Solitary sleep, cosleeping, and cosleeping (at 3 months)-to-solitary sleep (at 6 months). Mothers in cosleeping arrangements were more likely to be at higher socioeconomic risk, non-White, unemployed, and to have completed fewer years of education. Controlling for these variables and for duration of breast feeding and parental depressive and anxiety symptoms, subsequent 3 (sleep arrangement pattern) X 2 (infant age: 3 and 6 months) mixed-model analyses of covariance revealed that sleep arrangement patterns were more robustly linked with maternal sleep than with infant and father sleep. Mothers in cosleeping arrangements experienced more fragmented sleep and greater variability in fragmented sleep relative to mothers of infants in solitary sleep, and fathers in cosleeping arrangements showed greater variability across the week in the number of minutes of nighttime sleep. Cosleeping was associated with mother reports of less positive and more negative coparenting, and mothers in cosleeping arrangements were independently observed to be less emotionally available with their infants at bedtime compared to mothers in the other two sleep arrangement groups. These linkages were largely upheld after statistically controlling for mothers' stated preference for sleep arrangements they were using.

Neuronal gating of tactile input and sleep in 10-month-old infants at typical and elevated likelihood for autism spectrum disorder

Sleep problems in Autism Spectrum Disorder (ASD) emerge early in development, yet the origin remains unclear. Here, we characterise developmental trajectories in sleep onset latency (SOL) and night awakenings in infants at elevated likelihood (EL) for ASD (who have an older sibling with ASD) and infants at typical likelihood (TL) for ASD. Further, we test whether the ability to gate tactile input, using an EEG tactile suppression index (TSI), associates with variation in SOL and night awakenings. Parent-reported night awakenings and SOL from 124 infants (97 at EL for ASD) at 5, 10 and 14 months were analyzed using generalized estimating equations. Compared to TL infants, infants at EL had significantly more awakenings and longer SOL at 10 and 14 months. The TSI predicted SOL concurrently at 10 months, independent of ASD likelihood status, but not longitudinally at 14 months. The TSI did not predict night awakenings concurrently or longitudinally. These results imply that infants at EL for ASD wake up more frequently during the night and take longer to fall asleep from 10 months of age. At 10 months, sensory gating predicts SOL, but not night awakenings, suggesting sensory gating differentially affects neural mechanisms of sleep initiation and maintenance.

Associations of sleep characteristics with cognitive and gross motor development in toddlers

OBJECTIVE

To examine cross-sectional associations of sleep characteristics (duration, consolidation, timing, variability) with cognitive and gross motor development in toddlers.

METHODS

Participants were 205 toddlers (19.6 ± 4.3 months) from the GET-UP!

STUDY

Nap/nighttime sleep onset and offset were measured using an accelerometer and used to calculate nap/nighttime sleep duration. Total sleep duration was calculated and classified as meeting or not meeting the sleep recommendation of the Australian 24-Hour Movement Guidelines (11-14 h/d). Nighttime sleep ratio (ie, nighttime sleep duration: total sleep duration), indicative of consolidation, was expressed as a percent value. Nighttime sleep midpoint (ie, the midpoint between nighttime sleep onset and offset), indicating the lateness of sleep schedules, was converted to a decimal hour. For sleep variability, the intraindividual standard deviation of nighttime sleep duration and nighttime sleep midpoint was calculated, respectively. Cognitive development (Bayley Scales of Infant and Toddler Development-III) and specific domains of gross motor development (Peabody Developmental Motor Scales, 2nd edition) were measured.

RESULTS

Shorter nap duration (B = -0.87, 95%CI: -1.71, -0.02) and higher nighttime sleep ratio (B = 0.13, 95% CI: 0.02, 0.24) were associated with better cognitive development. Regarding gross motor development, positive associations were found for nighttime sleep duration (object manipulation: B = 0.26, 95% CI: 0.01, 0.51; gross motor quotient: B = 1.21, 95% CI: 0.04, 2.38) and total sleep duration (object manipulation: B = 0.28, 95% CI: 0.03, 0.52); negative associations were found for nighttime sleep midpoint (stationary: B = -0.31; 95% CI: -0.58, -0.06) and nighttime sleep duration variability (stationary: B = -0.32, 95% CI: -0.64, -0.004).

CONCLUSIONS

In toddlers, more consolidated sleep may be an indicator of better cognitive development. Promoting longer and more consistent nighttime sleep duration, as well as an earlier nighttime sleep schedule, may facilitate gross motor development. However, our findings for the associations of sleep characteristics with cognitive and gross motor development need to be confirmed in prospective studies.

Sleeping through COVID-19: a longitudinal comparison of 2019 and 2020 infant auto-videosomnography metrics

BACKGROUND

With the outbreak of the COVID-19 pandemic, pediatric experts called attention to the potential adverse effects of living restrictions (e.g., lockdown) on child well-being, but at the same time- acknowledged their possible benefits. To date, only few data-driven reports have been published on child sleep during COVID-19, and all have been based on parent- or self-reports. This study used auto-videosomnography to capture the effects of COVID-19 stay-at-home orders imposed in the USA on objectively measured infant sleep.

METHODS

Auto-videosomnography metrics of infants assessed nightly between January and May 2020 were compared with metrics of an equivalent infant cohort, assessed in the corresponding 2019 period. A total of 610 infants (50.7% girls) aged 6-18 months (M = 11.8, SD = 3.6) were included, with 71,472 analyzed nights. Multilevel models were applied to assess differences between 2019 and 2020 infant sleep pre- and during-lockdown.

RESULTS

Whereas infant cohorts were equivalent in demographic and January-March/April sleep characteristics, during the 2020 lockdown infants had longer nighttime sleep durations (M_difference  = 11.0 min, p = .01), later morning rise times (M_difference  = 9.5 min, p = .008), and later out-of-crib times (M_difference  = 12.3 min, p < .0001), compared to the equivalent 2019 period. In addition, weekday-weekend differences in sleep onset and midpoint times were diminished during 2020 home-confinement compared to the equivalent 2019 period (2019: M_difference  = 5.5 min, p < .0001; M_difference  = 4.5 min, p < .0001; 2020: M_difference  = 2.3 min, p = .01; M_difference  = 3.1 min, p < .0001, respectively).

CONCLUSIONS

Notwithstanding the negative implications of COVID-19 living restrictions in other domains, our findings indicate that there might be a silver lining-in promoting longer and more consistent infant sleep. These benefits should be considered in determining policy for the current and future pandemics.

Socioeconomic status and infant nighttime sleep across the second year of life: The moderating role of infant attachment security

This study examined socioeconomic status (SES) and attachment security as predictors of infant nighttime sleep during the second year. Participants included 128 mothers (86% White) with infants (48.4% boys). Data collection took place between April, 2009 and February, 2014. At 12, 18, and 24 months, infant sleep was assessed via actigraphy and daily diaries, and attachment with the Attachment Q-Set. SES indicators included income-to-needs ratios and education. Lower SES predicted greater variability in sleep duration and later sleep timing only for less secure infants. Less secure attachment was associated with poorer sleep at both between- and within-person levels, especially when infants were 12 months of age. Results emphasize the complex interactive effects of environmental and relational factors on infant sleep.

Infant sleep and negative reactivity: The role of maternal adversity and perinatal sleep

Sleep during infancy contributes to the development and maintenance of infant regulatory functioning and may be an early risk marker for more difficult temperamental traits like negative reactivity. Further, maternal adverse childhood experiences (ACEs) may predispose individuals to greater sleep disturbances in adulthood and have been linked with sleep disturbances in both mothers and infants. Thus, examining maternal history of ACEs and maternal sleep difficulties during pregnancy and postpartum may provide insight into underlying risk factors affecting infant sleep difficulties and early temperament development. Fifty-nine mothers from a diverse, community sample (44% white) completed questionnaires on ACEs, maternal sleep, infant sleep, and infant temperament at 30-weeks gestation, 6-weeks postpartum, and 16-weeks postpartum. Results indicated that maternal ACES and sleep problems during pregnancy have long term implications for infant negative reactivity at 16-weeks, with significant indirect effects through maternal and infant sleep problems at 6-weeks. Addressing psychosocial functioning and prenatal sleep during pregnancy, particularly among women with high ACEs, may be a target of intervention to improve maternal and infant sleep health during the postpartum, and reduce the risk for difficult infant temperament.

Sleep problems and infant motor and cognitive development across the first two years of life: The Beijing Longitudinal Study

The present study examined bidirectional effects between sleep problems (nocturnal awakenings and insufficient nocturnal sleep) and infant development (gross motor, fine motor, and cognition) in a sample of 182 infants (89 girls) and their parents living in Beijing (China). Using 3 waves of longitudinal data (at 6 months, 1 year, and 2 years of age), this study (a) explored the differences in sleep patterns and developmental outcomes between infants in the current sample and infants from other cultures; and primarily examined (b) whether nocturnal awakenings and insufficient nocturnal sleep prospectively predicted infant development; (c) or whether infant development predicted sleep problems. Mothers reported their children's sleep problems, and infant development was assessed with Bayley III. Sleep patterns of Beijing infants were slightly different from those from Finland and Singapore, and most scores on Bayley III in this Beijing sample were higher than those in Danish, Dutch and Sri Lankan samples. Sleep problems and developmental measures were stable across the 3 times of assessments, but cross-lagged associations were limited in number and strength. High scores on the Bayley at 6 months predicted less nocturnal awakenings at 1 year of age. Insufficient nocturnal sleep at 1 year predicted poor fine motor development at 2 years. Thus, findings suggest some bidirectional associations between infant development and sleep problems and further highlight the need to understand these relations within specific cultural contexts.

Child Sleep Problems Affect Mothers and Fathers Differently: How Infant and Young Child Sleep Affects Paternal and Maternal Sleep Quality, Emotion Regulation, and Sleep-Related Cognitions

PURPOSE

Problems in infant and young child sleep can represent a serious challenge to parental behavior of mother and father. However, most research about the effect of infant and young child sleep on parenting has focused on mothers. Therefore, the present study aimed to explore the perception and consequences of infant and young child sleep problems of both parents.

PARTICIPANTS AND METHODS

Participants were recruited via random sampling at, eg, kindergartens in North Rhine Westphalia. The sample includes data of heterosexual German-speaking couples with children without any medical or psychopathological problems. For this study, parents were asked to complete the test battery with regard to their youngest child. As sampling was via the kindergarten, the range of child age was 4-68 months. A survey assessed data of parents (N=196, 46% female). The test battery contained the following questionnaires: Children Sleep Habits Questionnaire (CSHQ), Pittsburgh Sleep Quality Index (PSQI), Self-Report Measure for the Assessment of Emotion Regulation Skills (SEK-27), and a German version of the Infant Sleep Vignettes Interpretation Scale (ISVIS). For the outcome variables of parental sleep as well as for parental emotional competence, the statistical tests of ANOVA were used, and for parental sleep-related cognitions with the grouping variables of infant and young child sleep as well as parental gender, a MANOVA was used. According to the analysis of group differences, the age of the child was also included additional to the grouping variable of parental gender and children's sleep.

RESULTS

Mothers and fathers in this sample were equally aware of their children's sleep problems and reported similar sleep quality and emotion regulation themselves (all p > 0.05). Mothers as well as fathers of children with sleep problems had lower parental sleep quality (F(1, 183) = 110.01, p < 0.001) and emotion regulation (F(1, 184) = 143.16, p < 0.001) compared to parents of children without sleep problems. In children under 26 months of age, the child's age seemed to have less negative impact on the father's sleep quality (F(1, 183) = 5.01, p < 0.001) and emotion regulation (F(1, 184) = 0.72, p < 0.05) than on the outcomes of the mother. With regard to sleep-related cognition, there were statistically significant effects of parental gender (F(2, 185) = 44.39, p < 0.001) and interaction effects of parental gender × child sleep problems observed (F(2, 185) = 31.91, p < 0.001).

CONCLUSION

The conclusion from this survey refers to the role of the father. According to the results, an association between paternal emotional competence, sleep quality as well as their sleep-related cognitions and infants and toddlers sleep behavior could be assumed in addition to and independent of the results of mothers. We would highlight the urgent need of inclusion of fathers in infant and developmental sleep research. In the context of sleep intervention, both parents should be provided with ongoing support to improve their sleep quality and competence in emotion regulation.

Comparing infant and toddler sleep patterns prior to and during the first wave of home confinement due to COVID-19 in Spain

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children's functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017-2018, n = 1380) and another during COVID-19 pandemic (March-May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p < 0.001). Based on the recommended BISQ criteria, we observed an increase in poor sleepers meeting at least one criterion of inadequate patterns during confinement (p < 0.001). Parental perception of a child's sleep as problematics were 39.4% and 44.1% (adjusted p = 0.363) before and under lockdown, respectively.

CONCLUSION

Home confinement generally affected infant's and toddler's sleep patterns negatively; however, parents did not report worse perception of sleep quality of their children. Follow-up studies can help understand the potential long-term effects of the COVID-19 pandemic on sleep patterns.

WHAT IS KNOWN

• Adequate sleep patterns in infants and toddlers are relevant as they are linked to proper and long-term social-emotional development as well as adequate daytime functioning. • Regarding sleep patterns in paediatrics during the COVID pandemic, recent literature has described an increase in total daily sleep time as well as more exposure to screens in children and adolescents, providing evidence of immediate collateral consequences of the COVID-19 outbreak.

WHAT IS NEW

• Comparing sleep patterns in two samples of infants and toddlers in Spain before and during COVID-confinement, we found later bedtimes as well as a significant increase in infants' and toddlers' sleep latency by >30 min during confinement. • Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children's sleep based on the BISQ criteria.

Parenting and maternal reported child sleep problems in infancy predict school-age aggression and inattention

OBJECTIVE

To examine caregiving predictors of maternal reported sleep problems and child behavioral and cognitive outcomes in early childhood.

DESIGN

A prospective longitudinal study from 6 to 84 months of age.

SETTING

Lab visits, assessments, and questionnaires conducted with a community-based sample.

PARTICIPANTS

One hundred sixty-four African American and White children, their mothers, and teachers.

MEASUREMENT

Parenting behavior was measured during a free-play task at 6 months of age, maternal-report of child sleep problems was completed at 6 timepoints, and teacher report of child aggression and attention was collected in kindergarten and second grade.

RESULTS

Latent growth curve modeling revealed that maternal reported sleep problems decreased in children from 18 to 84 months and harsh-intrusive parenting at 6 months predicted sleep problems at 18 months. Maternal reported sleep problems at 18 months predicted aggressive behaviors in kindergarten and second grade.

CONCLUSION

Parenting at 6 months of age exerts an influence on sleep quality at 18 months which is associated with aggressive behavior in early childhood.

The Interaction between Lockdown-Specific Conditions and Family-Specific Variables Explains the Presence of Child Insomnia during COVID-19: A Key Response to the Current Debate

It is still debated whether lockdown conditions in response to the coronavirus disease 2019 (COVID-19) health crisis seriously affected children’s sleep. For young children, some studies identified more insomnia, while others only transient disturbances, or even no effect. Based on the premise of mother–child synchrony, a well-known dynamic established in child development research, we hypothesized that principally, the children whose mothers perceived the lockdown as stressful and/or responded maladaptively, suffered sleep disturbances. The main objective of this study was to identify the family profiles, variables, and lockdown responses most linked to insomnia in young children. The sample consisted of 165 mothers, French vs. Swiss origin (accounting for different lockdown severities), of children 6 months to 5 years old. Validated sleep, stress, and behavior scales were used. Multiple regression, age-matched clustering, and structural equation modeling analyses provided evidence that insomnia in young children is indeed strongly linked to the mother’s reaction to the pandemic and lockdown. Specifically, reactions such as COVID-19 fear/anxiety and obsessive COVID-19 information seeking coincide with heightened vigilance, cascading into reduced child social contact, outings, and increased screen viewing, ultimately culminating in child insomnia and behavioral problems. Mother education level and child day care quality (e.g., home-schooling) were also identified as strong insomnia predictors.

A longitudinal study of the links between maternal and infant nocturnal wakefulness

STUDY OBJECTIVES

To examine the longitudinal links between maternal and infant nocturnal wakefulness by employing a trajectory-based approach, and to assess whether the strength of these links differs as a function of sleep assessment method (actigraphy vs. self-report) and sleeping arrangements.

METHODS

Maternal and infant nocturnal wakefulness were assessed with actigraphy and sleep diaries at home for 5 nights, at 3 (N = 191), 6 (N = 178), 12 (N = 155), and 18 (N = 135) months postpartum. Outcome measures included the number of night-wakings (NW) and the length of nocturnal wakefulness (WASO).

RESULTS

Strong associations between maternal and infant nocturnal wakefulness (controlling for nighttime breastfeeding) were found for NW and WASO. Trajectory analyses demonstrated that the strength of these relations decreased linearly from 3 to 18 months. Furthermore, the findings showed that the links between maternal and infant NW and WASO were stronger for maternal reports than for actigraphy. No consistent differences were found in the strength of the relations between maternal and infant NW and WASO as a function of sleeping arrangements (ie, room-sharing vs. solitary-sleeping families).

CONCLUSIONS

The results suggest that infant and maternal sleep are strongly intertwined, especially during the first 6 months. The decline in the synchronization between maternal and infant nocturnal wakefulness through infant development may be attributed to the growing ability of infants to self-soothe during the night. The findings emphasize the need to study sleep within a family context.

COVID-19 babies: auto-videosomnography and parent reports of infant sleep, screen time, and parent well-being in 2019 vs 2020

OBJECTIVE

The COVID-19 pandemic has profoundly impacted families, yet studies on its effects on infants and their parents have thus far been sparse and based mostly on retrospective parent reporting. This study aimed to prospectively evaluate the impact of COVID-19 living conditions on infant and parent sleep, as well as infant screen exposure, parent daytime sleepiness, and parent depression levels, using multi-method assessment.

METHODS

Infant and parent data collected in 2020 were compared with a matched cohort collected in 2019. The total sample included 1518 US infants aged 1-18 months (M = 8.5, SD = 4.6; 54% boys). Auto-videosomnography metrics were obtained from the 14-day period prior to survey completion (number of analyzed nights: M = 12.11 SD = 2.66 in the 2019 cohort; and M = 11.91 SD = 2.41 in the 2020 cohort). Parents completed online questionnaires regarding their infant's sleep and screen exposure, as well as their own sleep quality, daytime sleepiness, and depression levels.

RESULTS

Compared to 2019, infants in 2020 slept ∼40 min more per night on average, as indicated by auto-videosomnography. Infants additionally had earlier sleep timing, and increased parent-reported sleep-onset latency and nocturnal wakefulness. Infant screen time rose by 18.3 min per day for older infants, but remained stable for younger infants. Parents reported lower daytime sleepiness and higher depression symptomology during 2020, whereas no change was apparent in their sleep quality ratings.

CONCLUSIONS

Restricted living conditions during COVID-19 in the USA led to increased infant screen exposure and parental depression, but also to increased infant sleep duration and reduced parent sleepiness. Future research is needed to examine the mechanistic pathways through which COVID-19 impacted on infant and parent well-being.

Parental perceived child sleep problems: A concept analysis

PURPOSE

This paper aims to delineate a conceptual analysis of parental perceived child sleep problems.

DESIGN AND METHODS

Rodger's evolutionary approach to concept analysis was employed. A systematic literature search of PubMed, CINAHL, Medline, and PsycINFO was conducted from inception to June 2020. Peer-reviewed papers written in English focusing on parental perception of their children's sleep problems were included.

RESULTS

A total of 47 papers were included for analysis. Parental perceived child sleep problems can be defined as parental reliance on their observations and beliefs, and perceived locus of control to appraise an array of children's sleep-related signs and behaviors, which may contain bias but still reflects certain aspects of children's sleep health status. A wide range of physiological, psychosocial, familial, environmental, and cultural factors may contribute to parental perceived child sleep problems, which may further contribute to parent-child dyads' physical and mental health as well as the whole family's general wellness.

PRACTICE IMPLICATIONS

Defining the concept of parental perceived child sleep problems facilitate health professionals a foundation for consistent use, understanding, and evaluation of parent-reported child sleep outcome. Future research on the standard conceptual and operational definition of parental perceived child sleep problem, and its potential antecedents and consequences is warranted. The characteristic of parental perceived sleep problems, together with child sleep history and objective sleep measures should be integrated to evaluate child sleep health.

Sleep Consolidation, Sleep Problems, and Co-Sleeping: Rethinking Normal Infant Sleep as Species-Typical

Infants evolved in the context of close contact (including co-sleeping). Evolutionary context is rarely considered in psychological infant sleep research, and Western sleep researchers make assumptions about what optimal "normal" infant sleep is and how to achieve early, deep, infant sleep consolidation and avoid infant sleep problems. However, an evolutionary and anthropological view of infant sleep as species-typical recognizes that human evolution likely prepared the infant brain for optimal development within its evolutionary context - co-sleeping. Thus, "normal" infant sleep, sleep consolidation, and sleep problems should all be understood within the framework of co-sleeping infants, not the historically new-phenomenon of solitary-sleeping infants. Much work needs to be done in order to understand "normal" infant sleep as species-typical and how adaptive infants are to environments that stray from their evolutionary norm.

The contributory role of the family context in early childhood sleep health: A systematic review

Sleep-wake regulation is established during early childhood and contributes to life-long health. The family context is critical to the development of child sleep-wake regulation. The primary aim of this systematic review was to elucidate family-level constructs (outside of bedtime parenting) that contribute to early childhood (age 0-5 years) sleep health. We identified empirical research articles that investigate these relationships through systematically searching PubMed, Web of Science, and PsycINFO databases. The transactional model of sleep-wake regulation guided the selection of family-level search terms, including socioeconomic status (SES), family structure, household chaos, marital, co-parenting, and social relationships. Sleep search terms included sleep problems, duration, timing, and variability. We searched sleep and family terms in combination with infant, toddler, or preschool developmental age. Sixteen studies satisfied criteria for inclusion. Results indicated that the presence of household chaos and poor quality marital relationships were directly associated with early childhood sleep problems and variable sleep timing. Higher marital satisfaction and the presence of household routines were positively associated with sleep duration. Several, but not all, studies showed an association between lower SES and poor child sleep health. There were no significant direct associations for family structure and limited findings for the role of perceived social support and co-parenting relationship quality. Overall, operationalization and measurement of family and sleep constructs varied across studies, decreasing our ability to make comparisons and draw robust conclusions. Future research should identify modifiable family-level factors that can be targeted, in addition to bedtime parenting, to improve sleep-wake regulation development.

Infant sleep during COVID-19: Longitudinal analysis of infants of US mothers in home confinement versus working as usual

OBJECTIVES

This study longitudinally compared the sleep of infants in the United States whose mothers were in home confinement to those whose mothers were working as usual throughout the COVID-19 pandemic.

METHODS

Mothers of 572 infants (46% girls) aged 1-12 months (M = 5.9, standard deviation = 2.9) participated. Assessments were conducted on 4 occasions from late March to May 2020. Infant sleep was measured objectively using auto-videosomnography. Mothers reported their sheltering status, demographic characteristics, and infant sleep.

RESULTS

Infants of mothers in home confinement had later sleep offset times and longer nighttime sleep durations, compared to infants of mothers who were working as usual. At the end of March, these infants also had earlier bedtimes, more nighttime awakenings, and more parental nighttime visits, but differences were not apparent during April and May.

CONCLUSIONS

Living restrictions issued in the United States may have led to longer sleep durations and temporary delays in sleep consolidation for infants of mothers in home confinement.

Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families

BACKGROUND

Habits surrounding health behaviors (i.e., sleep, physical activity, diet) are developed in toddlerhood. Lack of consistent health habits may increase obesity risk among toddlers in low-income families.

PURPOSE

To compare the role of sleep onset consistency, physical activity and diet quality as mediators between household poverty and toddler weight.

METHODS

Two hundred and seven toddlers (mean age = 20.2 months, 46% female, 68.1% Black) participating in an obesity prevention trial were assessed at three time points over 12 months. Using Actical accelerometers, we assessed sleep and physical activity at each time point for up to 1 week. We defined sleep onset consistency as the standard deviation of sleep onset across all days. We calculated the Healthy Eating Index-2015 from a 24-hr dietary recall. We used WHO standards to calculate BMI-for-age z-scores from toddlers' weight/length, and calculated poverty ratio from parent-reported income and family size. Multilevel mediation models tested toddler sleep onset consistency, physical activity, and diet quality as mediators between household poverty and toddler BMI z-score.

RESULTS

Toddlers from households with higher poverty ratios had more inconsistent sleep onset times. Toddlers with more inconsistent sleep onset times had higher BMI z-scores across all timepoints, even when accounting for physical activity and diet quality. Sleep onset consistency indirectly explained the association between household poverty and BMI z-score.

CONCLUSIONS

Inconsistent sleep schedules could help explain the association between poverty and BMI. Future research should examine strategies to support low-income families to develop and maintain routines as a mechanism to prevent obesity and reduce disparities.

TRIAL REGISTRATION NUMBER

NCT02615158.

Parental Involvement in Children's Sleep Care and Nocturnal Awakenings in Infants and Toddlers

Background: Sleep regulation and consolidation represent critical developmental processes that occur in the first years of life. Recent studies have highlighted the contribution of caregivers to sleep development. However, the majority of them have primarily focused on maternal behaviors, overlooking fathers. The main goal of the present study was to investigate the associations between paternal and maternal involvement in children’s sleep care and the number of night awakenings reported by both parents in infants and toddlers. Methods: One-hundred-and-one families of infants aged 8 to 12 months and 54 families of toddlers aged 18 to 36 months filled out the following self-report questionnaires: The Brief Infant Sleep Questionnaire and an ad hoc questionnaire to assess parental involvement in sleep care for children. A moderate actor–partner interdependence (APIM) with path analysis was performed to test the predictive role of parental involvement on the children’s sleep (no. of nocturnal awakenings) and the moderation role of age on these relationships. Results: Paternal involvement in children’s sleep care was associated with the number of night awakenings reported by both parents. Moreover, a significant interaction effect emerged between the children’s age and paternal involvement in children’s sleep care for predicting nocturnal awakenings. Conclusions: The main outcomes of this study point to the protective role of paternal involvement in children’s sleep during the first years of life.

Longitudinal links between maternal factors and infant cognition: Moderation by infant sleep

The current study examined the moderating role of infant sleep in the link between maternal factors (i.e., maternal education, depressive symptoms, sleep disturbance) and infant cognition. Data come from 95 African American parent-child dyads. At 3 months of age, infant sleep was objectively measured using videosomnography and actigraphy, from which measures of sleep regulation and consolidation were calculated. Mothers also self-reported their level of education, depressive symptoms, and sleep quality. At 6 months of age, infants completed cognitive assessments, including a measure of general cognitive ability and observed attention behavior. Findings revealed that infant sleep quality interacted with maternal education and sleep disturbances to predict cognition. Specifically, the link between maternal education and infants' attention behavior was significant and positive for infants with better regulated sleep, but not for infants with poorly regulated sleep. Similarly, the link between maternal sleep disturbance and infant cognition depended on infant sleep quality. For infants with poorer sleep consolidation, increased maternal sleep disturbance predicted poorer infant general cognitive ability. For infants with better sleep consolidation, maternal sleep disturbance was positively related to both general cognitive ability and attention behavior. These findings suggest that infant sleep quality moderates the impact of environmental factors on cognitive functioning.

Maternal Antenatal Depression and Early Childhood Sleep: Potential Pathways Through Infant Temperament

Objective

Maternal depression is associated with infant and child sleep patterns, and with infant temperament. Here, we examine whether infant temperament mediated an association between maternal antenatal depression and toddler sleep.

Method

Within the prebirth longitudinal cohort Growing Up in New Zealand, symptoms of antenatal and postnatal depression were measured in 5,568 women using the Edinburgh Postnatal Depression Scale (EPDS). Infant temperament was measured at age 9 months using the Very Short Form of Infant Behavior Questionnaire-Revised (IBQ-R VSF). Sleep duration and nighttime awakenings were reported by parents when children were 2 years old.

Results

Independent associations of maternal depression with child sleep patterns at age 2 years, adjusted for maternal demographics, physical health, family relationships, and child health and feeding, were determined using multivariate logistic regression analysis. The odds of having ≥2 nighttime awakenings were increased for children whose mothers had antenatal (1.36, 1.07–1.73) but not postnatal (1.22, 0.88–1.68) or both antenatal and postnatal depression (0.89, 0.56–1.36). There was no association of maternal depression with shorter sleep duration. Two of five dimensions of infant temperament (fear and negative affect) were associated with both antenatal depression scores and increased nighttime awakenings. Mediation analyses controlling for postnatal depression and other predictors of child sleep supported an indirect pathway of antenatal depression to child sleep through infant temperamental negative affectivity.

Conclusion

Antenatal depression is independently associated with more frequent nighttime awakenings in early childhood. Findings support an indirect pathway through infant negative affect characteristics.