Daily dynamics in sleep and behavior of young African-American children: A convoluted dyad?!

Daily concordance between ecological stressors and sleep in young minority children during the pre-COVID-19 outbreak period

OBJECTIVE

As the COVID-19 pandemic brings widespread changes in families, the sociology of sleep becomes noticeable. Yet, the socio-contextual determinants of a biopsychosocial phenomenon as sleep are poorly investigated. We examine changes concomitantly occurring in the child's sleep per familial and community stressors.

METHODS

During the pre-COVID-19 outbreak period, in 24 minority children (5.4 ± 1.7 years old, 54.2% girls), sleep was objectively measured 24 h for two consecutive weeks, and this was repeated three times over the study period of three months. The caregiver filled out questionnaires surveying sociodemographic, community and family aspects.

RESULTS

Children went to bed at 22:26 and woke up at 07:04, with each a variability of about 50 min. Money and time were revealed as related key stressors to sleep. Five dimensions best fitted their association. In general, concurrent changes within the individual child indicate that mean sleep variables seem to relate to predominantly features of the stressors (explained variance of 34.7 to 56.7%), while variability of sleep tends to associate to situational aspects of the stressors (explained variance of 30.4 to 61.8%). Associations were best explained in terms of the 24 h dimension, particularly exposing sleep variability.

CONCLUSION

Individual variabilities in a child's sleep are associated with familial resources, such as caregiver's time to self, money and basic needs. Time spent in bed, a modifiable factor by society and shaper of sleep quantity and quality, plays a key role in stressor-sleep associations. Insights from biopsychosocial perspectives may be valuable for understanding COVID-19 sleep studies, and the development of (post-) COVID-19 sleep recommendations.

Sleep, Classroom Behavior, and Achievement Among Children of Color in Historically Disinvested Neighborhoods

Children of color are more likely to have poor sleep health than White children, placing them at risk for behavioral problems in the classroom and lower academic performance. Few studies, however, have utilized standardized measures of both classroom behavior and achievement. This study examined whether children's sleep (parent and teacher report) in first grade concurrently related to independent observations of classroom behavior and longitudinally predicted achievement test scores in second grade in a sample of primarily Black (86%) children (n = 572; age = 6.8) living in historically disinvested neighborhoods. Higher teacher-reported child sleepiness was associated with lower adaptive behaviors and higher problem behaviors in the classroom, and predicted lower achievement. Parent-reported bedtime resistance and disordered breathing also predicted lower achievement.

A review of developmental consequences of poor sleep in childhood

Sleep is a fairly diverse and complex construct to operationalize in a scientific and naturalistic context. We report a systematic review and meta-analysis of reviews published in the last 5 years on poor sleep and developmental outcomes. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 42 articles (or 1117 studies) qualified. They reported outcomes related to poor sleep investigated as sleep disorders (38.1%), sleep 'in general' (26.2%), sleep duration (23.8%), in terms of circadian rhythm (4.8%), intra-individual variability (2.4%), and napping (2.4%). Sleep was primarily subjectively reported (30.2%), yet the methodology of sleep assessment was often neither tabulated nor discussed. Overall, most papers had a health-scope, being primarily weight problems expressed as body mass index. Its relationship with performance was measured with the Wechsler intelligence tests, the child behavior checklist and the continuous performance test, whereas meta-analytic papers specifically focused on cognition with sleep disorder (i.e. sleep-disordered breathing; 38.6%), on health (i.e. weight) with sleep duration (25%) and behavior with sleep 'in general' (15.9%), having a high true variance. Nevertheless, an aggregated effect size d of 0.35 (95% confidence interval: 0.27-0.42) suggests that poor sleep is moderately affecting a child's performance and health. In conclusion, poor sleep can no longer be disregarded, yet methodologies that are more rigorous and a scope beyond health may foster a better understanding of the role of (poor) sleep across childhood neurodevelopment.

Adiposity in Adolescents: The Interplay of Sleep Duration and Sleep Variability

OBJECTIVE

To assess whether adiposity measures differed according to joint categories of sleep duration and sleep variability in a sample of Mexican adolescents.

STUDY DESIGN

A sample of 528 Mexico City adolescents aged 9-17 years wore wrist actigraphs for 6-7 days. Average sleep duration was categorized as age-specific sufficient or insufficient. Sleep variability, the standard deviation of sleep duration, was split at the median into stable versus variable. Adiposity measures-body mass index (BMI)-for-age Z score (BMIz), triceps skinfolds, waist circumference, and percent body fat-were collected by trained assistants. We regressed adiposity measures on combined sleep duration and variability categories. Log binomial models were used to estimate prevalence ratios and 95% CI for obesity (>2 BMIz) by joint categories of sleep duration and variability, adjusting for sex, age, and maternal education.

RESULTS

Approximately 40% of the adolescents had insufficient sleep and 13% were obese. Relative to sufficient-stable sleepers, adolescents with insufficient-stable sleep had higher adiposity across all 4 measures (eg, adjusted difference in BMIz was 0.68; 95% CI, 0.35-1.00) and higher obesity prevalence (prevalence ratio, 2.54; 95% CI, 1.36-4.75). Insufficient-variable sleepers had slightly higher BMIz than sufficient-stable sleepers (adjusted difference, 0.30; 95% CI, 0.00-0.59).

CONCLUSIONS

Adolescents with consistently insufficient sleep could be at greater risk for obesity. The finding that insufficient-variable sleepers had only slightly higher adiposity suggests that opportunities for "catch-up" sleep may be protective.

Agreement Between Actigraphy and Diary-Recorded Measures of Sleep in Children With Epilepsy

PURPOSE

To describe sleep patterns in young children with epilepsy and to examine levels of agreement between measurements derived from actigraphy and diary recordings.

DESIGN

Cross-sectional study.

METHODS

Eighty-nine toddlers and preschool-aged children with epilepsy wore an actigraph on their wrists for 7 consecutive days. Parents and caregivers maintained a concurrent sleep diary while the child was wearing the monitor. Levels of agreement between actigraphy and diary recordings were examined using the Bland and Altman method separately for all recording days, weekdays, and weekends.

FINDINGS

Discrepancies between actigraphy-derived and diary-documented sleep onset, sleep offset, actual sleep at night, wake after sleep onset, and daytime sleep were ±35, ±15, ±82, ±70, and ±29 min, respectively. Differences between actigraphy and diary-derived sleep variables were consistently greater for weekends than for weekdays. Discrepancies between actigraphy and diary-derived actual sleep at night were significantly greater for children who slept alone than for those who co-slept with a parent.

CONCLUSIONS

Our study demonstrates an acceptable agreement between actigraphy and diary recordings for sleep onset, sleep offset, and daytime sleep, but insufficient agreement for actual sleep at night and wake after sleep onset, with parents of children sleeping alone more likely to misestimate child sleep behaviors. Deviation of weekend sleep from weekdays further decreased the accuracy of parental sleep estimates and increased the discrepancies between actigraphy and diary.

CLINICAL RELEVANCE

Sleep in children with epilepsy assessed using diary recordings alone could be misleading, and actigraphy should be preferred over diaries when resources are available.

Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis

BACKGROUND

Although the scientific community has acknowledged modest improvements can be made to weight status and obesogenic behaviors (i.e., physical activity, sedentary/screen time, diet, and sleep) during the school year, studies suggests improvements are erased as elementary-age children are released to summer vacation. Emerging evidence shows children return to school after summer vacation displaying accelerated weight gain compared to the weight gained occurring during the school year. Understanding how summer days differ from when children are in school is, therefore, essential.

DISCUSSION

There is limited evidence on the etiology of accelerated weight gain during summer, with few studies comparing obesogenic behaviors on the same children during school and summer. For many children, summer days may be analogous to weekend days throughout the school year. Weekend days are often limited in consistent and formal structure, and thus differ from school days where segmented, pre-planned, restrictive, and compulsory components exist that shape obesogenic behaviors. The authors hypothesize that obesogenic behaviors are beneficially regulated when children are exposed to a structured day (i.e., school weekday) compared to what commonly occurs during summer. This is referred to as the 'Structured Days Hypothesis' (SDH). To illustrate how the SDH operates, this study examines empirical data that compares weekend day (less-structured) versus weekday (structured) obesogenic behaviors in U.S. elementary school-aged children. From 190 studies, 155 (~80%) demonstrate elementary-aged children's obesogenic behaviors are more unfavorable during weekend days compared to weekdays.

CONCLUSION

In light of the SDH, consistent evidence demonstrates the structured environment of weekdays may help to protect children by regulating obesogenic behaviors, most likely through compulsory physical activity opportunities, restricting caloric intake, reducing screen time occasions, and regulating sleep schedules. Summer is emerging as the critical period where childhood obesity prevention efforts need to be focused. The SDH can help researchers understand the drivers of obesogenic behaviors during summer and lead to innovative intervention development.