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Jiang J, Li Z, Li H, Yang J, Ma X, Yan B. Sleep architecture and the incidence of depressive symptoms in middle-aged and older adults: A community-based study. J Affect Disord 2024; 352:222-228. [PMID: 38342319 DOI: 10.1016/j.jad.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Rapid eye movement (REM) sleep and three stages of non-REM (NREM) sleep comprise the full sleep cycle. The changes in sleep have been linked to depression risk. This study aimed to explore the association between sleep architecture and depressive symptoms. METHODS A total of 3247 participants from the Sleep Heart Health Study (SHHS) were included in this cohort study. REM and NREM sleep were monitored by in-home polysomnography at SHHS visit 1. Depressive symptoms was reported as the first occurrence between SHHS visits 1 and 2 (mean follow-up of 5.3 years). Multivariable logistic regression was used to investigate the relationship between sleep stages and depressive symptoms. RESULTS In total, 225 cases of depressive symptoms (6.9 %) were observed between SHHS visits 1 and 2. A significant linear association between NREM Stage 1 and depressive symptoms was found after adjusting for potential covariates. Multivariable logistic regression analysis showed that percentage in NREM Stage 1 was associated with the incidence of depressive symptoms (odds ratio [OR], 1.06; 95 % confidence interval [CI], 1.02-1.10; P = 0.001), as were time in NREM Stage 1 and depressive symptoms (OR, 1.02; 95 % CI, 1.01-1.03; P = 0.001). However, no significant association with depressive symptoms was found for other sleep stage. LIMITATIONS The specific follow-up time for depressive symptoms diagnosis was missing. CONCLUSIONS Increased time or percentage in NREM Stage 1 was associated with a higher risk of developing depressive symptoms. The early change in sleep architecture were important for incidence of depressive symptoms and warrants constant concerns.
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Affiliation(s)
- Jialu Jiang
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhenyang Li
- Xi'an Jiaotong University Health Science Center, Xi'an, China; Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huimin Li
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Yang
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiancang Ma
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Bin Yan
- Department of Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Shaanxi Belt and Road Joint Laboratory of Precision Medicine in Psychiatry, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Don DM, Osterbauer B, Gowthaman D, Fisher L, Gillett ES. Polysomnographic Characteristics of Sleep Architecture in Children With Obstructive Sleep Apnea. Ann Otol Rhinol Laryngol 2024:34894241232477. [PMID: 38450648 DOI: 10.1177/00034894241232477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND The conventional measure of sleep fragmentation is via polysomnographic evaluation of sleep architecture. Adults with OSA have disruption in their sleep cycles and spend less time in deep sleep stages. However, there is no available evidence to suggest that this is also true for children and published results have been inconclusive. OBJECTIVE To determine polysomnographic characteristics of sleep architecture in children with OSA and investigate effects relative to OSA severity. METHODS Overnight polysomnograms (PSG) of children referred for suspected OSA were reviewed. Subjects were classified by apnea hypopnea index (AHI). PSG parameters of sleep architecture were recorded and analyzed according to OSA severity. RESULTS Two hundred and eleven children were studied (median age of 7.0 years, range 4-10 years) Stage N1 sleep was longer while stage N2 sleep and REM sleep was reduced in the OSA group when compared to those without OSA (6.10 vs 2.9, P < .001; 42.0 vs 49.7, P < .001; 14.0 vs 15.9, P = .05). The arousal index was also higher in the OSA group (12.9 vs 8.2, P < .001). There was a reduction in sleep efficiency and total sleep time and an increase in wake after sleep onset noted in the OSA group (83.90 vs 89.40, P = .003; 368.50 vs 387.25, P = .001; 40.1 ± 35.59 vs 28.66 ± 24.14, P = .007; 29.00 vs 20.50; P = .011). No significant difference was found in N3 sleep stage (33.60 vs 30.60, P = .14). CONCLUSION We found evidence that children with OSA have a disturbance in their sleep architecture. The changes indicate greater sleep fragmentation and more time spent in lighter stages of sleep. Future research is needed and should focus on more effective methods to measure alterations in sleep architecture.
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Affiliation(s)
- Debra M Don
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Beth Osterbauer
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Divya Gowthaman
- Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laurel Fisher
- Caruso Department of Otolaryngology, University of Southern California, Los Angeles, CA, USA
| | - Emily S Gillett
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
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3
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Benbir Senel G, Aktan Suzgun M, Bibinoglu Amirov C, Karadeniz D. The Comparison of the Sleep Structure and Sleep Spindle Activity in Children With Primary Snoring and Sleep-Disordered Breathing. Clin Pediatr (Phila) 2023; 62:565-570. [PMID: 36433642 DOI: 10.1177/00099228221139985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) in children is associated with changes in the structure of sleep. The possible effects of snoring on spindle activity have not been established. We analyzed the polysomnography recordings and sleep spindle activity in children with primary snoring and/or OSAS compared with healthy children. Fifty-one children were included; 8 had primary snoring, 16 had OSAS and snoring, 11 had OSAS without snoring, and 16 were healthy controls. The density (P = .034) and duration (P = .019) of sleep spindles were decreased in children with OSAS compared with controls. The sleep spindle activity did not show significant changes between children with primary snoring and healthy controls, or between OSAS with/without snoring. We conclude that it is not snoring per se but OSAS that affects sleep spindle activity. Obstructive sleep apnea syndrome with/without snoring deserves greater attention because it has different phenotypes of the disease with different pathophysiologies.
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Affiliation(s)
- G Benbir Senel
- Department of Neurology, Sleep and Disorders Unit, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - M Aktan Suzgun
- Department of Neurology, Sleep and Disorders Unit, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - C Bibinoglu Amirov
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - D Karadeniz
- Department of Neurology, Sleep and Disorders Unit, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ramirez FD, Groner JA, Owens JA, McCulloch CE, Cabana MD, Abuabara K. Sleep-Disordered Breathing and Sleep Quality in a Longitudinal Pediatric Cohort. Clin Pediatr (Phila) 2022; 61:469-474. [PMID: 35466717 DOI: 10.1177/00099228221092646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Faustine D Ramirez
- Department of Pediatrics, University of California San Francisco, CA, USA
| | - Judith A Groner
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA
| | - Judith A Owens
- Center for Pediatric Sleep Disorders, Boston Children's Hospital, Boston, MA, USA
- Boston Children's Hospital, Harvard Medical School, Waltham, MA, USA
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Michael D Cabana
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Katrina Abuabara
- Department of Dermatology, Program for Clinical Research, University of California, San Francisco, CA, USA
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Hagström K, Saarenpää-Heikkilä O, Himanen SL, Lampinlampi AM, Rantanen K. Neurobehavioral Outcomes in School-Aged Children with Primary Snoring. Arch Clin Neuropsychol 2020; 35:401-412. [PMID: 31813961 DOI: 10.1093/arclin/acz053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 09/04/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We assess behavioral and attentional problems and neurocognitive functioning in school-aged children with primary snoring (PS). METHODS Seventeen children with PS and 27 non-snoring peers aged 6-10 years took part in the study. All children underwent a polysomnography (PSG) at the Sleep Laboratory. Snoring was defined by parents and with PSG. Children with obstructive sleep apnea were excluded. The parents completed the Sleep Disturbance Scale for Children. Parents and teachers assessed behavioral and attentional problems with the Child Behavior Checklist and the Conners' Rating Scale-Revised. Neuropsychological assessment included the Wechsler Intelligence Scale for Children and the Developmental Neuropsychological Assessment (NEPSY test). RESULTS The PS group had significantly more parent-reported internalizing, total, and attentional problems than the control group. Teachers did not report behavioral problems in the PS group. The PS and control groups had equal IQ scores and similar core neurocognitive functions, except for one visuospatial subtest. The PS group had significantly more inspiratory flow limitation and increased diaphragmatic electromyography compared with the controls. Parents reported significantly more daytime sleepiness in the PS group. Daytime sleepiness and snoring time were consistently associated with more behavioral and attentional problems. Flow limitation and more oxygen saturation values under 90% were associated with attentional problems, higher oxygen desaturation index, and lower mean oxygen saturation percentage with reduced language functions. CONCLUSIONS Snoring with an increase in respiratory effort without apneas and hypopneas and parent-reported daytime sleepiness may be linked to daytime symptoms. School-aged children with PS are at risk for behavioral and attentional problems, but not cognitive impairments.
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Affiliation(s)
- Kati Hagström
- Lic.A Psych, Psychology Clinic, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
| | | | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, 33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
| | - Anna-Maria Lampinlampi
- Department of Clinical Neurophysiology, Pirkanmaa Hospital District, 33521 Tampere, Finland
| | - Kati Rantanen
- Department of Pediatrics, Tampere University Hospital, 33521 Tampere, Finland.,Psychology Clinic, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
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Chan M, Wong TCH, Weichard A, Nixon GM, Walter LM, Horne RSC. Sleep macro-architecture and micro-architecture in children born preterm with sleep disordered breathing. Pediatr Res 2020; 87:703-710. [PMID: 31195406 DOI: 10.1038/s41390-019-0453-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Both preterm birth and sleep disordered breathing (SDB) affect sleep in children. We compared the effects of SDB on sleep macro-architecture and micro-architecture in children born preterm (N = 50) and children born at term (N = 50). We hypothesized that sleep would be more disrupted in children born preterm. METHODS Polysomnographic studies matched for age (3-12 years) and SDB severity were analyzed. Sleep macro-architecture was assessed using standard criteria and micro-architecture was evaluated using spectral analysis of the electroencephalogram and slow wave activity (SWA) calculated for each sleep stage across the night. RESULTS Ex-preterm children (gestational age 29.3 ± 3.6 weeks, mean ± standard error of the mean) were not different from controls for demographic or respiratory parameters or sleep macro-architecture. Theta power in N2 tended to be higher for F4 (p < 0.05) and C4 (p < 0.07). In the second non-rapid eye movement period, SWA was significantly higher in the preterm group compared to the term group for both F4 and C4 (p < 0.05 for both). CONCLUSIONS Sleep micro-architecture in children born preterm showed increased theta power and SWA. These differences provide evidence of increased sleep debt and reduced dissipation of sleep debt across the night. Further studies are required to identify if these findings are related to impaired neurocognition and behavior.
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Affiliation(s)
- Martin Chan
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tracy C H Wong
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, VIC, Australia.
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7
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Shahveisi K, Jalali A, Moloudi MR, Moradi S, Maroufi A, Khazaie H. Sleep Architecture in Patients With Primary Snoring and Obstructive Sleep Apnea. Basic Clin Neurosci 2018; 9:147-156. [PMID: 29967674 PMCID: PMC6026090 DOI: 10.29252/nirp.bcn.9.2.147] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: This study aimed to investigate sleep architecture in patients with primary snoring and obstructive sleep apnea. Methods: In this study, we analyzed polysomnographic data of 391 clients who referred to Sleep Disorders Research Center (SDRS). These people were classified into three groups based on their Apnea-Hypopnea Index (AHI) and snoring; control, Primary Snoring (PS), and Obstructive Sleep Apnea (OSA) group. Sleep architecture variables were then assessed in all groups. Results: The results of this study indicated a decrease in deep sleep or Slow Waves Sleep (SWS) and increase in light sleep or stage 1 of non-REM sleep (N1) in OSA patients compared with the control and PS groups. After controlling the effects of confounding factors, i.e. age and Body Mass Index (BMI) (which was performed through multiple regression analysis) significant differences were observed among the three groups with regard to N1. However, with regard to SWS, after controlling confounding variables (age and BMI), no significant difference was found among the groups. Conclusion: The results indicated that OSA, regardless of age and BMI, may increase light (N1) sleep possibly via a decline in blood oxygen saturation (SpO2
). Such increase in N1 may be responsible for brain arousal. In addition, by controlling confounding factors (age and BMI), OSA did not affect SWS in OSA patients. However, further research is necessary to determine sleep architecture in more detail in the patients with OSA.
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Affiliation(s)
- Kaveh Shahveisi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Department of Psychiatric Nursing, Faculty of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shahla Moradi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azad Maroufi
- Neurosciences Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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8
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Durdik P, Sujanska A, Suroviakova S, Evangelisti M, Banovcin P, Villa MP. Sleep Architecture in Children With Common Phenotype of Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:9-14. [PMID: 29198306 DOI: 10.5664/jcsm.6868] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/21/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In children, the effect of the common phenotype of obstructive sleep apnea (OSA) on sleep architecture is not adequately documented. The aim of this study was to evaluate sleep architecture in a pediatric population with the common phenotype of OSA. METHODS The prospective cross-sectional study included 116 children in the age range of 3 to 8 years with suspected OSA and 51 healthy children. All children underwent standard overnight in-laboratory video polysomnography. Patients with obstructive apnea-hypopnea index ≥ 1, adenotonsillar hypertrophy, a long face, narrow palate or minor malocclusions, and no obesity were defined as a common phenotype. Polysomnographic parameters of sleep architecture and sleep clinical record were statistically analyzed according to OSA and its severity. RESULTS In total, 94 pediatric patients (59.60% male) received the diagnosis of the common phenotype of OSA (mean age of 5.25 ± 1.39 years). A lower percentage of stage N3 sleep (27.70 ± 3.76% versus 31.02 ± 4.23%; P < .05), a greater percentage of stage N1 sleep (8.40 ± 3.98% versus 2.68 ± 3.02%, P < .01), reduced deep sleep efficiency (46.01 ± 4.98% versus 50.25 ± 3.72%; P < .05) and longer sleep latency (18.40 ± 8.48 minutes versus 9.90 ± 11.55 minutes, P < .01) were found in children with the common phenotype of OSA compared with healthy controls. No significant differences were found in total sleep time, sleep efficiency, and percentage of stage R sleep and stage N2 sleep between groups and in sleep stage distribution and cyclization. CONCLUSIONS These findings suggest that the most common phenotype of pediatric OSA has a negative effect on the structure of sleep, but other clinical studies are needed to confirm this result.
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Affiliation(s)
- Peter Durdik
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia
| | - Anna Sujanska
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia.,Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Stanislava Suroviakova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia
| | - Melania Evangelisti
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Peter Banovcin
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Pediatric Department, Slovakia
| | - Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Pediatric Sleep Disease Centre, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Takahashi M, Wang G, Adachi M, Jiang F, Jiang Y, Saito M, Nakamura K. Differences in sleep problems between Japanese and Chinese preschoolers: a cross-cultural comparison within the Asian region. Sleep Med 2018; 48:42-48. [PMID: 29857290 DOI: 10.1016/j.sleep.2017.11.1145] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES Previous studies have performed cross-cultural comparisons of differences in childhood sleep problems between Asian and Western countries. However, whether such differences can be observed among Asian countries remains unclear. The present study aimed to investigate differences in the pattern of sleep problems between Japanese and Chinese preschoolers. METHODS Data were collected from one city in Japan and 10 cities in China. The present study recruited 438 Japanese and 1020 Chinese preschoolers aged four and five years. Sleep problems and patterns were assessed on the basis of parental reports using the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Analysis of covariance revealed no significant difference in total CSHQ scores between Japanese and Chinese preschoolers, thus indicating that the total severity of sleep problems did not differ between the groups. Japanese preschoolers exhibited higher scores on the bedtime resistance subscale of the CSHQ than Chinese preschoolers. Conversely, Chinese preschoolers exhibited higher subscale scores for night wakings and sleep-disordered breathing. In addition, Japanese preschoolers exhibited earlier bedtimes and wake times and shorter total sleep times than Chinese preschoolers. CONCLUSIONS Our findings indicate that the patterns of sleep problems in preschoolers differ between Japan and China and that such differences may be due to differences in cosleeping practices, bedtime routines, and/or environmental conditions. Thus, investigators studying sleep in preschoolers should consider regional differences in the pattern of sleep problems, even among Asian countries.
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Affiliation(s)
- Michio Takahashi
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan.
| | - Guanghai Wang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China; School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.
| | - Masaki Adachi
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Yanrui Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Manabu Saito
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Kazuhiko Nakamura
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan; Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
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