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

Parasomnias During the COVID-19 Pandemic

COVID-19 had a massive impact on sleep, resulting in overall increase of sleep disturbances. During lockdown many factors contributed to sleep disturbances, in particular changes in sleep-wake habits and stress. This article will describe the frequency and features of the principal parasomnias and the impact of the pandemic and the government restriction measures on sleep. Among different pathophysiological hypotheses, we will discuss the role of stress, considered as an expression of the allostatic load. Finally, during the pandemic, parasomnias were mainly investigated by questionnaires, with controversial results; video-polysomnographic studies are crucial to obtain a definitive diagnosis, even in critical conditions.

Let's Talk about Sleep Baby: Sexual Activity Postpartum and Its Links with Room Sharing, Parent Sleep, and Objectively Measured Infant Sleep and Parent Nighttime Crib Visits

The postpartum period may pose a considerable challenge for both parent sleep and sexual activity. This study assessed the links between partnered sexual frequency and satisfaction postpartum and parent sleep, infant sleep, parent nighttime caregiving, and parent-infant room sharing. Participants were 897 parents of infants aged 1-18-months (M = 8.8 ± 4.3, 49% girls). Parents completed an online survey about their sexual frequency and satisfaction, sleep, relationship satisfaction, depression, and demographic characteristics. Infant sleep and parent nighttime crib visits were measured objectively using auto-videosomnography during 2-weeks, with 8,460 nights assessed. Results indicated that the frequency of partnered sexual activity was 3.8 ± 4.2 times per month. Frequency of sexual activity increased with infant age, yet increases beyond the first 6 months postpartum were non-significant. Adjusted GEE modeling revealed that more parent nighttime crib visits were significantly associated with lower sexual frequency, regardless of infant age. Other parent and infant sleep-related factors were not significantly linked with sexual frequency in adjusted models. Moreover, sexual satisfaction was not associated with parent nighttime caregiving, parent or infant sleep, or parent-infant sleeping arrangements in adjusted models, suggesting that it may not be susceptible to the effects of disrupted sleep in the postpartum period. These findings suggest that it is not infant or parent sleep disruption per se, but rather parent nighttime engagement with the infant that is associated with parent sexual activity frequency. Longitudinal investigations are warranted to examine the directional pathways of these links.

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.

Sleep During the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected childhood sleep. Decreased sleep quality and duration, more bedtime resistance, difficulty initiating and maintaining sleep, and higher rates of parasomnias have all been noted. The mental health crisis with doubling rates of anxiety and depression has also had a profound influence on youth sleep. The pediatric sleep medicine field has responded to the COVID-19 pandemic by adapting existing practices for safety and greatly expanding telemedicine services. Research and training considerations are further discussed.

Psychological Research on Sleep Problems and Adjustment of Working Hours during Teleworking in the COVID-19 Pandemic: An Exploratory Study

Mandatory home isolation caused by COVID-19 in professional contexts led to a situation that required work activities to be converted into a remote modality. The literature on this topic is very recent, given the pandemic and the uncertainty of virtual and face-to-face work modalities. This study aimed to examine the effects of adults' prolonged exposure to screens on sleep quality, the type of devices used according to age and gender, periods of access to such devices and the impact on performance in the context of telework due to COVID-19. Specifically, the study analyzed the differences in the use of devices and in the time spent using them during and after teleworking between genders and age groups. A total of 127 Portuguese participants answered the Pittsburgh Sleep Quality Index and a questionnaire that we specifically developed to characterize teleworking habits. The results showed differences between men and women regarding the use of devices and its impact on sleep quality, as well as differences in terms of age. These results are discussed in terms of how the current work context may affect performance, sleep, gender differences and the adverse effects of exposure to screens during and after work hours.

Social and environmental effects of the COVID-19 pandemic on children

OBJECTIVE

This study aimed to review the literature, summarizing the existing evidence on the effects of the pandemic on children, adolescents and parents, with an emphasis on the psychological, emotional, and sleep quality consequences.

SOURCE OF DATA

Empirical studies identified in the following databases: MEDLINE, ISI Web of Knowledge/Web of Science, and preprint servers.

SYNTHESIS OF DATA

The findings point to a wide range of consequences for children and adolescents resulting from the COVID-19 pandemic, which mainly includes an increase in depressive mood symptoms. There is also an increase in anxiety symptoms, suicidal ideation, as well as potential delays in language and motor development resulting from deprivation of social interaction and the closing of schools. These effects are more severe due to previous neuropsychiatric conditions. For parents, there is an increase in anxiety, depressive and post-traumatic symptoms, which are more accentuated in those who suffered socioeconomic damage due to the pandemic. There was an important increase in situations of violence towards children by parents and caregivers during the pandemic. Also, changes in routine and fear of the pandemic have negatively impacted sleep quality, globally.

CONCLUSIONS

It is noteworthy that most studies published to date used a cross-sectional design and applied online screening questionnaires. The few studies with a longitudinal design suggest that these changes may have been transitory and more prevalent at the beginning of the pandemic.

Sleep of infants and toddlers during 12 months of the COVID-19 pandemic in the midwestern United States

STUDY OBJECTIVES

Cultural sleep practices and COVID-19 mitigation strategies vary worldwide. The sleep of infants and toddlers during the COVID-19 pandemic in the United States (US) is understudied.

METHODS

Caregivers of children aged <3 years responded to a cross-sectional survey during 2020 (divided into quarters, with year quarter 1 largely pre-lockdown). We assessed the global effect of year quarter on parent-reported total sleep time (TST, hours) and sleep onset latency (SOL, hours) using ANOVA. We used multivariable linear regression to assess the adjusted effect of year quarter on TST, SOL and parental frustration. We used logistic regression to assess the adjusted effect of year quarter on nap consistency.

RESULTS

Of 594 children, mean age was 18.5±9.7 months; 52% were female. In the adjusted analyses, the reference categories were: quarter 1 (year quarter); ≤6 months (age category); <$25,000 (household income). TST was associated with age category (12 to ≤24 month: β=-2.86;p=0.0004, 24 to ≤36 month: β=-3.25;p<0.0001), and maternal age (β=-0.04;p=0.05). SOL was associated with year quarter (year quarter 3: β=0.16; p =0.04), age category (24 to ≤36 months: β=0.28;p<0.0001), household income ($100,000-150,000: β =-0.15;p=0.03, >$150,000: β=-0.19;p=0.01) and lack of room sharing (β=-0.09; p=0.05). Parental frustration with sleep increased with age (all p<0.05) and lack of room sharing (p=0.01). The effect of lack of room sharing on nap consistency approached significance (aOR 1.88;95%CI 0.95, 3.72).

CONCLUSIONS

Social factors such as lower household income and room sharing affected the sleep of US infants and toddlers as opposed to the COVID-19 lockdown itself.

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.

Infants' and toddlers' digital media use and mothers' mental health: A comparative study before and during the COVID-19 pandemic

This study compared children's and mothers’ digital media use and mothers’ mental health in two samples: one accessed before (Group 1; N = 257; M = 33.18 years; SD = 4.79) and the other accessed during (Group 2; N = 256; M = 33.51 years; SD = 4.96) the COVID‐19 pandemic in Brazil. Mothers of children up to 3 years old (Group 1: M = 17.95 months, SD = 9.85; Group 2: M = 16.48 months, SD = 10.15) answered an online survey. Bivariate analysis, factorial ANOVA tests, and multiple linear regression were performed. Results suggest that mothers’ and children's media use duration was higher during the pandemic only among children over 12 months. Mothers’ media use duration (β = .18) and mothers’ intention to offer media (β = .23) contributed to the explanation of children's media use duration (F(4, 474) = 16.81; p < .001; R² = .12; R² adjusted = .117). Higher mothers’ common mental disorders symptoms were also positively correlated to mothers’ intention to offer media to children both before and during the pandemic. Results suggest that interventions focusing on infants and toddlers screen time reduction should target maternal aspects such as mental health, maternal screen time, and intention to offer media, taking into account the mothers’ needs when planning these actions.

Infant media use: A harm reduction approach

There are a myriad of potentially harmful developmental outcomes associated with infant digital media use. Studies revealing risk associated with early media use have informed the current American Academy of Pediatrics (AAP) recommendations that discourage most digital media use among children under 18 months of age. Recent research advances, however, suggest potential benefits of technology engagement in this age group. Additionally, surveys of parents reveal that most infants engage with digital media for at least 30 min a day, exceeding the AAP recommendations. In response to these discoveries and cultural trends, some scholars have made compelling cases to adapt the AAP guidelines for infants. A helpful model for developing infant digital media use guidelines for families may be the harm reduction approach. The intent of this review is to suggest adaptations to the AAP guidelines for infant media engagement using a harm reduction framework. This review describes the challenge of restrictive guidelines, briefly summarizes the harm reduction approach, provides a review of risks and benefits associated with infant media use in each developmental domain (physical, cognitive, and socioemotional), summarizes correlates of infant screen media use, and examines intervention strategies for reducing screen time. The paper concludes with examples of possible adaptations to current AAP infant media use recommendations using harm reduction and bioecological frameworks.

Development and dissemination of a consumer health information website on infant and toddler sleep

Sleep problems are prevalent in early childhood, with the majority of caregivers desiring to change something about their child's sleep. Quality-assured education and resources are needed to be related to infant and toddler sleep. This article describes the development and dissemination of a global consumer health information website (http://www.babysleep.com) by the Pediatric Sleep Council to provide publicly accessible evidence-based information and resources for caregivers and practitioners. The website includes sleep health-related information and resources. Three phases, including the launch, social media strategy, and search engine optimization, for promotion and dissemination of the site was implemented. Analysis of dissemination indicates exponential growth of the site since its launch. With access across the globe, the site has developed from its inception into a widely-used resource, with over 800,000 users from around the world (99% of countries).