National strategy on the integration of sleep and circadian rhythms into public health research and policies: Report from the Canadian Sleep and Circadian Network

Detecting psychometric and diagnostic performance of the RU_SATED v2.0 multidimensional sleep health scale in community-dwelling adults combining exploratory graph analysis and ROC analysis

OBJECTIVE

The RU_SATED scale is increasingly used across the globe to measure sleep health. However, there is a lack of consensus around its psychometric and diagnostic performance. We conducted an empirical investigation into the psychometrics of the Chinese version of the RU_SATED (RU_SATED-C) scale, with a focus on structural validity and diagnostic performance.

METHODS

1171 adults were enrolled from three communities in Hangzhou, China in July 2022. The dataset was spilt in half, and we ran a bootstrapped exploratory graph analysis (bootEGA) in one half and a confirmatory factor analysis (CFA) in the other half to assess structural validity. Correlations with insomnia, wellness, anxiety, and depression symptoms were examined in order to assess concurrent validity; and Cronbach's α and McDonald's ω were calculated to assess internal consistency. Additionally, a Receiver Operating Characteristic (ROC) analysis established and externally validated the optimal score for identifying insomnia symptoms.

RESULTS

A one-dimensional structure, as identified by bootEGA, was corroborated in the CFA [comparative fit index = 0.934, root mean square error of approximation = 0.088, standardized root mean square residual = 0.051]. A moderate correlation was shown with insomnia symptoms, while weak correlations were observed with wellness, anxiety, and depression symptoms. The RU_SATED-C scale displayed sub-optimal internal consistency where coefficients dropped if any item was removed. A recommended cutoff score of ≤13 was derived for probable insomnia with a satisfactory diagnostic performance.

CONCLUSION

The RU_SATED-C scale displayed a one-dimensional model, along with adequate concurrent validity, internal consistency, and diagnostic performance. Further work necessitates multi-scenario testing and additional validation using objective sleep assessments.

Sleep: The silent hero in cardiometabolic health

The essential role of sleep in overall health is increasingly recognized, yet it remains underemphasized in both clinical and public health contexts. Despite extensive research linking poor sleep health to chronic conditions such as cardiovascular disease, type 2 diabetes, and cognitive decline, sleep health is not routinely assessed or integrated into standard care practices. Sleep problems, including insomnia, sleep apnea, and poor sleep quality, are prevalent globally, affecting over 30 % of the population and contributing to significant public health burdens like cardiometabolic disease, mental health disorders and multimorbidity. The economic implications are substantial, with insufficient sleep imposing significant societal and financial costs worldwide. Recognizing this, recent initiatives like the American Heart Association's inclusion of sleep in the Life's Essential 8 framework highlight the importance of sleep in cardiometabolic health. Integrating sleep into clinical and public health strategies is crucial, due to the wide-ranging impact of sleep on cardiometabolic health. Social, environmental, and demographic factors also play significant roles in sleep health, with lower socioeconomic groups and women often experiencing poorer sleep, further exacerbating health disparities. Adopting a life course approach and promoting healthy sleep behaviors early in life are essential for mitigating long-term cardiometabolic risks. Effective evidence-based strategies for improving sleep behaviors and cardiometabolic health, beyond addressing sleep disorders, include prioritizing sleep hygiene, managing stress, promoting physical activity, maintaining a healthy diet, and reducing substance use, all of which contribute to overall well-being. In conclusion, incorporating sleep health into routine cardiometabolic risk stratification, prevention, and management is essential for improving overall health outcomes.

Students', parents' and teachers' perspectives on comprehensive school-based sleep promotion

Objective

Sleep deprivation is common among children and schools are ideal settings in which to influence children's sleep. Children spend a significant amount of time at school during key developmental periods, and programmes that influence students' well-being also benefit academic achievement. Comprehensive School Health (CSH) is an approach that prioritises school, home and community partnerships by supporting the development of health behaviours. However, sleep is often unaddressed in the school environment. The objective of this study was to integrate multiple partner perspectives to inform how to strengthen school-based sleep promotion using a CSH approach.

Design

A secondary qualitative analysis of student aged 9-11 (n = 45), parent/guardian (n = 24) and teacher (n = 19) interviews from participants representing elementary (Kindergarten - Grade 6) schools and communities in Alberta, Canada was conducted. Data were examined using an a priori framework in alignment with the four components of the CSH approach: social and physical environment, teaching and learning, policy and partnerships and services. Inductive content analysis was used to develop categories followed by subthemes within each CSH component.

Results

Subthemes identified within each component were as follows: social and physical environment (culture of healthy sleep habits; students influence each other); teaching and learning (formally integrate sleep-specific learning into curricula; school, teacher and parents/guardian collaboration); policy (sleep-positive classroom policies) and partnerships and services (community partnerships; school-home collaboration).

Conclusion

This research identifies recommendations from student, parent/guardian and teacher interviews to inform and strengthen school-based sleep promotion when taking a CSH approach. Findings can support school partner efforts to foster a school culture (or ethos) of healthy sleep habits leading to improvements in student sleep behaviours.

School start times and their association with rurality in British Columbia, Canada: An environmental scan

Study Objectives

Since later school start times are associated with increased sleep duration, our objectives were to identify mean school start times, the proportion of schools that start at 08:30 am or later, and determine if rurality was associated with school start times.

Methods

We conducted web searches for start times of 1759 standard schools in British Columbia (BC), Canada. Schools were categorized as elementary, elementary-middle, middle, middle-high, or high school and linked to an Index of Remoteness. We calculated descriptive statistics and used Analysis of Variance to assess for start time differences by grade category. We used Spearman's rank-order correlation to assess if there was a relationship between start time and rurality.

Results

We found start times for 1553 (88.2%) of the included schools. The mean start time was 08:40 am (SD = 0:15) and ranged from 07:10 am to 09:45 am. There was a significant effect of grade category on start time, F (5, 1600) = 6.03, p < .001, η 2 =.02, 95% CI [.006, .031] such that elementary-middle schools started significantly earlier (M = 08:34 am, SD = 0:17) than other grade categories. Overall, 1388 (86.4%) schools started at 08:30 am or later. Rurality was significantly correlated with school start time (r = -.198), such that more rural schools started earlier.

Conclusions

For the most part, school start times in BC meet recommendations that support childhood and adolescent sleep. Future research is needed to understand factors that promote the successful implementation of delayed school start times.

Years of life lost due to insufficient sleep and associated economic burden in China from 2010-18

Background

Research on the health and economic costs due to insufficient sleep remains scant in developing countries. In this study we aimed to estimate the years of life lost (YLLs) due to short sleep and quantify its economic burden in China.

Methods

We estimated both individual and aggregate YLLs due to short sleep (ie, ≤6 hours) among Chinese adults aged 20 years or older by sex and five-year age groups in 2010, 2014, and 2018. YLL estimates were derived from 1) the prevalence of short sleep using three survey waves of the China Family Panel Studies, 2) relative mortality risks from meta-analyses, and 3) life tables in China. YLL was the difference between the estimated life expectancy of an individual in the short sleep category vs in the recommended sleep category. We estimated the economic cost using the human capital approach.

Results

The sample sizes of the three survey waves were 31 393, 31 207, and 28 618. Younger age groups and men had more YLLs due to short sleep compared to their counterparts. For individuals aged 20-24, men had an average YLL of nearly 0.95, in contrast to the approximate 0.75 in women across the observed years of 2010, 2014, and 2018. The trend in individual YLLs remained consistent over these years. In aggregate, China experienced a rise from 66.75 million YLLs in 2010 to 95.29 million YLLs in 2014, and to 115.05 million YLLs in 2018. Compared to 2010 (USD 191.83 billion), the associated economic cost in 2014 increased to USD 422.24 billion, and the cost in 2018 more than tripled (USD 628.15 billion). The percentage of cost to Chinese gross domestic product in corresponding years was 3.23, 4.09, and 4.62%.

Conclusions

Insufficient sleep is associated with substantial YLLs in China, potentially impacting the population's overall life expectancy. The escalating economic toll attributed to short sleep underscores the urgent need for public health interventions to improve sleep health at the population level.

"Your Kid Has Potential, But They Need Sleep": Teacher Perspectives on School-Based Sleep Promotion in Alberta, Canada

BACKGROUND

Insufficient sleep is a growing public health concern. Thirty percent of Canadian children and youth are not meeting national sleep recommendations. Inadequate sleep can negatively influence students' academics and physical and psychosocial health. Schools have been identified as ideal health promotion settings to influence children's health including their sleep behaviors. The objective of this study was to explore teachers' perspectives on sleep behaviors and their role in school-based sleep promotion.

METHODS

Nineteen elementary teachers were purposively sampled from the greater Edmonton area, Alberta, Canada. Interpretive description was used as the guiding method, and data were generated through one-on-one semi-structured interviews. Inductive descriptive thematic analysis was used to identify interview themes.

RESULTS

Three themes related to teachers' perspectives on sleep behaviors and school-based sleep promotion were identified: the importance of students' sleep, prioritizing sleep as part of teaching and learning, and a culture of healthy sleep habits.

CONCLUSIONS

This study found that teachers considered sleep to be essential for elementary students' academic success and wellbeing, and a whole school approach was necessary to support a healthy sleep culture in schools.

Investigation of effects of Circadian Rhythm in Sport: A bibliometric analysis

PURPOSE

This study conducted a bibliometric analysis of the literature on circadian rhythms and sports to identify research trends, knowledge gaps, and future directions.

METHODS

A total of 301 manuscripts, including 245 articles and 56 reviews, were extracted from the Web of Science Core Collection (WoSCC) database, and the bibliometric analysis was performed using VOSviewer 1.6.16.

RESULTS

The analysis revealed a continuous increase in the volume of literature on circadian rhythms and sports over the past 38 years, with a focus on the effects of circadian rhythms on physical performance, sleep quality, and jet lag. The study identified 1107 authors who have contributed to this field, with the highest number of publications from Reilly T, Chtourou H, and Atkinson G. The publications were from 512 institutions in 59 countries/regions, with Liverpool John Moores University, University of Sfax, and Manouba University being the leading institutions. The USA, UK, and Australia had the largest number of publications. The top 3 journals were Chronobiology International, Biological Rhythm Research, and Sports Medicine.

CONCLUSION

Despite the increase in research, there are still several underexplored areas, such as the effects of circadian rhythms on cognitive and emotional processes in sports, the role of individual differences in circadian rhythms on sports outcomes, and the potential applications of circadian interventions for sports performance optimization. Future research should address these gaps to advance our understanding of the complex relationship between circadian rhythms and sports.

Parental Perspectives of Sleep in the Home: Shaping Home-School Partnerships in School-Based Sleep Promotion Initiatives

INTRODUCTION

Sleep is a critical component of child health and the prevention of chronic disease. Children may benefit from school-based sleep promotion; however, parents need to be involved for healthy sleep strategies learned at school to be translated to the home. The objective of this study was to explore parental perspectives on sleep behaviors and responsiveness to school-based sleep promotion.

METHODS

Twenty-five parents of school-aged children were purposively sampled for interviews from July 2019 through April 2020 in Alberta, Canada. Descriptive qualitative methodology was used, and data were generated through semistructured interviews and researcher field notes. Interviews were transcribed and themes were identified by using latent content analysis.

RESULTS

Three themes emerged from analysis: 1) sleep is valued and supported, 2) barriers to healthy sleep exist, and 3) schools are allies in promoting sleep. Parents perceived that sleep was essential for their child's health, facilitated healthy sleep practices in the home, and highlighted barriers (busy schedules and poor parental role models) that affected sleep. Parents supported and expressed value in school-based sleep promotion and noted factors that affected the success of school-based sleep promotion.

CONCLUSION

Parents are responsive to school-based sleep promotion. Promotion efforts should include resources that engage and involve parents in the school community. Throughout the development of resources to support school-based sleep promotion, additional consideration of parent-reported barriers to promoting healthy sleep in the home should be included.