Pediatric sleep health: It matters, and so does how we define it

The Sleep Train Program: Efficacy of a Behavioral Sleep Intervention for Children with Externalizing Problems

OBJECTIVES

The study objective was to examine the impact of a brief behavioral sleep intervention (The Sleep Train Program) on sleep and behavior in children with externalizing behavior problems.

METHOD

Children (3-8 years) presenting to a behavioral health clinic for externalizing problems were randomized to receive a behavioral sleep intervention or a mealtime intervention (active control). Families then completed parent management training followed by the cross-over intervention. Outcomes included parent-reported child sleep and behavior and actigraphic sleep, and were examined in the full sample and in a subsample of children with comorbid sleep difficulties.

RESULTS

In a subsample of children with both externalizing and sleep difficulties, children randomized to behavioral sleep intervention showed reduced externalizing problems (t = -2.75, p < .05), reduced night wakings (t = -2.21, p < .05), and improved parent-child interactions (t = 2.99, p = .01) and child behavior (t = -2.42, p < .05) at bedtime, compared to active control. In the full sample, in which some children did not present with sleep difficulties, behavioral sleep intervention, compared to active control, did not yield significant improvements in most sleep and behavior outcomes. Comparing sleep and behavior before and after behavioral sleep intervention across groups, children had fewer externalizing behaviors (t = 4.98, p < .001), improved sleep habits (t = -3.24, p < .05) and improved parent-child bedtime interaction (t = -3.24, p < .01), but no changes in sleep patterns.

CONCLUSION

A brief behavioral sleep intervention was efficacious in improving both sleep and behavior outcomes for children with comorbid sleep and externalizing difficulties, but not for children with only externalizing difficulties.

Disparities in sleep among diverse adolescents in two large statewide samples: A need for intersectional interventions

OBJECTIVES

Examine very short sleep among adolescents across multiple intersecting social positions and experiences of sexual orientation-based bullying and cyberbullying in two statewide samples.

METHODS

A harmonization of two large statewide school-based datasets from grades 9-12 (2019 Minnesota Student Survey, and 2018-2019 California Healthy Kids Survey) was utilized for the analysis (N = 379,710). Exhaustive chi-square automatic interaction detection (an approach for quantitative intersectionality research) explored variability in very short sleep (≤5 hours/night) among adolescents from multiple intersecting social positions (race/ethnicity, gender identity, sexual orientation, and sex assigned at birth), grade, state, and two types of bullying experiences (sexual orientation-based bullying and cyberbullying). Intersectional groups reporting the highest prevalence of very short sleep were identified. We compared very short sleep rates among adolescents from the same social positions who experienced bullying with those who did not experience bullying.

RESULTS

Very short sleep was common among this sample of adolescents (19.2%), especially among those holding multiple marginalized social positions (36.9%-51.4%). Adolescents who were transgender or gender diverse or questioning gender identity, and with minoritized sexual and racial/ethnic identities were overrepresented among high prevalence groups of very short sleep. Bullying experiences were reported by all highest prevalence groups. Adolescents who were bullied had 24.9%-51.3% higher rates of very short sleep than adolescents from the same intersecting social positions who were not bullied.

CONCLUSIONS

Very short sleep is pervasive among marginalized adolescents. Findings suggest that victimization contributes to adolescents' very short sleep rates. Individual-level interventions may fall short of promoting better sleep among adolescents; systemic interventions addressing bullying are needed.

CLINICAL TRIAL REGISTRATION

N/A.

Contribution of the Brief Family Strength-Oriented Therapeutic Conversation Intervention to Early Childhood Sleep Health: A Quasi-Experimental Study

The family context is an important factor for sleep health in early childhood. About 40% of children between 0 and 3 years have problems regarding sleep that can affect their development. The aim of this study was to investigate the contribution of the brief family strength-oriented therapeutic conversation intervention to early-childhood sleep health. Data were collected in 2020-2021 from 57 primary caregivers of young children with moderate or severe sleep difficulties. The intervention was delivered through (a) a one 60-min face-to-face family educational and support session and (b) one to six 20- to 40-min telephone sessions based on the families' needs. After the intervention, primary caregivers reported greater family support, more helpful beliefs about their infant's/child sleep patterns, better family quality of life (QOL), better self-regulation regarding learning to fall and staying asleep among infants, and longer sleep periods at night in infants. These findings may prevent infants sleep difficulties from increasing and becoming more serious.

The Relationship Between Parental Childhood Maltreatment and Children's Sleep Quality: An Intergenerational Perspective

Based on the hyperarousal theory and self-control theory, this study investigated the link between parental childhood maltreatment and children's sleep quality by examining the mediation effect of parental self-control and children's perceived parental support from an intergenerational transmission perspective. A total of 334 Chinese primary school students in grades 4-6 (50% girls, Mage = 10.49, SD = 0.97) reported on perceived parental support and sleep quality. In addition, childhood maltreatment and self-control were reported by their parents (Mfather's age = 40.48, Mmother's age = 38.18). The results showed that the father's childhood maltreatment was directly associated with children's sleep quality, while the mother's childhood maltreatment was indirectly linked to children's sleep quality. Furthermore, children's perceived parental support acted as mediators in the effect of mother's childhood maltreatment on children's sleep quality, and mother's childhood maltreatment also affected children's perceived parental support via mother's self-control, thus affecting children's sleep quality indirectly. These results have important practical implications for family-based interventions in children's sleep quality.

Characterizing the sleep location, patterns, and maternally perceived sleep problems of the infants of Māori and non-Māori mothers in Aotearoa New Zealand

OBJECTIVES

To investigate potential sleep inequities between the infants of Māori and non-Māori mothers in Aotearoa New Zealand, identify socio-ecological factors associated with infant sleep, and determine features of infant sleep that contribute to a mother-perceived infant sleep problem.

DESIGN

Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Well-being in Aotearoa New Zealand study when infants were approximately 12 weeks old.

PARTICIPANTS

383 Māori and 702 non-Māori mother-infant dyads.

METHODS

Chi-square and independent t-tests measured bivariate associations between maternal ethnicity and infant sleep characteristics. Multivariable and ordinal logistic regression models assessed the relative impact of different socio-ecological factors on infant sleep outcome variables.

RESULTS

Key developmental markers of infant sleep did not differ by maternal ethnicity. There were some ethnicity-based differences in sleep location. Maternal ethnicity, maternal age, parity, maternal depression, maternal relationship status, life stress, breastfeeding, work status, and bedsharing were related to different dimensions of infant sleep, and to maternal perceptions of a sleep problem.

CONCLUSION

Sleep at 12weeks is highly variable between infants and is associated with numerous socio-ecological factors. Findings support a social determinants explanation for sleep health inequities seen later in childhood.

The Influence of Substance Use on Sleep Duration Among South Korean Adolescents by Sex: A Secondary Analysis

PURPOSE

Although insufficient sleep influences cognitive function and physical and mental health in adolescents, many still get less sleep than the recommended duration. Adolescent substance use, including alcohol and tobacco, influences sleep disturbance. However, sex differences in the relationship between substance use and sleep health have not been extensively studied. This study aimed to examine the effect of substance use on sleep duration among South Korean adolescents by sex.

DESIGN AND METHODS

This secondary data analysis used the 4th Wave of the Korean Children and Youth Panel Survey 2018 and applied a multiple regression analysis. Tobacco use and alcohol consumption were assessed by asking whether the participants had ever smoked or drunk alcohol during the previous year. Sleep duration was calculated based on the participants' reports related to sleep and awake times on weekdays and weekends.

RESULTS

For male adolescents, substance use, either tobacco use or alcohol consumption, did not significantly affect sleep duration, whereas for female adolescents, alcohol consumption was found to influence sleep duration. Age and subjective health were additional influential factors for adolescents' sleep duration, regardless of sex.

PRACTICE IMPLICATIONS

Interventions for alcohol consumption should be considered to enhance sleep health in female South Korean adolescents. Further studies are needed to understand the underlying mechanisms of sleep health, particularly the effects of substance use, among male adolescents.

Association of Exposure to Interpersonal Racism and Racial Disparities in Inadequate Sleep Risk

OBJECTIVE

To examine the association between caregiver-report of their child's inadequate sleep and exposure to interpersonal racism within racially minoritized subpopulations.

STUDY DESIGN

We conducted cross-sectional analysis among racially minoritized 21 924 school-aged children and 27 142 adolescents using a National Survey of Children's Health sample from 2016 through 2021. Multivariable logistic regression models were fit to estimate predicted probabilities for the adjusted associations between caregiver-report of their child's inadequate sleep and prior exposure to interpersonal racism.

RESULTS

In bivariate models, caregiver report of child exposure to interpersonal racism was significantly associated with a higher probability of inadequate sleep within non-Hispanic Asian American/Pacific Islander school-aged children, Hispanic adolescents, and non-Hispanic multiracial adolescents. After adjusting for covariates, only the association within Hispanic youth remained significant though attenuated. Unexpectedly, non-Hispanic Black school-age children exposed to racism had a lower probability of inadequate sleep than non-Hispanic Black children without exposure to racism after adjusting for covariates.

CONCLUSIONS

Nationally representative pooled data that showed caregiver-report of Hispanic adolescents' inadequate sleep was associated with their exposure to interpersonal racism, although an association with inadequate sleep was not found in other racially minoritized subpopulations. Examining within-race associations helps to assess more accurately risk and target efforts that seek to address racism-related stress among racially minoritized subpopulations.

What Keeps Night Owls Well During the Week? Sleep Onset Consistency as a Moderator Between Morningness-Eveningness and Adolescent Development

OBJECTIVES

A preference for eveningness - one's perception of being most alert later in the day - is associated with negative developmental outcomes in adolescence. Sleep onset consistency is protective against such outcomes. Toward a more nuanced understanding of relations between sleep-wake processes and adolescent development, we examined weeknight sleep onset consistency as a moderator of relations between eveningness and multiple indicators of development.

METHOD

A sample of 272 high-school students (Mage = 17 years, SD = 9.12 months; n = 133 identified as female; 41% non-Hispanic Black/African-American, 59% non-Hispanic White/European-American) participated in a week of at-home sleep actigraphy assessment in 2017-2018. Adolescents reported their morningness - eveningness, internalizing symptoms (depression, anxiety), positive affect (optimism and subjective happiness), and physical health, and mothers reported on youths' behavior problems. Relations were examined between morningness - eveningness and each indicator of development; sleep onset consistency was examined as a moderator of these associations.

RESULTS

On average, adolescents with a preference for eveningness had higher levels of externalizing behaviors and internalizing symptoms and lower levels of positive affect and physical health compared to peers with a preference for morningness (Bs = -0.27*-0.12***). Each association was moderated by weeknight sleep onset consistency. Across all indicators of development, evening-preferring youth with more consistent weeknight sleep onset had 0.49-0.72 SD better outcomes on average than evening-preferring youth with less consistent weeknight sleep onset.

CONCLUSIONS

Falling asleep at roughly the same time each night can protect adolescent night owls from behavior problems and internalizing symptoms and can promote their positive affect and physical health.

Assessing the longitudinal association between sleep, diet quality and BMI z-score among Black adolescent girls

BACKGROUND

Cross-sectional research has suggested associations between diet, sleep and obesity, with sparse longitudinal research.

OBJECTIVES

To identify longitudinal mechanistic associations between sleep, diet and obesity.

METHODS

We used longitudinal data from a sample of Black adolescent girls. At T1 (enrolment), 6 months (T2) and 18 months (T3), we estimated sleep duration and quality (7-day accelerometry), diet quality (Healthy Eating Index [HEI-2020]) and body mass z-scores (zBMI) from measured height and weight. Longitudinal mediation using structural equation models examined the mechanistic roles of sleep, diet quality and zBMI.

RESULTS

At enrolment, girls (n = 441) were mean age 12.2 years (±0.71), 48.3% had overweight/obesity, and mean HEI 55.8 (±7.49). The association between sleep and diet quality did not vary over time. Sleep duration at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant. Sleep quality at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant.

CONCLUSIONS

Diet was not a mediator between sleep and obesity. Study strengths are the longitudinal design and direct measures of sleep and zBMI among a homogeneous sample.

Sleep Health Disparities

Sleep is an important and potentially modifiable determinant of many severe health outcomes. Sleep health disparities exist and are exemplified by reported differential rates of prevalence, severity, and outcomes among minority groups and low-socioeconomic-status backgrounds. In this review we highlight the concept of sleep health, review the evidence for disparities in sleep health, examine risk factors and consequences of poor sleep health, and discuss policy implications.

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.

Associations Between Sleep Health and Child Behavior at Age 6 Years in the INSIGHT Study

OBJECTIVE

Suboptimal sleep is associated with disruptive behaviors in childhood. We evaluate associations of mean and variability (SD) of sleep duration, quality, and timing with emotion regulation, impulsivity, and prosocial and antisocial behavior in children.

METHODS

Intervention Nurses Start Infants Growing on Healthy Trajectories, a randomized controlled trial designed for obesity prevention, compared a responsive parenting intervention delivered in the first 2.5 years after birth with a home safety control group. At age 6 years, children wore an actigraphy device for 7 days and participated in behavioral tasks evaluating behavioral control, emotion regulation, and prosocial and antisocial behaviors. Separate linear regression models examined associations between sleep and behavioral variables, adjusting for study group, child sex, and household income. Moderation analysis investigated whether the study group moderated relationships between sleep and positive age-appropriate behavior.

RESULTS

Children (N = 143, age 6.7 ± 0.3 years) were predominantly non-Hispanic White (95%). Mean actigraphic sleep duration, quality, and timing were not associated with behavioral variables. By contrast, greater variability in sleep onset timing was associated with greater impulsivity (B = 0.85, p = 0.004) and poorer emotion regulation (B = -0.65, p = 0.01). Greater variability in sleep midpoint timing was associated with greater impulsivity (B = 0.80, p = 0.03). The study group moderated the effect of sleep onset variability on behavior; only the home safety control group exhibited a significant negative relationship between variability in sleep onset timing and emotion regulation (B = -1.28, p = 0.0002).

CONCLUSION

Findings support the importance of consistency in sleep timing and how this may play a greater role in children's behavioral and emotional outcomes than mean actigraphic sleep duration and quality.

Psychometric examination of the patient-reported outcome measurement information system parent proxy pediatric sleep measures from early childhood to adolescence in a nationally representative Spanish sample

STUDY OBJECTIVES

To use a nationally representative sample to (1) evaluate the factor structure of the patient-reported outcome measurement information system (PROMIS) parent proxy pediatric sleep scales (Spanish translation), (2) examine the invariance of these scales across sex and across different developmental periods of childhood and adolescence, (3) confirm the information and precision of the scales using item response theory (IRT), and (4) provide age-based normative information.

METHODS

Parents of a nationally representative sample of 5525 Spanish children and adolescents ages 5-16 years (56.1% boys) completed the Spanish translation parent proxy short versions of the sleep disturbance and sleep-related impairment scales. We conducted confirmatory factor analyses, invariance analyses, and graded-response IRT analyses.

RESULTS

CFAs conducted separately on males and females within three age groups (early childhood: ages 5-8 years; middle childhood: ages 9-12 years; adolescence: ages 13-16 years) indicated all items had a substantial loading with one exception (the sleep continuity item ["my child slept through the night"] had a substantially lower loading and was removed for subsequent analyses). The scores on the two scales demonstrated invariance across sex within each age group. Using IRT analyses, both scales showed a high degree of information and precision from slightly below the trait means to slightly above two standard deviations above the trait means.

CONCLUSIONS

The strong psychometric properties of the short versions of the parent proxy PROMIS pediatric sleep disturbance and sleep-related impairment scales, coupled with age-based norms, suggest these scales are likely to be useful for research and clinical applications.

Late Bedtime from the Perspective of Adolescents: A Qualitative Study

Purpose

Later sleep timing is a key determinant of reduced sleep duration and quality in adolescents and is associated with negative mental and physical outcomes. However, little is known about adolescents' views on late bedtime. The study's purpose is to explore adolescents' perspectives on why they go to sleep late during school nights and what would help them to go to bed earlier.

Patients and Methods

We conducted online semi-structured interviews with 24 adolescents aged 14-17 years as a part of the international HBSC (Health Behaviour in School-aged Children) study. The data were collected via individual and group interviews and analyzed using a combination of consensual qualitative research methodology and thematic analysis.

Results

School demands and leisure time activities, particularly online socialization with peers, have been identified as one of the main themes related to why adolescents go to sleep late. Adolescents reported difficulties managing these competing activities during the day after school, often postponing them until late at night and prioritizing them to sleep. Adolescents also mentioned bedtime distress as a barrier to falling asleep. However, some adolescents did not perceive late bedtime as a problem, but rather as a habit and personal choice. They reported that better time management, less homework, engagement in physical activity, parent-set bedtime, and less time spent online in the evening would help them to go to bed earlier.

Conclusion

Our findings suggest that interventions to improve sleep timing in adolescents should focus on reducing school pressure, building supportive social networks; strengthening adolescents' self-regulation skills; and enhancing parental involvement in establishing sleep and daily routines for their adolescents.

Gender and Age Differences in the Relationship Between Smartphone Addiction and Sleep Duration in Korean Children: A Panel Quantile Regression Study

Purpose

This study analyzed the longitudinal relationship between smartphone addiction and sleep duration to investigate the factors contributing to sleep deprivation in Korean children.

Methods

To overcome the limitations of previous studies, panel quantile regression analysis was used to evaluate the relationship between smartphone addiction and sleep duration. Key variables were smartphone addiction, sleep duration, gender, and age.

Results

According to the study results, the level of smartphone addiction among children significantly increased from 2018 to 2022, while sleep duration continuously decreased. A particularly strong negative relationship between smartphone addiction and sleep duration was found.

Conclusion

These results suggest that smartphone addiction is strongly associated with sleep deprivation in children, emphasizing the need for policies and intervention measures to create a healthy sleep environment for children.

An Interpersonal and Meta-analytic Approach to Parenting Behaviors and Adolescent Sleep

Two dimensions of parenting behaviors-affiliative/non-affiliative and autonomy/control- are each consistently linked to adolescent sleep health. Parenting behaviors that facilitate good sleep likely involve affiliation (i.e., warmth) and some degree of parental guidance and appropriate autonomy-granting to the adolescent; however, these domains are often confounded in parenting assessments, which limits understanding and specificity of recommendations for providers and families on how to optimize adolescents' sleep. Thus, we categorized existing literature according to an interpersonal developmental framework to identify parenting behaviors most strongly linked to adolescent sleep health. Studies (k = 42) included 43,293 participants (M age = 14.84, SD age = 2.04). Structural analysis of social behavior (SASB) interpersonal coding was applied to define and operationalize parenting behaviors (independent variables). Dependent variables included measures of sleep health (i.e., sleep regularity, duration, efficiency, latency, timing, quality, alertness/sleepiness) and sleep disturbance. The final effect size of interest for analysis was a correlation coefficient r. Optimal parenting behaviors (e.g., warm, autonomy-granting, moderately controlling) were associated with longer sleep duration, earlier bedtime, less daytime sleepiness, shorter sleep latency, and fewer sleep disturbances. Suboptimal parenting behaviors (e.g., hostile, controlling) were associated with more daytime sleepiness and more sleep disturbances. This is one of the first studies to specify that, when paired with affiliation, both moderate control and moderate autonomy-granting were associated with better adolescent sleep health. Findings indicate that the importance of parental interpersonal warmth extends into adolescence and further suggest that the interpersonal security necessary for good sleep includes appropriate use of control and autonomy-granting behaviors.

Sleep patterns in adolescents and associations with substance use

OBJECTIVES

Good sleep during adolescence is crucial for maintaining physical and psychological health; however, sleep disturbance during this period may contribute to health risks, such as substance use. This study aimed to identify the latent sleep patterns across male and female adolescents, and their association with drug use.

METHOD

A cross-sectional study was conducted involving 1391 high school students (aged 15-17; 56.4% female). Participants completed the brief Pittsburgh Sleep Quality Index alongside other sleep measures, and the Timeline Follow-Back and Drug Use History Questionnaire to measure substance use. A multiple-group latent class analysis was used to identify sleep patterns across sexes, and pairwise Logistic Regression models to compare their association with substance use.

RESULTS

Four sleep patterns were identified with varying degrees of sleep difficulties: "Good Sleep" (43.3%), "Night Awakenings" (31.8%), "Poor Efficiency and Sleep Onset" (9.4%), and "Poor Sleep" (15.5%). Female adolescents were more likely to belong to Poor Sleep and Poor Efficiency and Sleep Onset patterns, and male adolescents to Good Sleep. Likewise, binge drinking and using alcohol for a longer period were associated with experiencing Poor Efficiency and Sleep Onset (OR=1.03 and 2.3, respectively); smoking tobacco within the past month was linked to Night Awakenings (OR=2.2); and using cannabis or illegal drugs to the Poor Sleep pattern (OR=2.4 and 2.6, respectively).

CONCLUSIONS

Varied sleep difficulties exist among adolescents that significantly correlate with different aspects of drug use. Targeted interventions that address both sleep and drug prevention are recommended.

Sleep health characteristics and positive mental health in Canadian youth: A cross-sectional analysis of the Health Behaviour in School-aged Children study

OBJECTIVES

This study investigated the associations between specific sleep health characteristics and indicators of positive mental health among Canadian youth in grades 6-10.

METHODS

We used cross-sectional data from the Canadian 2017/2018 Health Behaviour in School-aged Children study, a nationally representative sample of Canadian students. Our analyses included 14,868 participants (53.1% girls). We assessed the following self-reported characteristics of sleep health: nighttime insomnia symptoms, sleep duration, problems with daytime wakefulness, and weekend catch-up sleep. Positive mental health measures included self-reported life satisfaction, positive affect, self-efficacy, and self-confidence. Logistic regression models were used to assess associations while controlling for confounders.

RESULTS

Participants who had no or little nighttime insomnia symptoms, who met sleep duration recommendations, who had no or rare daytime wakefulness problems, and who had no or little weekend catch-up sleep were more likely to report high life satisfaction (range of adjusted odds ratios=1.29-2.50), high positive affect (range of adjusted odds ratios=1.35-3.60), high self-efficacy (range of adjusted odds ratios=1.22-2.54), and high self-confidence (range of adjusted odds ratios=1.28-2.31). Almost all of the associations remained significant in the gender- and age-stratified analyses.

CONCLUSION

The findings suggest that good sleep health is associated with higher odds of positive mental health among Canadian youth in grades 6-10. Further research is needed to understand the temporality of the associations and the underlying mechanisms.

Sleep health among youth outside of the gender binary: Findings from a national Canadian sample

OBJECTIVES

Sleep is important for adolescent health. The unique needs of suprabinary youth (youth with gender identities outside of the gender binary), along with the growing number of youth with these identities, underscores the need to better understand sleep health within this population. The current study's objectives were to (1) examine differences in sleep health between suprabinary and binary youth and (2) explore how social support, peer victimization, and technology use accounted for these differences.

METHODS

Data were drawn from the 2017/2018 Health Behavior in School Aged Children Survey. Adolescents (individuals ages 14 to 17, n = 10,186), indicated whether they were suprabinary (n = 182) or binary (n = 10,004), and completed measures of sleep health (difficulty falling asleep, difficulty staying awake, weekday and weekend sleep length), covariates (age, family affluence, race/ethnicity, depressive symptoms), as well as variables that may account for differences between suprabinary and binary youth (family, friend, and teacher support, as well as peer victimization, and technology use before bed).

RESULTS

Suprabinary youth reported worse sleep health on all outcomes, and differences persisted for both difficulty falling asleep and weekday sleep hours accounting for covariates. Significant indirect effects between suprabinary status were observed across all sleep outcomes for family support and school climate. Indirect effects for sleep quality were also observed via peer victimization.

CONCLUSIONS

Findings support the relevance of looking at basic health processes like sleep to better understand how the stressors associated with suprabinary status impact health outcomes among this vulnerable population.

Bidirectional relationships between chronotype and sleep hygiene in children with and without parental history of alcohol use disorder

STUDY OBJECTIVES

Children with evening chronotype may be at risk for insufficient sleep because their chronotype makes it difficult to sustain healthy sleep habits. We evaluated bidirectional relationships between chronotype and sleep hygiene.

METHODS

Two hundred forty-six children (n = 246 at T1, n = 200 at T2, n = 147 at T3), with a mean age of 9.9 (SD=1.4) at T1, participated in a longitudinal study on sleep and substance use. Participants either had a parental history of alcohol use disorder or were matched controls. The Adolescent Sleep Hygiene Scale measured sleep hygiene. Chronotype was measured using the Morningness/Eveningness Questionnaire. We used random intercept cross-lagged panel models to examine longitudinal relations between chronotype and sleep hygiene across three time points, each approximately 1 year apart.

RESULTS

Chronotype at T1 predicted sleep hygiene at T2 (b=0.38, p < .05). Chronotype at T2 predicted sleep hygiene at T3 (b=0.38, p < .05). T1 Sleep Hygiene predicted chronotype at T2 (b=0.27, p < .05). T2 Sleep Hygiene predicted chronotype at T3 (b=0.24, p < .05). Chronotype also predicted itself over time (T1-T2: b=0.31, p < .05; T2-T3: b=0.31, p < .05). Sleep hygiene did not predict itself at future time points. Parental history of alcohol use disorder did not predict sleep hygiene or chronotype.

CONCLUSIONS

There is a bidirectional relationship between chronotype and sleep hygiene; more eveningness predicts poorer sleep hygiene at a later time point, and poorer sleep hygiene predicts more eveningness later. Sleep hygiene is not stable over time and may be a more modifiable target for public health interventions than chronotype.

Social determinants of health at multiple socio-ecological levels and sleep health in adolescents: A scoping review

Heightened sleep disturbances occur in adolescence, yet existing research has predominantly focused on individual factors linked to poor sleep and a limited set of sleep outcomes, such as sleep duration and timing. This scoping review aimed to identify the multilevel social determinants of adolescent sleep health across domains, including regularity, satisfaction/quality, alertness/sleepiness, timing, efficiency/continuity, duration, and behavior. Social determinants of health (SDoH) were categorized through a socio-ecological lens, while sleep health domains were aligned with the RU-SATED and Peds B-SATED sleep health frameworks. A systematic database search resulted in 57 studies of non-clinical adolescent and young adult populations (age 10-24 y) in North America, published between 2014 and 2022. Research gaps include 1) absence of other sleep health domains other than duration which is predicated on the included studies using a limited set of sleep outcome measures rather than a more comprehensive measurement strategy that align with the multifaceted domains of sleep health, and 2) inconsistent terminology and/or absent conceptual and operational definitions of subjective sleep reports. The findings highlight the multilevel SDoH that influence adolescent sleep health, underscoring the need for more comprehensive research. Such efforts will facilitate the development of interventions focused on fostering optimal adolescent sleep health this populations.

Sleep Deficiency in Young Children

There is growing public health concern about the high prevalence of sleep deficiency in early childhood and the associated risk for sleep-associated poor health outcomes, including metabolic, cardiovascular, and mental health. The recent shift to conceptualize sleep health as a multidimensional construct, influenced by socioecological factors, highlights the potential role of sleep in health disparities. Understanding the development of sleep health and the emergence of sleep disorders in early life is a current priority in pediatric sleep research. Future behavioral sleep interventions should consider the multiple socioecological influences on children's sleep health and be tested using inclusive sampling methods.

Racial and ethnic sleep health disparities in adolescents and risk for type 2 diabetes: a narrative review

INTRODUCTION

Sleep is an essential factor for health and wellbeing in people across the age spectrum; yet many adolescents do not meet the recommended 8-10 h of nightly sleep. Unfortunately, habitually insufficient sleep, along with the metabolic changes of puberty, puts adolescents at increased risk for a host of adverse health outcomes such as obesity and type 2 diabetes (T2D). Furthermore, individuals from historically minoritized racial and ethnic groups (e.g. Hispanic/Latinx, African American/Black) are more likely to experience shorter sleep duration compared to adolescents of White/European origin, placing them at even greater risk for disparities in T2D risk.

METHODS

We conducted a literature review on the role of race and ethnicity in adolescent sleep health and its relation to cardiometabolic outcomes, specifically T2D. We use the minority stress model and the stress and coping theory as guiding theoretical frameworks to examine individual and societal level factors that may contribute to sleep health disparities and their downstream effects on T2D risk.

RESULTS

This review highlights that the unique race-related stressors adolescents from minoritized groups face may play a role in the sleep and T2D connection on a biological, psychological, and social level. However, although there has been advancement in the current research on adolescent racial and ethnic sleep health disparities in relation to T2D, mechanisms underlying these disparities in sleep health need further investigation. Addressing these gaps is crucial for identifying and mitigating sleep health disparities and T2D among racial and ethnic minority youth.

CONCLUSION

We conclude with a discussion of the implications and future research directions of racial and ethnic disparities in sleep health and T2D prevention research. A comprehensive understanding of adolescent sleep health disparities has potential to better inform preventative and educational programs, interventions, and policies that promote sleep health equity and improve cardiometabolic outcomes like T2D.

Evaluation of the association between excessive screen use, sleep patterns and behavioral and cognitive aspects in preschool population. A systematic review

In this review, we analyzed the possible relationship between the excessive use of screens and sleep patterns, and how this may affect certain behavioral and cognitive factors in preschool children. The selection, extraction and synthesis of the data were conducted according to PRISMA guidelines. The search was carried out in the electronic databases Medline (PubMed), PsycINFO (American Psychological Association), Scopus and Web of Science (WOS). Of the 597 articles initially identified, 13 met the inclusion criteria. The risk of bias of the articles selected was evaluated using a specific scale created for this purpose. The results found indicate that excessive use of screens is associated with a negative impact on the duration and quality of sleep-in preschoolers, and this worsening of sleep in infancy is related with a greater probability of the appearance of internalizing and externalizing behavioral problems and certain cognitive problems. The results also suggest that sleep could play a mediating or moderating role as a bioregulatory system that attenuates or increases the onset of behavioral and cognitive difficulties in those children most exposed to digital devices.

Parental obesity, health determinants, and cardiometabolic risk according to sleep duration in schoolchildren: analysis through structural equations

BACKGROUND

the independent association between parental obesity, sleep and lifestyle habits with cardiometabolic risk factors in children and adolescents has been widely explored in the literature. Our study represents a novel approach to comprehensively investigate a complex model encompassing various aspects associated with cardiometabolic risk in youth. Thus, the aim of the present study was to verify the relationship between parental obesity and cardiometabolic risk in children and adolescents, considering the mediator role of health indicators according to sleep time.

METHODS

This cross-sectional study was conducted on 3,973 children and adolescents aged 6 to 17 years attending public and private schools in a city located in Southern Brazil. Sleep duration, lifestyle, physical activity, natural food consumption, and parental obesity were evaluated through self-reported questionnaires. Physical fitness was evaluated according to the protocols of Projeto Esporte Brasil. The body fat percentage was evaluated through the measures of tricipital and subscapular folds, and the body mass index was calculated. The clustered metabolic risk score (cMetS) considered the summing z-scores of waist circumference, systolic blood pressure, triglycerides, total cholesterol/high-density lipoprotein cholesterol ratio, and fasting glucose, divided by five. A structural equation model was applied for statistical analysis.

RESULTS

The relationship between parental obesity and cardiometabolic risk was observed in children and adolescents with adequate sleep, being significant (p < 0.05) mediated by physical activity, natural food, physical fitness, and lifestyle. This was also observed when parental education was included in the inadequate sleep cluster model.

CONCLUSION

Present findings underscore the importance of sufficient sleep duration as a critical factor in understanding the complex interplay between parental obesity and cardiometabolic risk in children and adolescents.

The association between infant sleep, cognitive, and psychomotor development: a systematic review

STUDY OBJECTIVES

To synthesize findings of original articles examining the association between sleep-wake patterns of typically developing infants aged 0 to 18 months and cognitive and psychomotor development.

METHODS

A systematic search strategy was used to identify articles assessing the association between infant sleep (0 to 18 months) and cognitive/psychomotor development (Medline, PsycINFO, and SCOPUS). Of 7136 articles screened, 22 articles met inclusion criteria, and the results were subsequently synthesized. A quality assessment was conducted, and studies were categorized as "poor," "fair," or "good."

RESULTS

Out of 22 studies, 2 found exclusively significant associations (SAs) between infant sleep and cognitive/psychomotor development, 2 found no SAs and 17 found mixed results (MRs). Studies with exclusively significant results used a single sleep variable and single timepoint designs. Studies finding MRs or no SAs used multiple sleep, developmental variables, or multi-timepoint designs. Eight out of 10 studies and 7 out of 8 studies investigating nocturnal and total sleep duration, respectively, found no SA with developmental outcomes. While 63% of studies were rated as having good methodological quality, all studies but one had an estimated power of less than 0.80.

CONCLUSIONS

Findings of this review do not support conclusive associations between sleep-wake patterns in infancy and cognitive/psychomotor development. This conclusion contrasts with the literature in older populations, questioning if the association between sleep and development is of a different nature in infancy, potentially because of brain maturation. More studies including larger samples will be needed to clarify the presence or absence of such an association.

Looking beyond sleep duration in understanding obesity risk in adolescents: the role of circadian timing and misalignment on adolescent dietary outcomes, physical activity, and body mass index

Study Objectives

This study evaluated the differences in obesity-related outcomes across multiple adolescent sleep health domains, including circadian misalignment (CM), circadian timing, and sleep duration.

Methods

53 adolescents (aged 14-18; body mass index [BMI] percentile < 95%; 53.7% female) completed a cross-sectional study that included baseline assessment of height; weight; demographics; and 10 days assessment of sleep, physical activity, and dietary outcomes. Sleep duration, sleep timing, and physical activity data were collected from all participants using wrist-worn and waist-worn actigraphs. Dietary intake was measured using the Automated Self-Administered 24 Hours dietary recalls on 3 randomized days. Circadian timing was measured using dim-light melatonin onset (DLMO), and CM was calculated as the distance of time between DLMO and the average sleep onset time. Participants were categorized into groups (early vs late circadian timing, aligned vs misaligned circadian timing, and adequate sleep vs short sleep), and differences in dietary outcomes, physical activity, and BMI were analyzed using t-tests.

Results

Adolescents with later DLMO (M = 21:30 ± 1:11) had 0.63 higher BMI and 0.47% less averaged daily percent fat consumption than adolescents with early DLMO. Adolescents with CM (M = 1:42 ± 1:06) consumed 451.77 more averaged daily kcal consumption compared with those with circadian alignment. No statistically significant differences were found in any obesity-related outcome between sleep duration groups.

Conclusions

Our cross-sectional findings indicate that focusing on sleep timing and circadian alignment, beyond sleep duration, may promote better health outcomes for healthy adolescents. The findings of this study could enhance sleep education and inform clinical models for prevention efforts for pediatric obesity.

Childhood lead exposure and sleep problems in adolescents: a longitudinal cohort study

PURPOSE

Childhood lead exposure is linked to poorer neurobehavioral function in adolescence, but the relationship between lead and adolescent sleep health remains inconsistent. This study aimed to investigate concurrent and longitudinal associations between lead exposure and multiple sleep health domains in adolescents.

METHODS

A total of 972 adolescents from China Jintan Child Cohort were included in analyses. The Blood lead levels (BLLs) were assessed in two Waves, at ages 3-5 years (mean 6.50 ± 2.76 μg/dL) and 11-13 years (mean 3.12 ± 1.17 μg/dL). Sleep problems at age 11-13 were parent-reported via the Child Sleep Health Questionnaire (CSHQ) and self-reported by adolescents using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Both early and later BLLs were associated positively with parental reported sleep problems, including sleep onset delay, night waking, short duration, parasomnias, and disordered breathing. Sex-stratified analyzes showed that most adjusted associations between two-Wave BLLs and sleep outcomes (CSHQ and PSQI) remained statistically significant in males, with a minor increase in the magnitude of these associations. The association between Wave II BLLs and shorter self-reported sleep duration was only statistically significant in female adolescents. Compared to children with consistently low BLLs at both ages, those with persistently high BLLs at both ages had significantly shorter parental-reported sleep duration and worse sleep onset delay.

CONCLUSION

Findings suggest that both early and later childhood lead exposures link to more adolescent sleep problems, with recent BLLs showing stronger associations with poor adolescent sleep health reported by their parents.

Sleep Characteristics Among Children with a Parental History of Alcohol Use Disorder

Purpose of Review

The purpose of the review was to examine findings on sleep characteristics among children with a parental history of alcohol use disorder (CPHAUDs) in different age groups. We identified unanswered questions and discussed directions for future research. We also discussed the implications of these current findings on alcohol prevention and intervention programs.

Recent Findings

Parental ratings and youth report of sleep difficulties have been longitudinally associated with the emergence of alcohol use and alcohol-related problems among both CPHAUDsand non-CPHAUDs. There were inconsistent findings comparing sleep characteristics in these two groups. Studies that used self-report and parental ratings reported no or minimal differences while studies that used actigraphy and polysomnography found significant, albeit moderate but meaningful differences.

Summary

Current research shows that CPHAUDs and non-CPHAUDs are similar on most objective and subjective sleep measures. There are a few significant differences between the two groups that may have implications for the development of behavioral problems, substance use and other risk behaviors.

Perceptions of sleep health among African American mothers regarding their preschool-aged children: A qualitative study to decrease sleep health disparities

OBJECTIVES

African American children are documented as having poor sleep health due to shorter sleep duration, sleep timing, and sleep behaviors compared to White peers, contributing to child health disparities. Identifying cultural-environmental, and societal factors impacting a child's sleep among African American families is essential for developing interventions for this population. This study evaluated holistically why African American children may have poorer sleep health by examining sleep duration, timing, and behaviors. This was assessed by examining sleep-related beliefs, barriers, and facilitators to sleep schedules and routines. We also explored parental ideas for a sleep intervention.

METHODS

African American mothers of preschool-aged children (2-5years) were recruited using local partnerships and social media. Individual semistructured interviews were conducted by phone. Interviews were transcribed, coded, and analyzed thematically using grounded-theory.

RESULTS

Eighteen African American mothers completed the study. Five themes related to sleep emerged: The importance of adequate nighttime sleep, the influence of family and friends on parental sleep practices, the relationship between environmental and home dynamics on child sleep duration, the impact of acute and chronic societal-level stressors on family sleep health, and considerations for culturally tailored interventions to improve child sleep health.

CONCLUSIONS

Good sleep health was important among African American mothers. Cultural-environmental and societal factors significantly impact children's sleep health. Clinicians and researchers should be aware of financial resources and home dynamics leading to challenges with adequate sleep health when developing or adapting sleep interventions. Identifying cultural-environmental, and societal factors must be considered for targeted efforts to improve sleep health in African American children.

The measurement of young children's nocturnal sleep health and the development of the Perception of Infant and Toddler Sleep Scale (PoITSS) in Aotearoa New Zealand whānau (families)

OBJECTIVES

To modify an existing questionnaire Brief Infant Sleep Questionnaire - Revised (BISQ-R) to ensure that it is suitable to measure nocturnal sleep health in a diverse sample of young children from Aotearoa New Zealand whānau (families), and to develop a "Perception of Infant and Toddler Sleep Scale" (PoITSS) to use as a primary outcome measurement in an upcoming trial.

METHODS

Items from the BISQ-R were adapted for use among ethnically diverse whānau, and tested online with caregivers of 0-2 year old children. A PoITSS score was generated by scaling the responses from three of the questionnaire items to create a value between 0 (very poor) and 10 (very good). Caregivers provided qualitative feedback about the ease of interpreting and answering questionnaire items.

RESULTS

Caregivers of 957 children (35% Māori, 12% Pacific) completed the questionnaire. Few differences in children's nocturnal sleep were observed by demographic characteristics. The mean PoITSS score was 6.9 (SD 2.3) and was slightly higher among Māori children (mean difference 0.4, 95% CI 0.1, 0.7). Test-retest indicated good reliability (ICC=0.81). While the majority (86%) of caregivers did not find it difficult to answer any of the items which formed the PoITSS, qualitative feedback indicated that simple modifications to some items would help ensure that they would be well understood by most caregivers.

CONCLUSIONS

Items from the BISQ-R were successfully adapted, and the PoITSS scale was shown to be appropriate, for use in ethnically diverse Aotearoa New Zealand whānau with young children.

A policy analysis of sleep-related legislation for Canadian licensed childcare facilities

BACKGROUND

National legislative guidelines for sleep and rest are lacking in the Canadian licensed childcare sector. No review of Canadian legislation for licensed childcare facilities has focused on sleep. This paper provides a review of the Canadian provincial and territorial legislative landscape, regarding sleep, rest, and naps in licensed childcare centers.

METHODS

Childcare statutes and regulations for each province and territory were identified and downloaded on a particular date. Statutes and regulations were reviewed focusing on sections articulating licensed childcare facility mandates governing sleep, rest, naps, and sleep equipment. An excel file was used to facilitate systematic data retrieval and comparisons across provinces and territories. Two authors developed and discussed themes that summarized data from the documents.

RESULTS

No statutes indicated recommendations for sleep, rest, or naps. Only one regulation defined rest (Alberta). Our analysis of regulations identified four themes representing sleep, rest, and naps: programming (general programming, daily programming); space (dedicated space, amount of space, age-specific space); equipment (developmental appropriateness, acceptable sleep equipment, age-specific equipment); and safety (staffing during sleep/rest, sleep position, sleep monitoring, sleep equipment safety, prohibited practices). In Canada, minimal regulatory consistency is evident in required sleep programming, space, acceptability of sleep equipment, and sleep safety considerations. Most jurisdictions' regulations indicated necessity for developmentally appropriate rest or sleep areas and equipment, in particular for infants, but there was minimal consistency in defining infant age groups.

CONCLUSIONS

Although we identified themes related to sleep across regulations, childcare regulations differ in their definitions of infants and specifications for children's sleep and rest in licensed Canadian childcare facilities. Without adequate definitions in legislative components of appropriate sleep duration linked to children's developmental stages, childcare facilities lack guidance to support healthy sleep for children in their care. Future research can examine translation of healthy sleep guidelines into government legislation and mandates for sleep, rest, and naps among young children in licensed childcare.

Pioneering a multi-phase framework to harmonize self-reported sleep data across cohorts

STUDY OBJECTIVES

Harmonizing and aggregating data across studies enables pooled analyses that support external validation and enhance replicability and generalizability. However, the multidimensional nature of sleep poses challenges for data harmonization and aggregation. Here we describe and implement our process for harmonizing self-reported sleep data.

METHODS

We established a multi-phase framework to harmonize self-reported sleep data: (1) compile items, (2) group items into domains, (3) harmonize items, and (4) evaluate harmonizability. We applied this process to produce a pooled multi-cohort sample of five US cohorts plus a separate yet fully harmonized sample from Rotterdam, Netherlands. Sleep and sociodemographic data are described and compared to demonstrate the utility of harmonization and aggregation.

RESULTS

We collected 190 unique self-reported sleep items and grouped them into 15 conceptual domains. Using these domains as guiderails, we developed 14 harmonized items measuring aspects of satisfaction, alertness/sleepiness, timing, efficiency, duration, insomnia, and sleep apnea. External raters determined that 13 of these 14 items had moderate-to-high harmonizability. Alertness/Sleepiness items had lower harmonizability, while continuous, quantitative items (e.g. timing, total sleep time, and efficiency) had higher harmonizability. Descriptive statistics identified features that are more consistent (e.g. wake-up time and duration) and more heterogeneous (e.g. time in bed and bedtime) across samples.

CONCLUSIONS

Our process can guide researchers and cohort stewards toward effective sleep harmonization and provide a foundation for further methodological development in this expanding field. Broader national and international initiatives promoting common data elements across cohorts are needed to enhance future harmonization and aggregation efforts.

Sleep insufficiency and bedtime irregularity in children with ADHD: A population-based analysis

BACKGROUND

Sleep is impaired in children with attention-deficit/hyperactivity disorder (ADHD). However, population-based examination of indicators of sleep insufficiency and bedtime irregularity is limited. This investigation examined associations between ADHD, weeknight sleep insufficiency, and bedtime irregularity in a nationally-representative child sample, and indicators of these sleep outcomes in ADHD.

METHODS

Parents of children aged 3-17 years with ADHD (n = 7671) were surveyed through the 2020-2021 National Survey of Children's Health. Inverse probability of treatment weighting generated a weighted matched control sample (n = 51,572). Weighted generalized linear models were performed without and with age-stratification to examine associations between ADHD and sleep, adjusting for sociodemographics in the full sample, and between nineteen sociodemographic and clinical variables and sleep in ADHD.

RESULTS

Having ADHD was associated with increased odds of sleep insufficiency and bedtime irregularity relative to controls, even after adjusting for sociodemographic variables. In ADHD, older age was associated with lower sleep insufficiency and greater bedtime irregularity. Black race, increased poverty, higher ADHD severity, depression, and increased screen time were associated with greater sleep insufficiency and bedtime irregularity. Adverse childhood experiences (ACEs) were associated with greater sleep insufficiency. Behavioral/conduct problems, female sex, and absence of both ADHD medication use and ASD diagnosis were associated with poorer bedtime irregularity. Age-stratified results are reported in text.

CONCLUSIONS

Children with ADHD face heightened risk for insufficient sleep and irregular bedtimes. Findings suggest intervention targets (e.g., Black race, poverty, depression, screen time) to improve both sleep insufficiency and bedtime irregularity. Results highlight ACEs and behavioral/conduct problems as targets to improve sleep insufficiency and bedtime regularity, respectively. Age-stratified findings are discussed.

Bedtime Regularity and Sleep Sufficiency in Children With Tourette Syndrome

BACKGROUND

Despite research demonstrating sleep disturbance in children with Tourette syndrome (TS), few studies have examined bedtime regularity and sleep sufficiency, two important sleep health dimensions. Therefore, this study examined bedtime regularity and sleep sufficiency in children with TS relative to matched healthy control subjects, and its associated demographic, clinical, and behavioral factors.

METHODS

Participants were 384 parents or caregivers of children aged three to 17 years, including 192 with current TS and 192 matched healthy control subjects drawn from the 2020-2021 cycle of the National Survey of Children's Health. Parents completed questions assessing demographic (i.e., age, race, sex), clinical (i.e., attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder, anxiety, depression, tic severity, behavioral or conduct problems, ADHD medication, health condition-related impairment), and behavioral (i.e., screen time) characteristics. Mann-Whitney U test and chi-square test of independence were performed to compare groups on bedtime regularity and sleep sufficiency, respectively. Ordinal regression and binary logistic regression without and with backward elimination were performed to evaluate indicators of bedtime regularity and sleep sufficiency, respectively, in children with TS.

RESULTS

Children with current TS had significantly poorer bedtime regularity, but not sleep sufficiency, relative to matched healthy control subjects. In children with TS, anxiety and two or more hours of daily screen time were associated with higher likelihood of poor bedtime regularity. Autism was associated with lower likelihood of insufficient sleep, and depression was associated with increased likelihood of insufficient sleep.

CONCLUSIONS

Findings put forth screen time, anxiety, and depression as intervention targets to optimize sleep health in children with TS.

The enigma of sleep: Implications of sleep neuroscience for the dental clinician and patient

BACKGROUND

Sleep disturbances have been shown to result in considerable morbidity and mortality. It is important for dental clinicians to understand the neuroscience behind sleep disorders.

TYPES OF STUDIES REVIEWED

The authors conducted a search of the literature published from January 1990 through March 2024 of sleep medicine-related articles, with a focus on neuroscience. The authors prioritized articles about the science of sleep as related to dental medicine.

RESULTS

The authors found a proliferation of articles related to sleep neuroscience along with its implications in dental medicine. The authors also found that the intricate neuroscientific principles of sleep medicine are being investigated robustly. The salient features of, and the differences between, central and obstructive sleep apneas have been elucidated. Sleep genes, such as CRY, PER1, PER2, and CLOCK, and their relationship to cancer and neurodegeneration are also additions to this rapidly developing science.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The dental clinician has the potential to be the first to screen patients for possible sleep disorders and make prompt referrals to the appropriate medical professionals. This can be lifesaving as well as minimize potential future morbidity for the patient.

A Comprehensive Assessment of Bedtime Routines and Strategies to Aid Sleep Onset in College Students: A Web-Based Survey

College students often experience sleep-wake alterations. Different factors can contribute to insomnia symptoms in this population. The present study aims at investigating pre-sleep behaviours and strategies used to aid sleep onset in young college students and their association with insomnia symptoms. A total of 548 Italian college students (mean age = 23.48 years, range = 19-30 years, 80.5% female) completed a web-based survey on pre-sleep behaviours and sleep-onset facilitators, insomnia symptoms and sleep hygiene, anxiety and depression, and coping strategies. The use of electronic devices at bedtime and as a sleep-onset facilitator was predominant. Students using specific behaviours as sleep-onset facilitators were characterised by more psychological difficulties and poorer sleep. In multivariable linear regression analysis, the frequency of using medications and melatonin, regardless of motivations, was associated with higher insomnia symptoms. The use of specific sleep-onset facilitators positively correlated with the severity of insomnia symptoms. Many students engage in behaviours that are considered sleep-interfering and that are often employed in an attempt to facilitate sleep onset without benefits. Overall, the motivational factors behind pre-sleep behaviours need to be addressed in preventive programs targeting young college students.

The time sensitive and dose-responsive association between parental corporal punishment and sleep disturbances in preschoolers: A prospective cohort study

BACKGROUND

To examine whether parental corporal punishment is associated with increased risk of concurrent and later sleep disturbances among preschoolers, and whether the association is time-sensitive or dose-responsive.

METHODS

This 3-year prospective cohort study used data from the Shanghai Children's Health, Education and Lifestyle Evaluation, Preschool(SCHEDULE-P). Participants were newly enrolled preschoolers in November 2016(wave 1) and followed up in April 2018(wave 2) and April 2019(wave 3). Parents reported the children's corporal punishment experiences and sleep disturbances at each wave survey. Children's risk of sleep disturbances in relation to corporal punishment was examined using logistic regression, adjusting for children's age, gender, emotional/behavioral problems, family annual income, and maternal educational level.

RESULTS

The participants of 19,668 children included 9436(47.98 %) females, with a mean age of 3.73(SD = 0.29) years at wave 1. Exposure to corporal punishment was associated with increased odds of concurrent sleep disturbances at wave 1, 2, and 3 (aOR,1.57; 95 % CI, 1.40-1.75; P < .001; aOR,1.60; 95 % CI, 1.43-1.80; P < .001; aOR,1.74; 95 % CI, 1.54-1.95; P < .001), respectively. Exposure to corporal punishment at any wave of preschool was associated with increased odds of sleep disturbances at wave 3, and the risks were greater for proximal and accumulative corporal punishment exposure.

CONCLUSION

There is a time-sensitive and dose-responsive association between corporal punishment and sleep disturbance among preschoolers, with greater risk of sleep disturbances for proximal and accumulative exposure of corporal punishment. Promoting positive parenting strategies and avoiding corporal punishment can be a promising strategy to prevent and intervene sleep disturbances in preschoolers.

Social media use and sleep health among adolescents in Canada

INTRODUCTION

Public health concerns over the impact of social media use (SMU) on adolescent health are growing. We investigated the relationship between SMU and sleep health in adolescents in Canada aged 11 to 17 years.

METHODS

Data from the 2017-2018 Health Behaviour in School-aged Children study were available for 12 557 participants (55.2% female). SMU was categorized by frequency of use (non-active, active and intense) and the presence of addiction-like symptoms (problematic). Mixed effects logistic regression models identified associations between SMU and seven sleep health indicators (insomnia symptoms, daytime wakefulness problems, screen time before bed, meeting sleep duration recommendations, sleep variability and late bedtime on school and non-school days).

RESULTS

Compared to active SMU, non-active SMU was associated with better sleep indicators, except for insomnia symptoms. Intense SMU was associated with greater odds of having poor sleep health indicators (adjusted odds ratio [aORs] from 1.09 to 2.24) and problematic SMU with the highest odds (aORs from 1.67 to 3.24). Associations with problematic SMU were greater among girls than boys, including having a later bedtime on school days (aOR = 3.74 vs. 1.84) and on non-school days (aOR = 4.13 vs. 2.18). Associations between SMU and sleep outcomes did not differ by age group.

CONCLUSION

Intense and problematic SMU were associated with greater odds of poor sleep health among adolescents in Canada, with stronger associations among girls than boys. Further research is needed to understand the mechanisms underlying associations between SMU and sleep to inform public health recommendations.

To sleep or to breastfeed: Associations between feeding method and sleep in infants and children

AIM

This study aimed to understand the association between feeding method, specifically breastfeeding versus non-breastfeeding, at 6 and 12 months and infant sleep over the first 3 years of life.

METHODS

A sample of 444 mother-infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment cohort were analysed. Based on retrospective maternal reports between 3-24 months, infants' breastfeeding status was determined at 6 and 12 months. Nocturnal sleep duration, longest period of consecutive sleep, and total sleep over 24 h were measured by maternal reports at 6, 12, 24 and 36 months.

RESULTS

Generalized Estimating Equations revealed no significant association between feeding status, both at 6 and 12 months, and nocturnal sleep duration or total sleep over 24 h between 6-36 months (p > 0.05). However, breastfeeding at both 6 and 12 months was associated with shorter periods of consecutive sleep, at 6 and 12 months (p < 0.05) but not at 24 and 36 months (p > 0.05).

CONCLUSION

Our findings suggest that breastfeeding seems to be associated with more infant sleep fragmentation but not with total sleep duration in early infancy. However, this sleep fragmentation does not persist into later infancy and early toddlerhood.

Sleep and fundamental movement skills in primary schoolchildren: The REACT project

OBJECTIVE

Whether sleep is related to fundamental movement skills (FMS) in the pediatric population is largely unknown. The objective of this study was to examine the association between sleep characteristics (duration, efficiency, regularity) and FMS proficiency levels in school-aged children.

METHODS

This cross-sectional study included 996 children (mean age: 8.3 ± 1.2 years) from 25 of the 32 primary schools in Matosinhos, northern Portugal. Data collection occurred between January and June 2022. Sleep was assessed using an ActiGraph wGT3X-BT accelerometer worn on the wrist for 7 consecutive days. FMS proficiency levels were assessed in the schools with a new digital platform (Meu Educativo®) that evaluated five object control skills (dribble, kick, catch, throw, and underhand roll), with a total score ranging between 5 and 15. Multilevel ordinal logistic regression was used to test the associations between sleep characteristics and FMS proficiency levels. Covariates included age, sex, body mass index z-score, socioeconomic status, and moderate-to-vigorous physical activity.

RESULTS

The results showed that sleep characteristics (duration, efficiency, and regularity) were not related to FMS proficiency. Being a boy, older age, and higher moderate-to-vigorous physical activity levels were all significantly associated with better FMS proficiency levels. There were no significant sex-by-age interactions.

CONCLUSION

Sleep was not found to be related to FMS performance in children. This finding suggests that sleep is not a good correlate of FMS proficiency levels in school-aged children, and attention should be dedicated to other more important factors such as skill-learning-specific physical activity.

The Complex Relationship between Sleep and Cognitive Reserve: A Narrative Review Based on Human Studies

Sleep and brain/cognitive/neural reserve significantly impact well-being and cognition throughout life. This review aims to explore the intricate relationship between such factors, with reference to their effects on human cognitive functions. The specific goal is to understand the bidirectional influence that sleep and reserve exert on each other. Up to 6 February 2024, a methodical search of the literature was conducted using the PubMed database with terms related to brain, cognitive or neural reserve, and healthy or disturbed sleep. Based on the inclusion criteria, 11 articles were selected and analyzed for this review. The articles focus almost exclusively on cognitive reserve, with no explicit connection between sleep and brain or neural reserve. The results evidence sleep's role as a builder of cognitive reserve and cognitive reserve's role as a moderator in the effects of physiological and pathological sleep on cognitive functions. In conclusion, the findings of the present review support the notion that both sleep and cognitive reserve are critical factors in cognitive functioning. Deepening comprehension of the interactions between them is essential for devising strategies to enhance brain health and resilience against age- and pathology-related conditions.

Investigation of the Association between Sleep Disorders with Subsequent Depression in Children and Adolescents-A Retrospective Cohort Study with 62,796 Patients

BACKGROUND

Poor quality of sleep is a widespread issue in modern society, and even children are being diagnosed with sleep disorders nowadays. Sleep disruption in children can lead to poor mental health in the long term. The present study aimed to evaluate the association between sleep disorders and subsequent depression in children and adolescents.

METHODS

This retrospective cohort study used electronic medical records from the IQVIATM Disease Analyzer database. It included children and adolescents aged 6-16 with an initial diagnosis of a sleep disorder and age- and gender-matched patients without sleep disorders treated by one of 274 office-based pediatricians in Germany between January 2010 and December 2022. The five-year cumulative incidence of depression in the cohorts with and without sleep disorders was studied with Kaplan-Meier curves using the log-rank test. Multivariable Cox regression analyses were used to assess the association between sleep disorders and depression.

RESULTS

The present study included 10,466 children and adolescents with and 52,330 without sleep disorder diagnosis (mean age 10 ± 3 years, 48% female). Within five years after the index date, 5% of sleep disorder patients and 2% of the matched non-sleep disorder cohort had been diagnosed with depression. A strong and significant association was observed between sleep disorders and subsequent depression (HR: 2.34; 95% CI: 2.09-2.63). This association was stronger in adolescents (HR: 3.78; 95% CI: 3.13-4.56) than in children. Upon the exclusion of depression diagnoses in the first year after the index date, the association between sleep disorders and depression remained strong and significant (HR: 1.92; 95% CI: 1.68-2.19).

CONCLUSIONS

This study indicates a strong and significant association between sleep disorders and depression.

Data-driven, generalizable prediction of adolescent sleep disturbances in the multisite Adolescent Brain Cognitive Development Study

STUDY OBJECTIVES

Sleep disturbances are common in adolescence and associated with a host of negative outcomes. Here, we assess associations between multifaceted sleep disturbances and a broad set of psychological, cognitive, and demographic variables using a data-driven approach, canonical correlation analysis (CCA).

METHODS

Baseline data from 9093 participants from the Adolescent Brain Cognitive Development (ABCD) Study were examined using CCA, a multivariate statistical approach that identifies many-to-many associations between two sets of variables by finding combinations for each set of variables that maximize their correlation. We combined CCA with leave-one-site-out cross-validation across ABCD sites to examine the robustness of results and generalizability to new participants. The statistical significance of canonical correlations was determined by non-parametric permutation tests that accounted for twin, family, and site structure. To assess the stability of the associations identified at baseline, CCA was repeated using 2-year follow-up data from 4247 ABCD Study participants.

RESULTS

Two significant sets of associations were identified: (1) difficulty initiating and maintaining sleep and excessive daytime somnolence were strongly linked to nearly all domains of psychopathology (r2 = 0.36, p < .0001); (2) sleep breathing disorders were linked to BMI and African American/black race (r2 = 0.08, p < .0001). These associations generalized to unseen participants at all 22 ABCD sites and were replicated using 2-year follow-up data.

CONCLUSIONS

These findings underscore interwoven links between sleep disturbances in early adolescence and psychological, social, and demographic factors.

Evaluating Sleep Challenges in Hospitalized Youth

OBJECTIVE

To characterize sleep quality and sleep disruptions among youth hospitalized outside of the intensive care unit (ICU).

PATIENTS AND METHODS

Participants were eligible for the survey-based study if they were 8-17 years old, English-speaking, hospitalized for ≥3 days outside of the ICU, and developmentally able to understand surveys. Survey administration included a sleep diary, the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and a study-specific Inpatient Sleep Disruptors Questionnaire. The chart review provided additional clinical information. Descriptive and comparative statistics were performed to assess the association between overnight clinical monitoring and daytime sleepiness.

RESULTS

Forty-five participants (mean age 13.4 years, 60% female), recruited between May and December 2022, were included in the study. Mean total sleep time (8.2 ± 1.7 hours) and ESS-CHAD score (8.6 ± 4.3) were normal with 79% reporting fair to good sleep the previous night. Participants rated alarms on equipment, vital signs, and noise as most disruptive to sleep. Participants with vital signs every four hours showed higher levels of daytime sleepiness compared with participants with vitals measured every shift (9.3 vs. 6.3; p=0.04).

CONCLUSIONS

Most participants reported normal sleep, although there was wide variability with a portion with impaired sleep quality and elevated daytime sleepiness. Alarms on equipment, vital signs, and noise were most disruptive, and increased vital sign frequency was also associated with increased daytime sleepiness. In clinically stable pediatric patients, a reduction in vital sign monitoring overnight may be an important change to improve patient sleep.

Time use and dimensions of healthy sleep: A cross-sectional study of Australian children and adults

BACKGROUND

Sleep is increasingly recognized as a multidimensional construct that occurs within the 24-hour day. Despite advances in our understanding, studies continue to consider the relationship between sleep, sedentary time and physical activity separately, and not as part of the 24-hour day.

AIMS

To determine the association between the 24-hour activity composition and dimensions of healthy sleep.

METHODS

This study examined data on 1168 children (mean age 12years; 49% female) and 1360 adults (mean age 44years; 87% female) collected as part of the Child Health CheckPoint study. Participants were asked to wear a GENEActiv monitor (Activinsights, Cambs, UK) on their nondominant wrist for eight consecutive days to measure 24-hour time-use. Compositional data analysis was used to examine the association between time use (actigraphy-derived sleep duration, sedentary time, light physical activity and moderate-vigorous physical activity) and dimensions of healthy sleep. Healthy sleep was conceptualized in terms of continuity/efficiency, timing, alertness/sleepiness, satisfaction/quality, and regularity. Time allocations were also examined.

RESULTS

The 24-hour activity composition was significantly associated with all objectively measured and self-report dimensions of healthy sleep in both children and adults. Allocating more time to sleep was associated with earlier sleep onsets, later sleep offsets, less efficient and more consistent sleep patterns for both children and adults.

CONCLUSION

This study highlights the integral relationship between daily activities and dimensions of sleep. Considering sleep within the 24-hour day activity composition framework may help inform lifestyle decisions to improve sleep health.

Daytime Sleepiness from Preschool Children's and Parents' Perspectives: Is There a Difference?

This cross-sectional study investigated the level of daytime sleepiness and sleep-related behaviors in preschool children and compared their self-evaluations with the evaluations of their parents. It was conducted in Split-Dalmatian County, Croatia, among 196 preschool children aged 6-7 years seen at regular medical examinations, accompanied by their parents, using the Epworth sleepiness scale for children and parents/caregivers. Compared to their child's reports, parents tended to underestimate their child's sleepiness while sitting in a classroom at school (p = 0.001) and overestimate their child's sleepiness when lying down to rest or nap in the afternoon (p < 0.001). Boys were sleepier while sitting in a classroom at school during the morning than girls (p = 0.032). As much as 48.2% of preschool children had their own cellphones/tablets. Boys used video games (p < 0.001) and cellphones/tablets more than girls did (p = 0.064). Parental estimation of children playing video games at bedtime was lower than the child's report (p < 0.001). Children who had a TV in their bedroom reported more daytime sleepiness (p = 0.049), and those who played video games at bedtime went to sleep later during the weekend (p = 0.024). Also, children owning cellphone/tablets had longer sleep latency during the weekend compared to children not owning a cellphone (p = 0.015). This study confirmed that parents tend to underestimate children's habits of playing video games at bedtime and children's sleepiness during morning classes. Preschool children who use electronic devices at bedtime more frequently have prolonged sleep latency. These findings provide further evidence of the effects of electronic media devices on preschoolers' sleep patterns and daytime sleepiness.

Development of the Parenting Behavior Checklist to Promote Preschoolers' Sleep (PCPP)

OBJECTIVES

To develop the Parenting Behavior Checklist to Promote Preschoolers' sleep (PCPP), quantify sleep-promoting parenting behaviors for children, and examine the scale's reliability and validity.

METHODS

The PCPP was developed based on the recommendations of the ABCs of SLEEPING for children's sleep, which is strongly supported by research evidence. Its validity and reliability were evaluated using data from 140 participants. Structural validity was estimated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency was evaluated by Cronbach's α. Hypothesis testing was evaluated by analyzing the correlations between each factor of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) and the PCPP.

RESULTS

Regarding structural validity, EFA was conducted because CFA showed a poor model fit. The PCPP comprised one factor and six items. The JSQ-P subfactors of insomnia or circadian rhythm sleep-wake disorders, undesirable morning symptoms and behaviors, and insufficient sleep were moderately negatively correlated with the PCPP; the subfactor of undesirable daytime behaviors related to sleep problems was weakly negatively correlated with the PCPP. Thus, the sleep-promoting parenting behaviors listed in the PCPP were associated with better sleep in children.

CONCLUSIONS

The PCPP showed sufficient reliability and validity. Future studies should use the scale to examine more effective interventions regarding sleep-promoting parental behaviors for children.