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Hart CN, Coffman DL, Carskadon MA, Raynor HA, Jelalian E, Owens JA, Hawley NL, Wing RR. Earlier Bedtimes Mediate the Effect of a Brief Behavioral Sleep Intervention on Children's Weight Status. J Pediatr 2024:114265. [PMID: 39214349 DOI: 10.1016/j.jpeds.2024.114265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Whether the effect of a brief behavioral sleep intervention on child weight status resulted from observed differences in sleep duration and/or bedtimes was assessed. Findings demonstrate that the intervention's beneficial effect on weight regulation was due to earlier bedtimes, suggesting the potential importance of earlier bedtimes for obesity prevention.
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Affiliation(s)
- Chantelle N Hart
- Center for Obesity Research and Education and Department of Social and Behavioral Sciences, Temple University.
| | | | - Mary A Carskadon
- Psychiatry & Human Behavior, Alpert Medical School of Brown University
| | | | - Elissa Jelalian
- Psychiatry & Human Behavior, Alpert Medical School of Brown University; Weight Control & Diabetes Research Center, The Miriam Hospital
| | | | | | - Rena R Wing
- Psychiatry & Human Behavior, Alpert Medical School of Brown University; Weight Control & Diabetes Research Center, The Miriam Hospital
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Decker JE, Morales KH, Fair MA, Vallecorsa G, Subramanyam S, Fiks AG, Mayne S, Williamson AA, Mitchell JA. Classifying intervention components used in sleep duration interventions for children: A systematic review and meta-analysis. Sleep Med Rev 2024; 78:101995. [PMID: 39216182 DOI: 10.1016/j.smrv.2024.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
The Multiphase Optimization Strategy (MOST) is a three-phase iterative framework that could accelerate the development of behavioral interventions. This systematic review and meta-analysis was conducted within the MOST preparation phase and aimed to classify components included in pediatric sleep duration interventions, using the Behavior Change Technique (BCT) Taxonomy. Across 37 interventions, 46 out of 93 BCTs have been used, with an average of 8 techniques used per study. The most common BCTs used were instruction on how to perform the behavior (N = 29; code 4.1), practical social support (N = 22; code: 3.2), and behavioral practice/rehearsal (N = 22; code: 8.1). A latent class analysis identified two classes of interventions, distinguished by the presence of BCTs falling within the following behavior change groups: shaping knowledge, natural consequences, comparison of behavior, and repetition and substitution. Our meta-analysis revealed that interventions belonging to the latent class with these behavior change groups (N = 15) had a pooled positive intervention effect of 14 min (95 % CI: 8-21) versus 8 min (95 % CI: 1-15) for interventions without these behavior change groups (N = 19). This systematic review and meta-analysis will enhance the development of sleep promotion interventions and guide the selection of candidate intervention components for future optimization and randomized control trials.
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Affiliation(s)
- Jessica E Decker
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maddy A Fair
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Giuliana Vallecorsa
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sanjana Subramanyam
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Mayne
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel A Williamson
- The Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland, OR, USA; Department of Psychology, College of Arts and Sciences, University of Oregon, Eugene, OR, USA
| | - Jonathan A Mitchell
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Spaeth AM, Hawley NL, Carskadon MA, Raynor HA, Jelalian E, Owens JA, Wing RR, Hart CN. Behavioral Intervention that Extends Sleep Duration Leads to Greater Self-Control in School-Aged Children. J Dev Behav Pediatr 2024:00004703-990000000-00185. [PMID: 38990144 DOI: 10.1097/dbp.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/24/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Short sleep and evening phase preference associate with impaired self-control, yet few studies have assessed the efficacy of sleep extension for improving this behavioral domain. Thus, this secondary analysis of a behavioral sleep intervention measured whether an intervention that enhanced children's sleep also affected self-control. Differences by chronotype were also explored. METHODS Sixty-seven children (8-11 yr), who reportedly slept <9.5 hr/d, were randomized to either a control or sleep intervention condition (i.e., 4-session behavioral intervention to enhance sleep by 1-1.5 hr/night). Chronotype was assessed using the Child Chronotype Questionnaire at baseline, and self-control was assessed using the Self-Control Rating Scale (SCRS, a caregiver report) at baseline and 8 weeks postrandomization. Total sleep time (TST) was measured using wrist actigraphy for 1 week at both baseline and 8 weeks postrandomization. Partial correlations and mixed-model ANOVAs were used for statistical analyses, with age as a covariate. RESULTS At baseline, children with shorter TST (r = -0.29, p = 0.02) and an evening preference (r = 0.26, p = 0.049) were perceived as having lower self-control by their caregivers. Significant condition*time interaction effects were found for TST (p < 0.001) and SCRS score (p = 0.046): From baseline to follow-up, children randomized to the sleep intervention exhibited a significant increase in TST and were perceived as having greater self-control by their caregiver; children randomized to the control condition exhibited no change in TST or in SCRS score. The condition*chronotype*time interaction effect was not significant. CONCLUSION A brief sleep intervention that enhanced TST also resulted in enhanced caregiver reported self-control in school-age children. Results add to the growing evidence for the importance of sleep health in children.
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Affiliation(s)
- Andrea M Spaeth
- Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, NJ
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - Hollie A Raynor
- Department of Nutrition, College of Education, Health and Human Sciences, The University of Tennessee-Knoxville, Knoxville, TN
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
| | - Judith A Owens
- Department of Neurology, Boston Children's Hospital, Boston, MA; and
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences and Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA
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Allison KC, Parnarouskis L, Moore MD, Minnick AM. Insomnia, Short Sleep, and Their Treatments: Review of Their Associations with Weight. Curr Obes Rep 2024; 13:203-213. [PMID: 38776004 PMCID: PMC11150288 DOI: 10.1007/s13679-024-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE OF REVIEW Insomnia and short sleep have been linked with weight gain and obesity. However, these findings have not been consistent across studies. We review recent evidence for the association between insomnia, short sleep, and weight gain, as well as the relationship between behavioral and pharmacological treatments for sleep and weight. RECENT FINDINGS The relationship between insomnia and obesity is mixed, with stronger associations between insomnia with short sleep and obesity than other presentations of insomnia. Short sleep is associated with weight gain. Z-drugs and benzodiazapines do not appear to impact weight, but many antidepressants and antipsychotics that are used for insomnia treatment do cause weight gain. The relationships between insomnia and short sleep with weight gain and obesity are inconsistent. More prospective trials are needed to identify mediators and moderators of this relationship to better develop and deliver effective interventions for both sleep and weight problems.
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Affiliation(s)
- Kelly C Allison
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA.
| | - Lindsey Parnarouskis
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Molly D Moore
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA
| | - Alyssa M Minnick
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104-3309, USA
- InBody BWA, Audubon, PA, 19403, USA
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Gebre A, Hawley N, Carskadon MA, Raynor H, Jelalian E, Owens J, Wing RR, Hart CN. Child routines moderate a brief behavioral intervention to enhance sleep in school-aged children. J Pediatr Psychol 2024; 49:365-371. [PMID: 38553029 PMCID: PMC11098045 DOI: 10.1093/jpepsy/jsae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To examine whether child routines (the consistency or variation in children's daily routines, household responsibilities, discipline routines, and homework routines) moderated the effectiveness of a brief behavioral intervention to enhance sleep in school-aged children. METHODS Secondary analysis was conducted with a subset of 66 families with short sleeping (≤9.5 hr/day) children, 8-11 years old (female = 68%; mean age = 9.76, SD = 1.02) who completed the Child Routines Inventory at baseline and were then randomized to receive a behavioral sleep intervention (n = 32) or to control (n = 34). Sleep period was objectively measured using wrist actigraphy at baseline and 2 months post-randomization. Moderation analysis was performed using ordinary least squares regression using the PROCESS macro for SPSS. RESULTS Controlling for sleep period at baseline, treatment condition was significantly related to the sleep period at 2 months post-randomization, with the intervention group achieving a longer sleep period compared to the usual sleep period group (control) (b = 46.30, p < .01). Intervention response was moderated by child routines (b = 1.43, p < .05). Specifically, the intervention produced the greatest change in sleep period for children who engaged in greater routine behaviors at baseline than those who engaged in fewer routine behaviors. CONCLUSIONS Families that engage in routine behaviors may be better equipped to adopt the behavioral modifications required to get a good night's sleep. The findings highlight the importance of working with families to establish routine behaviors to improve responses to behavioral sleep interventions.
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Affiliation(s)
- Azeb Gebre
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Nicola Hawley
- Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, United States
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States
| | - Hollie Raynor
- Department of Nutrition, University of Tennessee at Knoxville, Knoxville, TN, United States
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States
| | - Judith Owens
- Department of Neurology and Center for Pediatric Sleep Disorders, Boston Children’s Hospital, Boston, MA, United States
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States
| | - Chantelle N Hart
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia, PA, United States
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Mitchell JA, Morales KH, Williamson AA, Jawahar A, Juste L, Vajravelu ME, Zemel BS, Dinges DF, Fiks AG. Promoting Sleep Duration in the Pediatric Setting Using a Mobile Health Platform: A Randomized Optimization Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.04.23284151. [PMID: 36711634 PMCID: PMC9882437 DOI: 10.1101/2023.01.04.23284151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective Determine the optimal combination of digital health intervention component settings that increase average sleep duration by ≥30 minutes per weeknight. Methods Optimization trial using a 25 factorial design. The trial included 2 week run-in, 7 week intervention, and 2 week follow-up periods. Typically developing children aged 9-12y, with weeknight sleep duration <8.5 hours were enrolled (N=97). All received sleep monitoring and performance feedback. The five candidate intervention components (with their settings to which participants were randomized) were: 1) sleep goal (guideline-based or personalized); 2) screen time reduction messaging (inactive or active); 3) daily routine establishing messaging (inactive or active); 4) child-directed loss-framed financial incentive (inactive or active); and 5) caregiver-directed loss-framed financial incentive (inactive or active). The primary outcome was weeknight sleep duration (hours per night). The optimization criterion was: ≥30 minutes average increase in sleep duration on weeknights. Results Average baseline sleep duration was 7.7 hours per night. The highest ranked combination included the core intervention plus the following intervention components: sleep goal (either setting was effective), caregiver-directed loss-framed incentive, messaging to reduce screen time, and messaging to establish daily routines. This combination increased weeknight sleep duration by an average of 39.6 (95% CI: 36.0, 43.1) minutes during the intervention period and by 33.2 (95% CI: 28.9, 37.4) minutes during the follow-up period. Conclusions Optimal combinations of digital health intervention component settings were identified that effectively increased weeknight sleep duration. This could be a valuable remote patient monitoring approach to treat insufficient sleep in the pediatric setting.
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Affiliation(s)
- Jonathan A Mitchell
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ariel A Williamson
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia
| | - Abigail Jawahar
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
| | - Lionola Juste
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
| | - Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
| | - David F Dinges
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia
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