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Leman TY, Barden S, Swisher VS, Joyce DS, Kaplan KA, Zeitzer JM, Loo SK, Ricketts EJ. Sleep insufficiency and bedtime irregularity in children with ADHD: A population-based analysis. Sleep Med 2024; 121:117-126. [PMID: 38959718 DOI: 10.1016/j.sleep.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Abstract
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.
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Affiliation(s)
- Talia Y Leman
- Department of Psychological and Brain Sciences, University of Iowa, USA
| | - Sophia Barden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Valerie S Swisher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Daniel S Joyce
- Centre for Health Research and School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Sandra K Loo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA.
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2
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Inoue M, Nakajima S, Inada N, Oi H, Sato N, Miyazaki Y, Takashina H, Tagaya H, Adachi Y, Kuga H. Development of the Parenting Behavior Checklist to Promote Preschoolers' Sleep (PCPP). Behav Sleep Med 2024; 22:275-284. [PMID: 37545146 DOI: 10.1080/15402002.2023.2241590] [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] [Indexed: 08/08/2023]
Abstract
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.
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Affiliation(s)
- Mari Inoue
- Graduate School of Medical Science, Kitasato University, Kanagawa, Japan
| | - Shun Nakajima
- Faculty of Liberal Arts, Department of Psychology, Teikyo University, Tokyo, Japan
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoko Inada
- Faculty of Liberal Arts, Department of Psychology, Teikyo University, Tokyo, Japan
- Faculty of Psychology and Sociology, Taisho University, Tokyo, Japan
| | - Hitomi Oi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoko Sato
- Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
| | - Yuri Miyazaki
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hikari Takashina
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hirokuni Tagaya
- Graduate School of Medical Science, Kitasato University, Kanagawa, Japan
| | | | - Hironori Kuga
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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3
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Yeo AJ, Cohenuram A, Dunsiger S, Boergers J, Kopel SJ, Koinis-Mitchell D. The Sleep Environment, Napping, and Sleep Outcomes among Urban Children With and Without Asthma. Behav Sleep Med 2024; 22:76-86. [PMID: 36843326 PMCID: PMC10457429 DOI: 10.1080/15402002.2023.2184369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVES Children with asthma living in U.S. urban neighborhoods experience increased risk for asthma morbidity and poor sleep outcomes. In addition to asthma, environmental factors (e.g. noise, uncomfortable temperature, light exposure) related to urban poverty may disturb children's sleep. This study examined the association between environmental factors and sleep outcomes among urban children with and without asthma, and whether napping underlies the environment-sleep link. Additionally, the study tested whether these associations differed by health status (i.e. asthma) or race/ethnicity. METHOD Participants included urban children aged 7-9 years with (N = 251) and without (N = 130) asthma from Latino, Black, or non-Latino White (NLW) background. Caregivers reported sleep environmental factors and naps. Sleep duration, efficiency, and nightly awakenings were assessed via actigraphy. RESULTS Regardless of health status, frequent exposure to noise and light was associated with poorer sleep outcomes only among Latino children. In the full sample with and without asthma, noise exposure during nighttime sleep was related to more frequent daytime naps, which were linked to shorter nighttime sleep duration. CONCLUSIONS Exposure to noise and light may play a particularly influential role in shaping urban children's sleep outcomes. Racial/ethnic differences and the potential mediating role of napping in this environment-sleep association may inform tailored interventions.
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Affiliation(s)
- Anna J Yeo
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Anna Cohenuram
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Julie Boergers
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
| | - Sheryl J Kopel
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
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4
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Price E, Li X, Xu Y, Mansuri A, McCall WV, Su S, Wang X. Age, sex and race distribution of accelerometer-derived sleep variability in US school-aged children and adults. Sci Rep 2023; 13:22114. [PMID: 38092889 PMCID: PMC10719297 DOI: 10.1038/s41598-023-49484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
Sleep variability (e.g. intra-individual variabilities in sleep duration or sleep timing, social jetlag, and catch-up sleep) is an important factor impacting health and mortality. However, limited information is available on the distribution of these sleep parameters across the human life span. We aimed to provide distribution of sleep variability related parameters across lifespan by sex and race in a national representative sample from the U.S. population. The study included 9981 participants 6 years and older from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, who had 4-7 days of valid 24-h accelerometer recording with at least one day obtained during weekend (Friday or Saturday night). Of the study participants, 43% showed ≥ 60 min sleep duration standard deviation (SD), 51% experienced ≥ 60 min catch-up sleep, 20% showed ≥ 60 min sleep midpoint SD, and 43% experienced ≥ 60 min social jetlag. American youth and young adults averaged greater sleep variability compared to other age groups. Non-Hispanic Blacks showed greater sleep variability in all parameters compared to other racial groups. There was a main effect of sex on sleep midpoint SD and social jetlag with males averaging slightly more than females. Our study provides important observations on sleep variability parameters of residents of the United States by using objectively measured sleep patterns and will provide unique insights for personalized advice on sleep hygiene.
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Affiliation(s)
- Elexis Price
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Yanyan Xu
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Building HS-1721, Augusta, GA, 30912, USA
| | - Asifhusen Mansuri
- Division of Pediatric Nephrology and Hypertension, Children's Hospital of Georgia, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Shaoyong Su
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Building HS-1721, Augusta, GA, 30912, USA
| | - Xiaoling Wang
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Building HS-1721, Augusta, GA, 30912, USA.
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Lupini F, Daniel LC, Mindell JA, Williamson AA. Variation in Caregiver-Reported Child Sleep Patterns and Problems by Family Socioeconomic Indicators. J Dev Behav Pediatr 2023; 44:e551-e558. [PMID: 37796628 PMCID: PMC11129725 DOI: 10.1097/dbp.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/06/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Previous studies of sleep patterns, as well as rates and correlates of perceived problems in early childhood, indicate variation by neighborhood-level socioeconomic indicators. The purpose of this study was to examine variation in (1) sleep patterns, behaviors, and problems by family-based socioeconomic indicators (income-to-needs ratio and caregiver education level) and (2) sociodemographic and sleep correlates of a caregiver-endorsed child sleep problem across and within socioeconomic indicator groups in a diverse sample. METHODS Two hundred eighty-three caregiver-child dyads (ages 1-5 years) completed the Brief Child Sleep Questionnaire. Family-level socioeconomic indicators included income-to-needs ratio and caregiver educational level. RESULTS Sleep patterns varied based on income-to-needs ratio, with children living in poverty experiencing the longest sleep onset latencies and night awakening durations and shortest nighttime sleep durations. Rates of an endorsed child sleep problem were similar across income-to-needs groups. Although sleep patterns did not vary by caregiver education level, caregivers with an education beyond high school were more likely to endorse a child sleep problem; later bedtimes, more frequent night awakenings, and greater bedtime difficulties were the strongest correlates of a perceived sleep problem in this subgroup. No specific correlates of a child sleep problem emerged for those with a high school education or less. CONCLUSION Sleep patterns may be more robustly linked to family income-to-needs ratio, whereas perceptions of a child sleep problem may be more linked to caregiver education level. Clinicians should consider expanding sleep screening questions to include specific sleep outcomes to effectively assess child sleep and guide intervention.
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Affiliation(s)
- Francesca Lupini
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA
| | | | - Jodi A. Mindell
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ariel A. Williamson
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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6
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Gueye-Ndiaye S, Williamson AA, Redline S. Disparities in Sleep-Disordered Breathing: Upstream Risk Factors, Mechanisms, and Implications. Clin Chest Med 2023; 44:585-603. [PMID: 37517837 PMCID: PMC10513750 DOI: 10.1016/j.ccm.2023.03.012] [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] [Indexed: 08/01/2023]
Abstract
Sleep-disordered breathing (SDB) refers to a spectrum of disorders ranging from habitual snoring without frank episodes of obstructed breathing or desaturation during sleep to obstructive sleep apnea, where apneas and hypopneas repetitively occur with resultant intermittent hypoxia, arousal, and sleep disruption. Disparities in SDB reflect its overall high prevalence in children and adults from racially and ethnically minoritized or low socioeconomic status backgrounds coupled with high rates of underdiagnosis and suboptimal treatment.
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, 2716 South Street Boulevard, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Redline
- Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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7
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Ordway MR, Sadler LS, Jeon S, Pierre JC, Canapari C, Redeker NS. Early emergence of racial and ethnic differences in sleep health among toddlers living in low-income families. Sleep Health 2023; 9:389-397. [PMID: 37453903 PMCID: PMC10517059 DOI: 10.1016/j.sleh.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/08/2023] [Accepted: 02/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Emerging evidence suggests racial and ethnic and socioeconomic differences in children's sleep health, yet few have examined these differences among very young children. The purpose of this study is to identify potential racial, ethnic, and sociodeomographic factors associated with multiple dimensions of sleep health in toddlers living in very low-income families. PARTICIPANTS Sample included 110 racially and ethnically diverse dyads with toddlers aged 12-15 months living in low-income families. METHODS Actigraph data (9 days and nights), caregiver completed sleep diaries, Brief Infant Sleep Questionnaire-extended, and caregiver-reported socioeconomic characteristics were collected. RESULTS Toddlers' average sleep duration (10.25 hours; SD = 0.76) was less than the age-based recommendations. There were significant race and ethnic differences in toddler's actigraph-measured bedtime (p < .001) and variability in bedtimes (p = .004). Non-LatinX White toddlers had earlier bedtimes and less variability than Black and LatinX children. These between-group differences remained statistically significant after controlling for measured socioeconomic variables (p's < 0.001). Within racial and ethnic group differences in bedtime and bedtime variability by education, employment, and marital status were identified with medium to large effect sizes. CONCLUSIONS Racial and ethnic between-group differences in sleep occurred as early as 12 months of age and were not explained by sociodemographic variables (eg, income-to-needs, education, housing). Further research is necessary to determine structural and contextual factors that explain the racial and ethnic differences in sleep health in early childhood. Identifying these factors may inform the development of socially and culturally tailored interventions to reduce sleep health disparities.
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Affiliation(s)
- Monica R Ordway
- Yale School of Medicine, Department of Pediatrics, New Haven, Connecticut, USA; Yale School of Nursing, West Haven, Connecticut, USA.
| | - Lois S Sadler
- Yale School of Nursing and Yale Child Study Center, West Haven, Connecticut, USA
| | | | - Jasmyne C Pierre
- Yale University, Department of Psychology, New Haven, Connecticut, USA
| | - Craig Canapari
- Yale School of Medicine, Department of Pediatrics, New Haven, Connecticut, USA
| | - Nancy S Redeker
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
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Li Y, Lin S, Cheslack-Postava K, Tang H, Fan F, Hoven CW. Racial and ethnic disparities in insufficient sleep among US in infants and preschoolers. Sleep Health 2023; 9:268-276. [PMID: 36813679 DOI: 10.1016/j.sleh.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged. METHODS We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR). RESULTS An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents' education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors. CONCLUSIONS More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.
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Affiliation(s)
- Yuanyuan Li
- Department of Psychology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, China; Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Keely Cheslack-Postava
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Huilan Tang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Fang Fan
- Key Laboratory of Brain, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia Univresity, USA.
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Lupini F, Williamson AA. Health Disparities in Pediatric Sleep. Sleep Med Clin 2023; 18:225-234. [PMID: 37120165 PMCID: PMC10210975 DOI: 10.1016/j.jsmc.2023.01.005] [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] [Indexed: 02/27/2023]
Abstract
This article reviews disparities in pediatric sleep health and sleep disorders from early childhood through adolescence (birth to age 18 years). Sleep health is a multidimensional construct including sleep duration, consolidation, and other domains, whereas sleep disorders reflect both behaviorally (eg, insomnia) and medically based (eg, sleep disordered breathing) sleep diagnoses. Using a socioecological framework, we review multilevel (ie, child, family, school, health-care system, neighborhood, and sociocultural) factors linked to sleep health disparities. Mechanistic research and studies using an intersectional lens to understand overlapping marginalized identities are needed to inform multilevel interventions to promote sleep health equity in pediatrics.
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Affiliation(s)
- Francesca Lupini
- Children's National Hospital, 111 Michigan Avenue Northwest, 6 Floor CTR Suite, Room M7658, Washington, DC 20010, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street Boulevard, Room 8202, Philadelphia, PA 19146, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA.
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10
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Williamson AA, Johnson TJ, Tapia IE. Health disparities in pediatric sleep-disordered breathing. Paediatr Respir Rev 2023; 45:2-7. [PMID: 35277358 PMCID: PMC9329494 DOI: 10.1016/j.prrv.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.
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Affiliation(s)
- Ariel A Williamson
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Lucchini M, Bekelman TA, Li M, Knapp EA, Dong Y, Ballard S, Deoni S, Dunlop AL, Elliott AJ, Ferrara A, Friedman C, Galarce M, Gilbert-Diamond D, Glueck D, Hedderson M, Hockett CW, Karagas MR, LeBourgeois MK, Margolis A, McDonald J, Ngai P, Pellerite M, Sauder K, Ma T, Dabelea D. Impact of the COVID-19 pandemic on children's sleep habits: an ECHO study. Pediatr Res 2023; 93:586-594. [PMID: 36195633 PMCID: PMC9531212 DOI: 10.1038/s41390-022-02309-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/04/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sleep in childhood is affected by behavioral, environmental, and parental factors. We propose that these factors were altered during the COVID-19 pandemic. This study investigates sleep habit changes during the pandemic in 528 children 4-12 years old in the US, leveraging data from the Environmental Influences on Child Health Outcomes (ECHO) Program. METHODS Data collection occurred in July 2019-March 2020 (pre-pandemic) and two pandemic periods: December 2020-April 2021 and May-August 2021. Qualitative interviews were performed in 38 participants. RESULTS We found no changes in sleep duration, but a shift to later sleep midpoint during the pandemic periods. There was an increase in latency at the first pandemic collection period but no increase in the frequency of bedtime resistance, and a reduced frequency of naps during the pandemic. Qualitative interviews revealed that parents prioritized routines to maintain sleep duration but were more flexible regarding timing. Children from racial/ethnic minoritized communities slept less at night, had later sleep midpoint, and napped more frequently across all collection periods, warranting in-depth investigation to examine and address root causes. CONCLUSIONS The COVID-19 pandemic significantly impacted children sleep, but parental knowledge of the importance of sleep might have played a significant protective role. IMPACT During the COVID-19 pandemic, US children changed their sleep habits, going to bed and waking up later, but their sleep duration did not change. Sleep latency was longer. Parental knowledge of sleep importance might have played a protective role. Regardless of data collection periods, children from racial/ethnic minoritized communities slept less and went to bed later. This is one of the first study on this topic in the US, including prospective pre-pandemic qualitative and quantitative data on sleep habits. Our findings highlight the pandemic long-term impact on childhood sleep. Results warrants further investigations on implications for overall childhood health.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Traci A Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mingyi Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yanan Dong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Suyin Ballard
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean Deoni
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy J Elliott
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Assiamira Ferrara
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Chloe Friedman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Maren Galarce
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Deborah Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Monique Hedderson
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Christine W Hockett
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Margaret R Karagas
- Department of Epidemiology, Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Monique K LeBourgeois
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Amy Margolis
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia McDonald
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Pakkay Ngai
- Division of Pediatric Pulmonology, Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | | | - Katherine Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tengfei Ma
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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12
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Nicholson L, Bohnert AM, Crowley SJ. A developmental perspective on sleep consistency: Preschool age through emerging adulthood. Behav Sleep Med 2023; 21:97-116. [PMID: 35014925 DOI: 10.1080/15402002.2021.2024192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE/BACKGROUND Beyond sleep duration, the regularity of sleep patterns (e.g., sleep consistency), including variability in sleep timing (e.g., bedtime, wake time) and duration, is a critical marker of sleep health. Sleep consistency is captured using a variety of methods within the literature (e.g., sleep intraindividual variability, social jetlag), but most of the research focuses on adolescents. METHODS Drawing on a developmental perspective, this narrative review highlights how normative changes at the individual (e.g., biological, cognitive, and social) and contextual (e.g., home, school, sociocultural) levels may contribute to inconsistent sleep patterns across development. RESULTS AND CONCLUSIONS This review emphasizes how inconsistent sleep may increase across pivotal transitions throughout development (e.g., elimination of naps, puberty, summertime, entering college). Finally, recommendations for measuring sleep consistency and areas to address in future research are discussed.
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Affiliation(s)
- Laura Nicholson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Amy M Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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13
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Pham C, Desmarais E, Jones V, French BF, Wang Z, Putnam S, Casalin S, Linhares MBM, Lecannelier F, Tuovinen S, Heinonen K, Raikkonen K, Montirosso R, Giusti L, Park SY, Han SY, Lee EG, Huitron B, de Weerth C, Beijers R, Majdandžić M, Gonzalez-Salinas C, Acar I, Slobodskaya H, Kozlova E, Ahmetoglu E, Benga O, Gartstein MA. Relations between bedtime parenting behaviors and temperament across 14 cultures. Front Psychol 2022; 13:1004082. [PMID: 36507001 PMCID: PMC9731114 DOI: 10.3389/fpsyg.2022.1004082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The present study examined parental sleep-supporting practices during toddlerhood in relation to temperament across 14 cultures. We hypothesized that passive sleep-supporting techniques (e.g., talking, cuddling), but not active techniques (e.g., walking, doing an activity together), would be associated with less challenging temperament profiles: higher Surgency (SUR) and Effortful Control (EC) and lower Negative Emotionality (NE), with fine-grained dimensions exhibiting relationships consistent with their overarching factors (e.g., parallel passive sleep-supporting approach effects for dimensions of NE). Methods Caregivers (N = 841) across 14 cultures (M = 61 families per site) reported toddler (between 17 and 40 months of age; 52% male) temperament and sleep-supporting activities. Utilizing linear multilevel regression models and group-mean centering procedures, we assessed the role of between- and within-cultural variance in sleep-supporting practices in relation to temperament. Results Both within-and between-culture differences in passive sleep-supporting techniques were associated with temperament attributes, (e.g., lower NE at the between-culture level; higher within-culture EC). For active techniques only within-culture effects were significant (e.g., demonstrating a positive association with NE). Adding sleep-supporting behaviors to the regression models accounted for significantly more between-culture temperament variance than child age and gender alone. Conclusion Hypotheses were largely supported. Findings suggest parental sleep practices could be potential targets for interventions to mitigate risk posed by challenging temperament profiles (e.g., reducing active techniques that are associated with greater distress proneness and NE).
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Affiliation(s)
- Christie Pham
- Department of Psychology, Washington State University, Pullman, WA, United States,*Correspondence: Christie Pham,
| | - Eric Desmarais
- Department of Psychology, Washington State University, Pullman, WA, United States
| | - Victoria Jones
- Department of Psychology, Washington State University, Pullman, WA, United States
| | - Brian F. French
- College of Education, Washington State University, Pullman, WA, United States
| | - Zhengyan Wang
- College of Psychology, Capital Normal University, Beijing, China
| | | | - Sara Casalin
- Department of Psychology, University of Leuven, Leuven, Belgium
| | | | | | - Soile Tuovinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland,Department of Social Sciences, University of Tampere, Tampere, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland,Department of Social Sciences, University of Tampere, Tampere, Finland
| | - Katri Raikkonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Rosario Montirosso
- 0-3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Lorenzo Giusti
- 0-3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Seong-Yeon Park
- Department of Child Development, Ewha Woman’s University, Seoul, South Korea
| | - Sae-Young Han
- Department of Child Development, Ewha Woman’s University, Seoul, South Korea
| | - Eun Gyoung Lee
- Department of Child Development, Ewha Woman’s University, Seoul, South Korea,Ewha Social Science Research Institute, Seoul, South Korea
| | - Blanca Huitron
- Department of Psychology, National Autonomous University of Mexico, México City, Mexico
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands,Department of Developmental Psychology, Radboud University, Nijmegen, Netherlands
| | - Mirjana Majdandžić
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | | | - Ibrahim Acar
- Department of Psychology, Özyeğin University, Istanbul, Turkey
| | - Helena Slobodskaya
- Research Institute of Neuroscience and Medicine, Novosibirsk State University, Novosibirsk, Russia
| | - Elena Kozlova
- Research Institute of Neuroscience and Medicine, Novosibirsk State University, Novosibirsk, Russia
| | - Emine Ahmetoglu
- Department of Early Childhood Education, Trakya University in Edirne, Edirne, Turkey
| | - Oana Benga
- Department of Psychology, Babes Bolyai University, Cluj-Napoca, Romania
| | - Maria A. Gartstein
- Department of Psychology, Washington State University, Pullman, WA, United States
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14
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Lucchini M, Ordway MR, Kyle MH, Pini N, Barbosa JR, Sania A, Shuffrey LC, Firestein MR, Fernández CR, Fifer WP, Alcántara C, Monk C, Dumitriu D. Racial/ethnic disparities in infant sleep in the COVID-19 Mother Baby Outcomes (COMBO) study. Sleep Health 2022; 8:429-439. [PMID: 36038499 PMCID: PMC9411732 DOI: 10.1016/j.sleh.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Investigate racial and ethnic differences in infant sleep and examine associations with insurance status and parent-infant bedtime behavioral factors (PIBBF). METHODS Participants are part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative, Columbia University. Data on infant sleep (night, day and overall sleep duration, night awakenings, latency, infant's sleep as a problem) were collected at 4 months postpartum. Regressions estimated associations between race/ethnicity, insurance status, PIBBF and infants' sleep. RESULTS A total of 296 infants were eligible (34.4% non-Hispanic White [NHW], 10.1% Black/African American [B/AA], 55.4% Hispanic). B/AA and Hispanic mothers were more likely to have Medicaid, bed/room-share, and report later infant bedtime compared to NHW mothers. Infants of B/AA mothers had longer sleep latency compared to NHW. Infants of Hispanic mothers slept less at night (∼70 ± 12 minutes) and more during the day (∼41 ± 12 minutes) and Hispanic mothers were less likely to consider infants' sleep as a problem compared to NHW (odds ratio 0.4; 95% confidence interval: 0.2-0.7). After adjustment for insurance status and PIBBF, differences by race/ethnicity for night and day sleep duration and perception of infant's sleep as a problem persisted (∼32 ± 14 minutes, 35 ± 15 minutes, and odds ratio 0.4; 95% confidence interval: 0.2-0.8 respectively). Later bedtime was associated with less sleep at night (∼21 ± 4 minutes) and overall (∼17 ± 5 minutes), and longer latency. Infants who did not fall asleep independently had longer sleep latency, and co-sleeping infants had more night awakenings. CONCLUSIONS Results show racial/ethnic differences in sleep in 4-month-old infants across sleep domains. The findings of our study suggest that PIBBF have an essential role in healthy infant sleep, but they may not be equitably experienced across racial/ethnic groups.
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Affiliation(s)
- Maristella Lucchini
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
| | | | - Margaret H Kyle
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicolò Pini
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer R Barbosa
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Ayesha Sania
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren C Shuffrey
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Morgan R Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Cristina R Fernández
- New York-Presbyterian Hospital, New York, New York, USA; Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - William P Fifer
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | | | - Catherine Monk
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA; Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dani Dumitriu
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA; Sackler Institute, Zuckerman Institute, and the Columbia Population Research Center, Columbia University, New York, New York, USA.
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15
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Li S, Sun J, Dong J. Family Socio-Economic Status and Children's Play Behaviors: The Mediating Role of Home Environment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1385. [PMID: 36138694 PMCID: PMC9497565 DOI: 10.3390/children9091385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
Family socio-economic status (SES) is a significant predictor of children's early learning performance, while little is known about the relationship between family SES and children's play. This study aimed to examine how family SES was related to different aspects of children's play behaviors and whether the home environment served as a mediator in this relationship. A total of 844 mothers of children aged three to six (Nboys = 431) from different SES backgrounds (Nlow-SES = 123, Nmedium-SES = 322, Nhigh-SES = 399) reported the situation of the home environment and their children's play behaviors with self-developed questionnaires. Results of regression analyses showed that family SES significantly predicted the level of Imagination, Approaches to Learning, and Emotion Expression in children's play and that the home environment partially mediated such relationships. The results indicate SES-related differences in children's play behaviors and offer the possibility of narrowing such discrepancies by establishing a child-friendly home environment.
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Affiliation(s)
- Sixian Li
- School of Education, South China Normal University, Guangzhou 510631, China
| | - Jin Sun
- Department of Early Childhood Education, The Education University of Hong Kong, Taipo 999077, Hong Kong
| | - Jingxuan Dong
- School of Education, South China Normal University, Guangzhou 510631, China
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16
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Abstract
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.
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Affiliation(s)
| | - Sarah Logan
- Yale School of Nursing, PO Box 27399, West Haven, CT 06516-7399, USA
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17
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Quante M, McGee GW, Yu X, von Ash T, Luo M, Kaplan ER, Rueschman M, Haneuse S, Davison KK, Redline S, Taveras EM. Associations of sleep-related behaviors and the sleep environment at infant age one month with sleep patterns in infants five months later. Sleep Med 2022; 94:31-37. [DOI: 10.1016/j.sleep.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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18
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Lupini F, Leichman ES, Gould RA, Walters RM, Mindell JA, Williamson AA. Correlates of a caregiver-reported child sleep problem and variation by community disadvantage. Sleep Med 2022; 90:83-90. [PMID: 35123150 PMCID: PMC9206234 DOI: 10.1016/j.sleep.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies of sleep patterns and perceived problems in early childhood indicate variation by family socioeconomic status. The purpose of this study was to examine variation in correlates of a caregiver-perceived child sleep problem across and within levels of community disadvantage in a large US sample. METHODS Caregivers of 14,980 young children (ages 0-35.9 months) in the US completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R) on the freely and publicly available Johnson's® Bedtime® Baby Sleep App. Zip code was used to identify a Distressed Communities Index (DCI) score, which represents community disadvantage based on neighborhood indicators. RESULTS Across all levels of community disadvantage, caregivers who reported greater impact of child sleep on their own sleep, bedtime difficulty, more frequent and longer night wakings, and increased total nighttime sleep were more likely to endorse a child sleep problem. These associations varied by level of community disadvantage. For caregivers living in more disadvantaged communities, impact of child sleep on their own sleep and night wakings were the strongest correlates of endorsing a child sleep problem, whereas for those in more advantaged communities the impact of child sleep on their own sleep and night wakings as well as additional aspects of sleep health, such as short sleep duration, were associated with endorsement of a child sleep problem. CONCLUSIONS Findings suggest that families living in more distressed communities are most likely to identify the impact of child sleep on their own sleep and night wakings in reporting a child sleep problem, whereas those from more prosperous communities consider these factors as well as other sleep parameters, including sleep duration. Clinicians should consider expanding screening questions for child sleep problems to include the perceived impact on caregiver sleep.
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Affiliation(s)
| | | | | | | | - Jodi A. Mindell
- Saint Joseph’s University, USA,Children’s Hospital of Philadelphia, USA,University of Pennsylvania, Perelman School of Medicine, USA,Corresponding author. Department of Psychology, Saint Joseph’s University, Philadelphia, PA 19131, USA. (J.A. Mindell)
| | - Ariel A. Williamson
- Children’s Hospital of Philadelphia, USA,University of Pennsylvania, Perelman School of Medicine, USA
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19
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Ursache A, Robbins R, Chung A, Dawson-McClure S, Kamboukos D, Calzada E, Jean-Louis G, Brotman LM. Sleep, Classroom Behavior, and Achievement Among Children of Color in Historically Disinvested Neighborhoods. Child Dev 2021; 92:1932-1950. [PMID: 34041742 PMCID: PMC9074088 DOI: 10.1111/cdev.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Children of color are more likely to have poor sleep health than White children, placing them at risk for behavioral problems in the classroom and lower academic performance. Few studies, however, have utilized standardized measures of both classroom behavior and achievement. This study examined whether children's sleep (parent and teacher report) in first grade concurrently related to independent observations of classroom behavior and longitudinally predicted achievement test scores in second grade in a sample of primarily Black (86%) children (n = 572; age = 6.8) living in historically disinvested neighborhoods. Higher teacher-reported child sleepiness was associated with lower adaptive behaviors and higher problem behaviors in the classroom, and predicted lower achievement. Parent-reported bedtime resistance and disordered breathing also predicted lower achievement.
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Affiliation(s)
- Alexandra Ursache
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Rebecca Robbins
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
- Department of Sleep and Circadian Disorders, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115
| | - Alicia Chung
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Spring Dawson-McClure
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Dimitra Kamboukos
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Esther Calzada
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712
| | - Girardin Jean-Louis
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Laurie Miller Brotman
- Department of Population Health, NYU Grossman School of Medicine, 227 East 30th Street, New York, NY 10016
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20
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Lewis KM, Rafihi-Ferreira RE, Freitag GF, Coffman M, Ollendick TH. A 25-Year Review of Nighttime Fears in Children: Past, Present, and Future. Clin Child Fam Psychol Rev 2021; 24:391-413. [PMID: 34125354 DOI: 10.1007/s10567-021-00354-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Nighttime fears in children are common, interfere with daily functioning, and result in considerable disruption in the family. The aim of the present review was to examine empirical literature from the past 25 years that investigated the assessment of nighttime fears in young children and the efficacy and effectiveness of psychosocial treatments for children's nighttime fears. The last review of this literature was in 1997 and examined studies conducted in and prior to 1995 (King et al. in Clin Psychol Rev 17:431-443, 1997). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of the literature aimed at providing a synthesis of the Randomized Control Trials (RCTs) and controlled single-case multiple baseline design studies (MBLs) on the treatment of nighttime fears in children. A search of the literature identified 12 articles, with nine studies utilizing a between-group randomized controlled trial design and three studies utilizing a multiple baseline design. Results demonstrated significant improvements in children's nighttime fears and reductions in disruptive nighttime behaviors using behavioral interventions and cognitive-behavioral strategies. This review provides a commentary on the effectiveness and limitations of the assessment and treatment approaches for nighttime fears in children and suggests directions for future research.
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Affiliation(s)
- Krystal M Lewis
- National Institute of Mental Health, 9000 Rockville Pike, 10 Center Drive, Bldg.10 RM B1D43S, Bethesda, MD, 20814, USA.
| | - Renatha El Rafihi-Ferreira
- Institute of Psychiatry, Hospital da Clinicas - Faculty of Medicine, University of Sao Paulo, 785 Ovídio Pires de Campos, São Paulo, SP, 05403903, Brazil
| | - Gabrielle F Freitag
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | | | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24060, USA
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21
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Mayne SL, Mitchell JA, Virudachalam S, Fiks AG, Williamson AA. Neighborhood environments and sleep among children and adolescents: A systematic review. Sleep Med Rev 2021; 57:101465. [PMID: 33827031 PMCID: PMC8164975 DOI: 10.1016/j.smrv.2021.101465] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/04/2021] [Accepted: 02/26/2021] [Indexed: 01/31/2023]
Abstract
Understanding salient environmental determinants of pediatric sleep is essential for informing interventions and public health initiatives. Emerging evidence suggests that the neighborhood environment can impact pediatric sleep, but this evidence has not yet been systematically reviewed. We conducted a systematic review of the scientific literature on associations between neighborhood environments and sleep in young children (0-5 y), school-aged children (6-12 y) and adolescents (13-18 y). We reviewed 85 articles published between 2003 and 2020. The most commonly examined neighborhood exposure was low socioeconomic status (40 studies), which was associated with sleep outcomes in 58% of studies (primarily shorter sleep duration, later sleep timing, or obstructive sleep apnea). Evidence was stronger for neighborhood safety/crime/violence (21 studies), with 86% of studies reporting associations with sleep outcomes (primarily self- or caregiver-reported sleep problems). Fewer studies examined associations of neighborhood physical environment exposures, including noise (15 studies), the built environment (seven studies), and air pollution (six studies). Limitations of the current body of evidence include 1) limited examination of neighborhood exposures other than socioeconomic status or safety, 2) use of primarily cross-sectional observational study designs, 3) lack of objective sleep outcome assessment, and 4) limits of current exposure assessment methods.
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Affiliation(s)
- Stephanie L Mayne
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Jonathan A Mitchell
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Alexander G Fiks
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Ariel A Williamson
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, USA; Sleep Center, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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22
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Williamson AA, Mindell JA. Cumulative socio-demographic risk factors and sleep outcomes in early childhood. Sleep 2021; 43:5573929. [PMID: 31555826 DOI: 10.1093/sleep/zsz233] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/22/2019] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES To examine associations between cumulative socio-demographic risk factors, sleep health habits, and sleep disorder symptoms in young children. METHODS Two hundred five caregiver-child dyads (child mean age ± SD: 3.3 ± 1.1 years; 53.7% girls; 62.9% black, 22.4% non-Hispanic/Latinx white, 4.4% Hispanic/Latinx; 85.4% maternal caregiver reporter) completed caregiver-rated sleep measures (Brief Child Sleep Questionnaire [BCSQ]; Pediatric Sleep Questionnaire [PSQ] snoring subscale), which were used to generate indexes of poor sleep health habits, pediatric insomnia symptoms, and obstructive sleep apnea (OSA) symptoms. A cumulative risk index was created reflecting caregiver, family, and neighborhood risks. RESULTS Overall, 84.5% of children had ≥ 1 poor sleep health habit, 62.9% had ≥ 1 insomnia symptom, and 40.0% had ≥ 1 OSA symptom. Poisson regression indicated that each increase in the number of cumulative risk factors was associated with a 10% increase in poor sleep health habits, a 9% increase in insomnia symptoms, and an 18% increase in OSA symptoms. Specific caregiver risks (depressive symptoms, lower educational attainment) and family risks (single caregiver, crowded home) were most predictive of poor sleep outcomes. CONCLUSIONS Poor sleep health habits and sleep disorder symptoms are highly prevalent in early childhood, particularly among families experiencing cumulative socio-demographic risks. Findings underscore the need for targeted screening and prevention for modifiable sleep behaviors and efforts to tailor such strategies for at-risk children and families, especially those living in crowded conditions, or with caregivers who are single or have a lower educational attainment or depressive symptoms.
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Affiliation(s)
- Ariel A Williamson
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jodi A Mindell
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Psychology, Saint Joseph's University, Philadelphia, PA
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23
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Yu X, Quante M, Rueschman M, Ash T, Kaplan ER, Guo N, Horan CM, Haneuse S, Davison K, Taveras EM, Redline S. Emergence of racial/ethnic and socioeconomic differences in objectively measured sleep-wake patterns in early infancy: results of the Rise & SHINE study. Sleep 2021; 44:zsaa193. [PMID: 33057653 PMCID: PMC7953214 DOI: 10.1093/sleep/zsaa193] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/30/2020] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES To characterize objectively assessed sleep-wake patterns in infants at approximately 1 month and 6 months and examine the differences among infants with different racial/ethnic backgrounds and household socioeconomic status (SES). METHODS Full-term healthy singletons wore an ankle-placed actigraph at approximately 1 month and 6 months and parents completed sleep diaries. Associations of racial/ethnic and socioeconomic indices with sleep outcomes were examined using multivariable analyses. Covariates included sex, birth weight for gestational age z-score, age at assessment, maternal education, household income, bed-sharing, and breastfeeding. RESULTS The sample included 306 infants, of whom 51% were female, 42.5% non-Hispanic white, 32.7% Hispanic, 17.3% Asian, and 7.5% black. Between 1 month and 6 months, night sleep duration increased by 65.7 minutes (95% CI: 55.4, 76.0), night awakenings decreased by 2.2 episodes (2.0, 2.4), and daytime sleep duration decreased by 73.3 minutes (66.4, 80.2). Compared to change in night sleep duration over this development period for white infants (82.3 minutes [66.5, 98.0]), night sleep increased less for Hispanic (48.9 minutes [30.8, 66.9]) and black infants (31.6 minutes [-5.9, 69.1]). Night sleep duration also increased less for infants with lower maternal education and household income. Asian infants had more frequent night awakenings. Adjustment for maternal education and household income attenuated all observed day and night sleep duration differences other than in Asians, where persistently reduced nighttime sleep at 6 months was observed. CONCLUSIONS Racial/ethnic differences in sleep emerge in early infancy. Night and 24-hour sleep durations increase less in Hispanic and black infants compared to white infants, with differences largely explained by SES.
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Affiliation(s)
- Xinting Yu
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- School of Social Work, Boston College, Chestnut Hill, MA
| | - Mirja Quante
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Michael Rueschman
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Tayla Ash
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI
| | - Emily R Kaplan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Na Guo
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Christine M Horan
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kirsten Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- School of Social Work, Boston College, Chestnut Hill, MA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Daniel LC, Childress JL, Flannery JL, Weaver-Rogers S, Garcia WI, Bonilla-Santiago G, Williamson AA. Identifying Modifiable Factors Linking Parenting and Sleep in Racial/Ethnic Minority Children. J Pediatr Psychol 2021; 45:867-876. [PMID: 32447371 DOI: 10.1093/jpepsy/jsaa034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Young children from racial and ethnic minority backgrounds are at risk for poor sleep, yet few studies have tested behavioral interventions in diverse samples. This study tests factors that could contribute to associations between parenting skills and child sleep to inform interventions for children at risk of poor sleep outcomes. Specifically, we examined household chaos, caregiver sleep knowledge, and caregiver sleep quality as putative mediators that may be relevant to interventions seeking to improve child sleep. METHODS Caregivers (M age 31.83 years; 46.2% African American; 52.1% Hispanic/Latinx, 95% female) of 119 1- to 5-year-old children (M age 3.99 years; 43.7% African American; 42.0% Hispanic/Latinx, 14.3% biracial; 51.3% female) completed measures of parenting practices, child and caregiver sleep, household chaos, and sleep knowledge. Indices of pediatric insomnia symptoms (difficulty falling/remaining asleep) and sleep health (sleep duration/hygiene) were constructed based on previous research. Parallel mediation models were conducted using ordinary least squares path analysis. RESULTS Lower household chaos significantly attenuated the relationship between positive parenting skills and better child sleep health, suggesting chaos may serve as a potential mediator. There were no significant contributing factors in the pediatric insomnia model. Sleep knowledge was related to sleep health and caregiver sleep quality was related to pediatric insomnia, independent of parenting skills. CONCLUSION Interventions to improve sleep in early childhood may be enhanced by targeting parenting skills and household routines to reduce chaos. Future longitudinal research is needed to test household chaos and other potential mediators of child sleep outcomes over time.
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Affiliation(s)
| | | | | | | | - Wanda I Garcia
- Early Learning Research Academy, Rutgers University - Camden.,Community Leadership Center, Rutgers University - Camden
| | - Gloria Bonilla-Santiago
- Early Learning Research Academy, Rutgers University - Camden.,Community Leadership Center, Rutgers University - Camden
| | - Ariel A Williamson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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25
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Lewien C, Genuneit J, Meigen C, Kiess W, Poulain T. Sleep-related difficulties in healthy children and adolescents. BMC Pediatr 2021; 21:82. [PMID: 33593333 PMCID: PMC7885393 DOI: 10.1186/s12887-021-02529-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/31/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND As sleep-related difficulties are a growing public health concern, it is important to gain an overview of the specific difficulty areas of the most vulnerable individuals: children. The current descriptive study presents the prevalence of sleep-related difficulties in two large samples of healthy children and adolescents and outlines the effects of age, gender, and socioeconomic status (SES) on various sleep-related difficulties. METHODS Participants were 855 4-9 year-old children (child sample) and 1,047 10-17 year-old adolescents (adolescent sample) participating 2011-2015 in the LIFE Child study, a population-based cohort study in Germany. Parents of the child participants completed the Children's Sleep Habits Questionnaire (CSHQ), whereas adolescents self-administered the Sleep Self Report (SSR). Familial SES was determined by a composite score considering parental education, occupational status, and income. Multiple regression analyses were carried out to address the research question. RESULTS Among 4-9 year-old children, the mean bedtime was reported to be 8 p.m., the mean wake-up time 7 a.m., and sleep duration decreased by 14 min/year of age. 22.6 % of the children and 20.0 % of the adolescents showed problematic amounts of sleep-related difficulties. In the child sample, bedtime resistance, sleep onset delay, sleep-related anxiety, night waking, and parasomnia were more frequent in younger than older children. In the adolescent sample, difficulties at bedtime were more frequent among the younger adolescents, whereas daytime sleepiness was more prominent in the older than the younger adolescents. Considering gender differences, sleep-related difficulties were more frequent among boys in the child sample and among girls in the adolescent sample. Lower SES was associated with increased sleep-related difficulties in the adolescent, but not the child sample. CONCLUSIONS The present results report sleep-related difficulties throughout both childhood and adolescence. Gender differences can already be observed in early childhood, while effects of SES emerge only later in adolescence. The awareness for this circumstance is of great importance for pediatric clinicians who ought to early identify sleep-related difficulties in particularly vulnerable individuals.
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Affiliation(s)
- Christiane Lewien
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
| | - Jon Genuneit
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.,Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Christof Meigen
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
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26
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Covington LB, Patterson F, Hale LE, Teti DM, Cordova A, Mayberry S, Hauenstein EJ. The contributory role of the family context in early childhood sleep health: A systematic review. Sleep Health 2021; 7:254-265. [PMID: 33436342 DOI: 10.1016/j.sleh.2020.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/25/2023]
Abstract
Sleep-wake regulation is established during early childhood and contributes to life-long health. The family context is critical to the development of child sleep-wake regulation. The primary aim of this systematic review was to elucidate family-level constructs (outside of bedtime parenting) that contribute to early childhood (age 0-5 years) sleep health. We identified empirical research articles that investigate these relationships through systematically searching PubMed, Web of Science, and PsycINFO databases. The transactional model of sleep-wake regulation guided the selection of family-level search terms, including socioeconomic status (SES), family structure, household chaos, marital, co-parenting, and social relationships. Sleep search terms included sleep problems, duration, timing, and variability. We searched sleep and family terms in combination with infant, toddler, or preschool developmental age. Sixteen studies satisfied criteria for inclusion. Results indicated that the presence of household chaos and poor quality marital relationships were directly associated with early childhood sleep problems and variable sleep timing. Higher marital satisfaction and the presence of household routines were positively associated with sleep duration. Several, but not all, studies showed an association between lower SES and poor child sleep health. There were no significant direct associations for family structure and limited findings for the role of perceived social support and co-parenting relationship quality. Overall, operationalization and measurement of family and sleep constructs varied across studies, decreasing our ability to make comparisons and draw robust conclusions. Future research should identify modifiable family-level factors that can be targeted, in addition to bedtime parenting, to improve sleep-wake regulation development.
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Affiliation(s)
- Lauren B Covington
- School of Nursing, College of Health Sciences, University of Delaware, 100 Discovery Boulevard, Newark, DE 19713, USA.
| | - Freda Patterson
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, 100 Discovery Boulevard, Newark, DE 19713, USA
| | - Lauren E Hale
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Health Sciences Center, Renaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794-8338, USA
| | - Douglas M Teti
- Department of Human Development & Family Studies, The Pennsylvania State University, 105 Health and Human Development Building, University Park, PA 16802, USA
| | - Angeni Cordova
- Epidemiology Program, College of Health Sciences, University of Delaware, 100 Discovery Boulevard, Newark, DE 19713, USA
| | - Shannon Mayberry
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, 100 Discovery Boulevard, Newark, DE 19713, USA
| | - Emily J Hauenstein
- School of Nursing, College of Health Sciences, University of Delaware, 100 Discovery Boulevard, Newark, DE 19713, USA
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27
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Deater-Deckard K, Chary M, McQuillan ME, Staples AD, Bates JE. Mothers' sleep deficits and cognitive performance: Moderation by stress and age. PLoS One 2021; 16:e0241188. [PMID: 33411778 PMCID: PMC7790244 DOI: 10.1371/journal.pone.0241188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022] Open
Abstract
There are well-known associations between stress, poor sleep, and cognitive deficits, but little is known about their interactive effects, which the present study explored in a sample of mothers of toddlers. Since certain types of cognitive decline start during the 20s and continue into later ages, we also explored whether mothers’ age interacted with stress and sleep in the prediction of cognitive functioning. We hypothesized that poorer sleep [measured using one week of 24-hour wrist actigraphy data] and having more chronic stressors [e.g., life events, household chaos, work/family role conflict] would be linked with poorer cognitive performance [both executive function and standardized cognitive ability tasks], and that the interactive combination of poorer sleep and more stressors would account for the effect. We also explored whether this process operated differently for younger versus older women. In a socioeconomically and geographically diverse community sample of 227 women with toddler-age children [age, M = 32.73 yrs, SD = 5.15 yrs], poorer cognitive performance was predicted by greater activity during the sleep period, shorter sleep duration, and lower night-to-night consistency in sleep; it was not associated with higher levels of stress. The interactive effects hypothesis was supported for sleep activity [fragmented sleep] and sleep timing [when mothers went to bed]. The combination of more exposure to stressors and frequent night waking was particularly deleterious for older women’s performance. For younger women, going to bed late was associated with poorer performance if they were experiencing high levels of stress; for those experiencing low levels of stress, going to bed late was associated with better performance.
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Affiliation(s)
- Kirby Deater-Deckard
- University of Massachusetts at Amherst, Amherst, Massachusetts, United States of America
| | - Mamatha Chary
- University of Massachusetts at Amherst, Amherst, Massachusetts, United States of America
- * E-mail:
| | - Maureen E. McQuillan
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Angela D. Staples
- Eastern Michigan University, Ypsilanti, Michigan, United States of America
| | - John E. Bates
- Indiana University, Bloomington, Indiana, United States of America
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28
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Kölbel M, Kirkham FJ, Dimitriou D. Developmental Profile of Sleep and Its Potential Impact on Daytime Functioning from Childhood to Adulthood in Sickle Cell Anaemia. Brain Sci 2020; 10:brainsci10120981. [PMID: 33327459 PMCID: PMC7764980 DOI: 10.3390/brainsci10120981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/12/2023] Open
Abstract
Young individuals with sickle cell anaemia (SCA) experience sleep disturbances and often experience daytime tiredness, which in turn may impact on their daytime functioning and academic attainment, but there are few longitudinal data. METHODS Data on sleep habits and behaviour were taken on the same day as an in-hospital polysomnography. This study assesses the developmental sleep profiles of children and young adults aged 4-23 years old with SCA. We examined retrospective polysomnography (PSG) and questionnaire data. RESULTS A total of 256 children with a median age of 10.67 years (130 male) were recruited and 179 returned for PSG 1.80-6.72 years later. Later bedtimes and a decrease in total sleep time (TST) were observed. Sleep disturbances, e.g., parasomnias and night waking, were highest in preschool children and young adults at their first visit. Participants with lower sleep quality, more movement during the night and increased night waking experienced daytime sleepiness, potentially an indicator of lower daytime functioning. Factors influencing sleep quantity included age, hydroxyurea prescription, mean overnight oxygen saturation, sleep onset latency, periodic limb movement, socioeconomic status and night waking. CONCLUSION Sleep serves an important role for daytime functioning in SCA; hence, quantitative (i.e., PSG for clinical symptoms, e.g., sleep-disordered breathing, nocturnal limb movement) and qualitative (i.e., questionnaires for habitual sleep behaviour) assessments of sleep should be mutually considered to guide interventions.
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Affiliation(s)
- Melanie Kölbel
- Department of Developmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Fenella J. Kirkham
- Department of Developmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
- Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
- Child Health, University Hospital Southampton, Southampton SO16 6YD, UK
- Paediatric Neurosciences, King’s College Hospital, London SE5 9RS, UK
- Correspondence: ; Tel.: +44-2079052981
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK;
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29
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Tomaz SA, Hinkley T, Jones RA, Watson ED, Twine R, Kahn K, Norris SA, Draper CE. Screen Time and Sleep of Rural and Urban South African Preschool Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155449. [PMID: 32751089 PMCID: PMC7432324 DOI: 10.3390/ijerph17155449] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 01/10/2023]
Abstract
This study aimed to investigate the extent to which preschool children meet guidelines for screen time (<1 h/day) and sleep (10-13 h/24-h) and explored home factors that affect these behaviors. Parents of preschoolers across income settings in South Africa (urban high-income n = 27, urban low-income n = 96 and rural low-income n = 142) completed a questionnaire. Urban high-income children had higher rates of exceeding screen time guidelines (67.0%) than children from urban low-income (26.0%) and rural low-income (3.5%) settings. Most children (81.0%) met sleep guidelines on weekdays and on weekends (75.0%). More urban high-income children met the sleep guideline, in comparison to both low-income settings. Fewer urban high-income parents (50.0%) thought that screen time would not affect their preschooler's health, compared to urban low-income (90.4%) and rural low-income (81.7%) parents. Weeknight bedtime was positively correlated with both weekday screen time (p = 0.001) and weekday TV time (p = 0.005), indicating that more time on screens correlated with later bedtimes. Meeting screen time and sleep guidelines differs across income settings, but it is evident that parents of preschoolers across all income settings would benefit from greater awareness about guidelines.
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Affiliation(s)
- Simone A. Tomaz
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town 7700, South Africa
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, Scotland, UK
- Correspondence: (S.A.T.); (C.E.D.)
| | - Trina Hinkley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3125, Australia;
| | - Rachel A. Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong 2500, Australia;
| | - Estelle D. Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, University of Witwatersrand, Johannesburg 2000, South Africa;
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa; (R.T.); (K.K.)
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa; (R.T.); (K.K.)
| | - Shane A. Norris
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa;
| | - Catherine E. Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town 7700, South Africa
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa;
- Correspondence: (S.A.T.); (C.E.D.)
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30
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Kracht CL, Webster EK, Staiano AE. Sociodemographic Differences in Young Children Meeting 24-Hour Movement Guidelines. J Phys Act Health 2019; 16:908-915. [PMID: 31491748 PMCID: PMC7058481 DOI: 10.1123/jpah.2019-0018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/13/2019] [Accepted: 07/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about variation in meeting the 24-Hour Movement Guidelines (including physical activity [PA], sleep, and screen time [ST]) in early childhood. The aim was to evaluate sociodemographic differences in meeting the 24-Hour Movement Guidelines. METHODS Parents of 3-4 year old children reported sociodemographic information and ST. Sleep and PA were measured using accelerometry, and height and weight were objectively measured. The 24-Hour Movement Guidelines include daily PA (total PA: ≥3 h; including ≥1 h of moderate to vigorous), sleep (10-13 h), and ST (≤1 h). Meeting guidelines by age, sex, race, poverty level, and weight status were assessed using chi-square and linear regression models. RESULTS Of 107 children, 57% were white and 26% lived in households at or below the poverty level. Most children met the PA (91.5%) and sleep (86.9%) guidelines, but few met ST (14.0%) or all 3 (11.3%) guidelines. African American children and children who lived at or below the poverty level were less likely to meet the sleep, ST, and all 3 guidelines compared with others (P < .01 for all). There were no other differences. CONCLUSION These results suggest future interventions should focus on reducing differences in movement, namely in sleep and ST.
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Affiliation(s)
- Chelsea L. Kracht
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
| | - E. Kipling Webster
- Louisiana State University’s School of Kinesiology, 112 Long Fieldhouse, Baton Rouge, LA, 70803
| | - Amanda E. Staiano
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
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31
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Diversity in pediatric behavioral sleep intervention studies. Sleep Med Rev 2019; 47:103-111. [DOI: 10.1016/j.smrv.2019.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022]
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32
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Park SH, Park CG, Bahorski JS, Cormier E. Factors influencing obesity among preschoolers: multilevel approach. Int Nurs Rev 2019; 66:346-355. [PMID: 31016729 DOI: 10.1111/inr.12513] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Childhood obesity is a complex and multifaceted problem involving interactions among child, family and community environment. AIM The purpose of this study was to examine the contributing factors to early childhood obesity within a multilevel context, including child and family, childcare setting and community. METHODS A cross-sectional, quantitative research design was employed. A total of 129 preschoolers and their parents in northwest Florida participated in this study. Child height and weight were measured, and body mass index (BMI) was calculated. Parents and directors of preschools completed survey questionnaires to assess child/family, childcare setting and community factors, respectively. Hierarchical multiple regression was used to evaluate the association of each level of factors with child BMI z-score. RESULTS Twenty-one per cent of children were overweight or obese (≥85th BMI percentile). In hierarchical multiple regression, household income, parent beliefs, attitudes and practices for child feeding, family obesogenic environment, child routines (screen time on weekends, sleep hours, bedtime) and physical activity environment were significantly related to child BMI z-score. CONCLUSIONS The findings of this study provide a broader understanding of factors that influence child BMI z-score. Shaping a non-obesogenic environment by establishing healthy routines for children in the home, childcare setting and community is essential in childhood obesity prevention. IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY Paediatric nurses should routinely assess accurate parental perception of child weight, feeding style and child routines in well-child care visits. Healthcare professionals and health policymakers should enact policies that build a healthy environment for preschoolers in their childcare setting and community.
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Affiliation(s)
- S H Park
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - C G Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - J S Bahorski
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - E Cormier
- College of Nursing, Florida State University, Tallahassee, FL, USA
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Smith JP, Hardy ST, Hale LE, Gazmararian JA. Racial disparities and sleep among preschool aged children: a systematic review. Sleep Health 2018; 5:49-57. [PMID: 30670165 DOI: 10.1016/j.sleh.2018.09.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/31/2018] [Accepted: 09/23/2018] [Indexed: 11/26/2022]
Abstract
Sleep disorders and sleep insufficiency are common among preschool-aged children. Studies among school-aged children show disordered sleep is often more prevalent among racial minority groups. The primary aim of this systematic review was to critically appraise empirical data to elucidate the relationship between race and key sleep variables among children aged 2 to 5 years old. By systematically searching PubMed, Web of Science, and EBSCO databases, we identified empirical research articles conducted in the United States that investigate this relationship. We searched for variables relevant to (1) insufficient sleep duration, (2) poor sleep quality, (3) irregular timing of sleep, including sleep/wake problems and irregular bedtime onset and wake times (4) and sleep/circadian disorders. Nine studies satisfied the criteria for inclusion: five investigated nocturnal sleep duration, five investigated bedtime-related variables, four investigated daytime sleep (napping), three investigated total sleep, two investigated sleep quality, and one investigated wake times. Four studies specifically addressed racial and demographic differences in sleep variables as the primary aim, while the remaining five contained analyses addressing racial and demographic differences in sleep as secondary aims. Non-Hispanic white, white, or European-American race was used as the reference category in all studies. The results provided consistent evidence that white, non-Hispanic children were more likely to go to bed earlier and more regularly, have longer nocturnal sleep, and nap less than most racial and ethnic minorities. Combined, this literature presents a compelling narrative implicating race as an important factor in sleep patterns among a preschool age population.
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Affiliation(s)
- Jonathan P Smith
- Department of Epidemiology, Emory University, Atlanta, GA, 30322.
| | - Shakia T Hardy
- Department of Epidemiology, Emory University, Atlanta, GA, 30322
| | - Lauren E Hale
- Department of Family, Population, and Preventative Medicine, Stony Brook University, Stony Brook, NY, 11794-8338
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34
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Hoyniak CP, Bates JE, Staples AD, Rudasill KM, Molfese DL, Molfese VJ. Child Sleep and Socioeconomic Context in the Development of Cognitive Abilities in Early Childhood. Child Dev 2018; 90:1718-1737. [PMID: 29484637 DOI: 10.1111/cdev.13042] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite a robust literature examining the association between sleep problems and cognitive abilities in childhood, little is known about this association in toddlerhood, a period of rapid cognitive development. The present study examined the association between various sleep problems, using actigraphy, and performance on a standardized test of cognitive abilities, longitudinally across three ages (30, 36, and 42 months) in a large sample of toddlers (N = 493). Results revealed a between-subject effect in which the children who had more delayed sleep schedules on average also showed poorer cognitive abilities on average but did not support a within-subjects effect. Results also showed that delayed sleep explains part of the association between family socioeconomic context and child cognitive abilities.
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Williamson AA, Rubens SL, Patrick KE, Moore M, Mindell JA. Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers. J Clin Sleep Med 2017; 13:1281-1288. [PMID: 28992828 DOI: 10.5664/jcsm.6798] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/25/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Community-based research indicates that Black preschoolers tend to have more bedtime difficulties and are at higher risk for obstructive sleep apnea (OSA) compared to White preschoolers. This study examined differences in sleep patterns and problems by race among a clinical sample of Black and White preschoolers at an outpatient sleep clinic. METHODS Data were collected from electronic medical records for 125 children ages 2-5 years (mean = 3.37 years, 64.0% White, 36.0% Black; 59.2% male) presenting at a pediatric sleep clinic in an academic medical center. Neighborhood income data were based on ZIP codes entered into the United States Census Bureau's American Fact Finder. RESULTS Black patients (51.1%) were significantly more likely than White patients (20.0%) to bed-share with a caregiver (χ2 = 12.99, P ≤ .001). There were no other significant differences in presenting sleep patterns (bed/wake times, sleep onset latency, naps, night awakenings, or sleep opportunity). Logistic regressions showed that White patients were more likely to present with difficulty falling/staying asleep and receive an insomnia diagnosis, and Black patients were more likely to present with OSA-related concerns and receive a diagnosis of suspected OSA, even when controlling for relevant sociodemographic covariates. CONCLUSIONS In contrast to community-based research, Black and White children showed similar sleep patterns. However, there were differences by race in referral questions and diagnoses. Findings suggest the need to consider caregiver perceptions and other sociocultural factors that may contribute to differential rates of presentation for sleep services, as well as potential health disparities in this regard.
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Affiliation(s)
- Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Melisa Moore
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jodi A Mindell
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Saint Joseph's University, Philadelphia, Pennsylvania
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Restrepo C, Manfredini D, Lobbezoo F. Sleep behaviors in children with different frequencies of parental-reported sleep bruxism. J Dent 2017; 66:83-90. [PMID: 28807776 DOI: 10.1016/j.jdent.2017.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/26/2017] [Accepted: 08/06/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Knowledge on the relationship between sleep bruxism (SB) and sleep behaviors in children is still fragmental, especially when socioeconomic factors are concerned. To assess sleep behaviors in children with different frequencies of proxy-reported SB. METHODS Parents of 1475 Colombian children, aged 9.8±1.6years, belonging to 3 different social layers, filled out a questionnaire on their childreńs sleep (Childreńs Sleep Habits Questionnaire [CSHQ]). Differences in sleep behaviors were assessed for the total sample and the three socioeconomic layers, using one-way ANOVA and Bonferroni post-hoc tests or Kruskal-Wallis and Dunn's post-hoc tests, based on the normality of outcome variables. RESULTS Most sleep patterns and daytime sleepiness were similar for children with different frequencies of proxy-reported SB, without differences among socioeconomic layers, whilst sleep disorders and parasomnias increased with the frequency of proxy-reported SB, independently on the socioeconomic layer (Bonferroni post-hoc<0.001). The association between sleep-related habits and the frequency of proxy-reported SB was different for each socioeconomic layer. CONCLUSION Among the various sleep behaviors under investigation, some sleep disorders and parasomnias seem to be associated with parental-reported SB in children. The influence of socioeconomic conditions on sleep behaviors seems not relevant. Based on these results, more specific studies on the association between different sleep behaviors are needed. CLINICAL SIGNIFICANCE Sleep behaviors, sociodemographic and socioeconomic features are correlated with SB in adults. However, in children, good evidence about this topic is lacking. This article give information to help clinicians evaluating sleep behaviors, sociodemographic and socioeconomic characteristics, when assessing sleep bruxism, based on evidence.
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Affiliation(s)
- Claudia Restrepo
- CES-LPH Research Group, Universidad CES, Calle 10 A No. 22-04, Medellín, Colombia.
| | - Daniele Manfredini
- School of Dentistry, Department of Neuroscience, University of Padova, Via 8 Febbraio 1848, 2, 35122, Padova, Italy
| | - Frank Lobbezoo
- Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
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Mindell JA, Sedmak R, Boyle JT, Butler R, Williamson AA. Sleep Well!: A Pilot Study of an Education Campaign to Improve Sleep of Socioeconomically Disadvantaged Children. J Clin Sleep Med 2016; 12:1593-1599. [PMID: 27655459 DOI: 10.5664/jcsm.6338] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Socioeconomically disadvantaged children are at risk for poor sleep hygiene and increased sleep problems. This pilot study examined the efficacy of Sleep Well!, a parent-based sleep education endeavor, which supplemented an outreach program that provides beds to socioeconomically disadvantaged children. METHODS In addition to receiving a bed, 152 children (mean age = 5.95 years, 57.2% boys) were randomly assigned to sleep education (3 messages: bedtime before 21:00; no caffeine; keep electronics out of the bedroom) or control (dental hygiene education) conditions. All education was provided at both the time of scheduling and delivery of a bed to each child. Parent-reported sleep data were collected at baseline and at 4-week follow-up. RESULTS Provision of a bed was associated with reduced bedroom electronics and increased parent-reported nighttime sleep duration for all children. However, relative to control children, intervention children showed even greater reductions in electronics (baseline mean = 1.91 items, follow-up mean = 0.85 items) and improvements in sleep duration (baseline mean = 9.75 hours, follow-up mean = 10.19 hours). There was no intervention effect for caffeine consumption or bedtime from baseline to follow-up. CONCLUSIONS Providing beds to socioeconomically disadvantaged children resulted in increased sleep duration and decreased use of electronics at bedtime, while the combination of a bed and brief parent sleep education conferred additional sleep benefits. Further study of brief child sleep interventions is warranted, particularly among socioeconomically disadvantaged children who are at risk for sleep problems.
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Affiliation(s)
- Jodi A Mindell
- Saint Joseph's University, Philadelphia, PA.,The Children's Hospital of Philadelphia, Philadelphia, PA
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