Nighttime Sleep Duration and Sleep Behaviors among Toddlers from Low-Income Families: Associations with Obesogenic Behaviors and Obesity and the Role of Parenting

Sleep Duration Is Associated with Household Food Insecurity and Sugar-Sweetened Beverage Intake Among Women, Infants and Children Participating Children Ages 0-5

PURPOSE

To determine associations between child and household characteristics and sleep duration among low-income children in Los Angeles County.

DESIGN

Cross-sectional study.

SETTING

Survey data collected in 2017 and 2020 in Los Angeles County, California.

SAMPLE

Special Supplemental Nutrition Program for Women, Infants and Children (WIC) households with children ages 4-60 months.

MEASURES

Sleep duration for children 4-60 months old (less than recommended (LTR), recommended range, more than recommended (MTR)), household food insecurity (HFI), sociodemographics, and daily servings of sugar-sweetened beverages (SSB).

ANALYSIS

Multinomial logistic regression, stratified by child age, was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between household/child characteristics and LTR or MTR sleep compared to recommended duration among WIC participating children 4-60 months old.

RESULTS

The final sample included 3512 children ages 4-23 months and 6035 children ages 24-60 months. In the study population, 32% (3-5 years old) to 44% (4-11months) of children under 5 did not meet the recommended hours of sleep per night. HFI was associated with higher odds of LTR (OR 1.27, CI 1.12-1.45) and MTR (OR 1.46, CI 1.15-1.87) sleep among 24-60 month-old children. Each additional daily SSB serving was associated with higher odds of LTR sleep (4-23 months: OR 1.10, CI 1.02-1.19; 24-59 months: OR 1.12, CI 1.08-1.17).

CONCLUSIONS

HFI and SSB intake are associated with not getting the recommended amount of sleep among low-income WIC participating children. Nutrition assistance program participants may benefit from receiving information about recommended sleep duration for young children and how to establish sleep routines to optimize sleep duration.

A tendency toward evening chronotype associates with less healthy diet among preschoolers: cross-sectional findings from the DAGIS study

Study Objectives

Evidence suggests that adolescents and adults with a later chronotype have poorer sleep habits and are more susceptible to unhealthy behaviors, but little is known about these associations in younger children. The objective of the study was to (1) identify and compare individual chronotype tendencies among preschool-aged children and (2) investigate associations of sleep dimensions and chronotype with diet.

Methods

Participants were 636 3-6 years old (mean ± SD age: 4.74 ± 0.89 years, 49% girls) preschoolers from the cross-sectional Increased Health and Well-Being in Preschoolers (DAGIS) study in Finland. Sleep duration, sleep variability (in duration and midpoint), social jetlag, and midsleep on weekends adjusted for sleep debt (MSWEadj) were measured with 7-day actigraphy. Morning, intermediate, and evening chronotype tendencies were defined based on the lowest and highest 10th percentile cutoffs of MSWEadj. Food, energy, and macronutrient intake were assessed from 3-day records. Associations between sleep dimensions and diet were assessed with regression models.

Results

MSWEadj was 1:13 ± 14 minutes for morning (n = 64), 2:25 ± 28 minutes for intermediate (n = 560), and 3:38 ± 15 minutes for evening (n = 64) chronotype tendency. Children with an evening chronotype tendency had greater social jetlag and sleep variability. Having an evening chronotype tendency was associated with higher added sugar, higher sugary food consumption, and lower vegetable consumption compared to intermediate tendency types. A later chronotype (MSWEadj) was associated with higher sugary food consumption, as well as lower vegetable and fiber intake. Sleep duration, social jetlag, and sleep variability were not associated with diet.

Conclusions

Several less healthy sleep and diet behaviors were observed among children with later chronotypes. Future public health interventions aimed towards children would benefit from taking into account chronotype.

Longitudinal sleep multi-trajectories from age 1 to 5.5 years and their early correlates: results from the Étude Longitudinale Française depuis l'Enfance birth cohort study

STUDY OBJECTIVES

To identify sleep multi-trajectories in children from age 1 to 5.5 years and their early correlates.

METHODS

We collected early family, maternal, and child characteristics, including children's nighttime sleep duration (NSD) and daytime sleep duration (DSD), night waking (NW), and sleep-onset difficulties (SOD), by parental phone interviews at age 2 months and 1-, 2-, 3.5-, and 5.5 years. Group-based multi-trajectory modeling identified sleep multi-trajectory groups. Multinomial logistic regression assessed associations with early factors.

RESULTS

We identified five distinct sleep multi-trajectory groups for NSD, DSD, NW, and SOD in 9273 included children. The "Good sleepers" (31.6%) and "Long sleepers" (31.0%) groups had low NW and SOD prevalence and shorter NSD but longer DSD in "Good sleepers" than in "Long sleepers." The "Good sleepers but few SOD" group (10.3%) had long NSD and DSD but a SOD peak at age 3.5 years; the "Improving NW and SOD" group (9.6%) showed short but rapidly increasing NSD to a plateau and high but decreasing NW and SOD; the "Persistent NW and SOD" group (17.5%) had persistent high NW and SOD. Maternal depression during pregnancy and sleep habits at age 1 (e.g. parental presence or feeding to fall asleep, sleeping at least part of the night away from own bed) were common risk factors associated with the most disordered sleep multi-trajectory groups.

CONCLUSIONS

We identified distinct sleep multi-trajectory groups and early life-associated factors in preschoolers. Most of the factors associated with the most sleep-disordered multi-trajectory groups are likely modifiable and provide clues for early prevention interventions.

Development and Psychometric Properties of the Sleep Parenting Scale for Infants

Although infants' sleep behaviors are shaped by their interactions with parents at bedtime, few tools exist to capture parents' sleep parenting practices. This study developed a Sleep Parenting Scale for Infants (SPS-I) and aimed to (1) explore and validate its factorial structure, (2) examine its measurement invariance across mothers and fathers, and (3) investigate its reliability and concurrent and convergent validity. SPS-I was developed via a combination of items modified from existing scales and the development of novel items. Participants included 188 mothers and 152 mother-father dyads resulting in 340 mothers and 152 fathers; about half were non-Hispanic white. Mothers and fathers completed a 14-item SPS-I for their 12-month-old infant. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore and validate SPS-I's underlying structure. Multigroup CFA was used to examine measurement invariance across mothers and fathers. Reliability was examined using Cronbach's alpha. Concurrent validity was assessed using linear regressions examining associations between SPS-I factors and parent-reported infants nighttime sleep duration. Convergent validity was assessed using paired-sample t-tests to test whether the SPS-I subscale scores were similar between mothers and fathers in the same household. EFA and CFA confirmed a 3-factor, 12-item model: sleep routines, sleep autonomy, and screen media in the sleep environment. SPS-I was invariant across mothers and fathers and was reliable. Concurrent and convergent validity were established. SPS-I has good psychometric properties, supporting its use for characterizing sleep routines, sleep autonomy, and screen media in the sleep environment by mothers and fathers.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2002799 .

Anemia in pregnancy and sleep of 6-month-old infants: A prospective cohort study

Objective

Anemia has been reported to adversely influence sleep in infants. However, the association between anemia in pregnancy and infant sleep remains unclear. We aimed to examine the association between maternal anemia in pregnancy and sleep parameters of 6-month-old infants.

Methods

We enrolled 2,410 mother-infant pairs between 2018 and 2021 in Hefei. Data on maternal hemoglobin concentration were collected at 24–28 gestational weeks from the electronic medical records of the hospitals. Nocturnal and daytime sleep duration, number of night awakenings, nocturnal wakefulness, and sleep latency of infants aged 6 months were measured using the Brief Infant Sleep Questionnaire with five items. A restricted cubic spline model was used to examine the relationship between maternal hemoglobin concentration and infant nocturnal sleep duration after adjusting for potential confounders.

Results

In our study, 807 (33.5%) mothers had anemia during pregnancy. Compared to infants born to mothers without anemia, infants born to mothers with anemia in pregnancy had shorter nocturnal sleep duration [mean (SD), 560.29 (79.57) mins vs. 574.27 (75.36) mins] at the age of 6 months. Subgroup analysis showed consistent significant differences in nocturnal sleep duration between infant born to anemic and non-anemic mothers, except in case of stratification by preterm birth [mean difference (mins), 2.03 (95% CI, −20.01, −24.07)] and pre-pregnancy obesity [mean difference (mins), −0.85 (95% CI, −16.86, −15.16)]. A J-shaped nonlinear correlation curve was observed between maternal hemoglobin concentration and infant nocturnal sleep duration. Compared with mothers without daily iron supplementation, mothers who had daily iron supplementation had higher hemoglobin concentrations [mean (SD), 112.39 (11.33) g/L vs. 110.66 (10.65) g/L] at delivery and their infants had longer nocturnal sleep duration [mean (SD), 565.99 (82.46) mins vs. 553.66 (76.03) mins].

Conclusion

Anemia in pregnancy may have an adverse influence on the sleep of 6-mon-old infants, and the relationship between maternal hemoglobin concentration and nocturnal sleep duration is nonlinear.

The timing and quality of sleep was associated with dietary quality and anthropometry in toddlers born preterm

AIM

The aim of the study was to examine prospective associations of sleep characteristics (duration, timing, quality) with dietary and anthropometric measures among toddlers born preterm (<35 weeks).

METHODS

Children participated in the Omega Tots trial at 10-17 months' corrected age (Ohio, USA; 26 April 2012 to 6 April 2017). Caregivers reported toddlers' sleep at baseline using the Brief Infant Sleep Questionnaire. After 180 days, caregivers reported toddlers' past month diet in a food frequency questionnaire, and anthropometry was measured using standardised protocols. The toddler diet quality index (TDQI: higher scores indicating better quality), and weight-for-length, triceps skinfold and subscapular skinfold z-scores were calculated. Linear and logistic regression assessed adjusted associations with dietary and anthropometric outcomes at 180-day follow-up (n = 284), and linear mixed models assessed changes in anthropometry.

RESULTS

Daytime sleep was associated with lower TDQI (β_adj per hour = -1.62 (95% CI: -2.71, -0.52)) whereas night-time sleep was associated with higher TDQI (β_adj  = 1.01 (95% CI: 0.16, 1.85)). Night-time awakenings and caregiver-reported sleep problems were also associated with lower TDQI. Night awakening duration and sleep-onset latency were associated with higher triceps skinfold z-score.

CONCLUSION

Daytime and night-time caregiver-reported sleep showed opposite associations with diet quality, suggesting that sleep timing may be important.

The association between sleeping behavior, obesity, psychological depression, and eating habits among adolescents in the emirate of Abu Dhabi–United Arab Emirates

Objective

The study aimed to investigate the association between sleeping behavior (specifically sleep duration), body mass index (BMI), eating habits, and psychological mood depression among adolescents in the Emirate of Abu Dhabi- UAE.

Methods and materials

A subsample of three hundred and ninety-five participants (209 females and 186 males) from middle and high schools (aged 12–18 years) in the emirate of Abu Dhabi completed the surveys in the presence of their parents and two research assistants. Measures of daytime sleepiness and other sleep parameters (sleep duration on weekdays and weekends), eating habits, and mood depression questionnaires were reported.

Results

Differences in BMI between males and females were statistically significant (26.12 ± 4.5 vs. 24.4 ± 4.3; p < 0.01). There was a negative linear association (p < 0.01) between the students’ BMI and the weekday/ weekend sleep duration. The average weekday and weekend sleep duration ranged from 5.7 hours (weekdays) to 9.3 hours(weekend). The study showed that an increase in BMI was correlated to mood depression (r = 0.396, p<0.01). In terms of eating habits, there was a significant association between eating unhealthy food and sleep duration; 72.6% of students who slept less than 6 hours reported unhealthy eating habits (p <0.05).

Conclusion

The study showed a clear association between short sleep duration and obesity among adolescents in the UAE. This relationship between sleep duration and obesity is less studied and less understandable. Future research about exploring how sleeping behaviors can affect obesity during adolescence can support understanding this association and create an effective intervention.

Play-Sleep Nexus in Indonesian Preschool Children before and during the COVID-19 Pandemic

The COVID-19 pandemic has transformed Indonesians' behaviors and has had an impact on many facets of daily life. People's lives are becoming increasingly dependent on digital technologies, which is a phenomenon with conflicting effects on people's health and happiness. This cross-sectional study focused on one such influence, namely, how the shift from the period before to during COVID-19 has affected children's playtime and sleep duration. As part of a multicenter study, 618 adult caregivers (parents, family members, or babysitters) who visited the kindergarten in question on behalf of preschool children aged 2-5 years (4.04 ± 1.39) were surveyed on the children's play and sleep habits before and during the COVID-19 pandemic in Indonesia, particularly Java Island (before pandemic, N = 309; during pandemic, N = 309). ANOVA was used for a statistical analysis to describe the difference between groups and within time collections. Significant favorable relationships were found between pre-pandemic and post-pandemic playtime and sleeping time on weekdays, weekends, and averaged weekday-weekend (r = 0.437; 0.180 and 0.321, all p < 0.05) were detected. Before the pandemic, children's playtime (4.11 vs. 3.55 h) and sleep duration (10.92 vs. 10.70 h) were significantly greater on the weekend than on the weekday (p < 0.05) but not during the pandemic (playtime: 3.48 vs. 3.45 h and sleep duration: 10.83 vs. 10.80 h; all p > 0.05). The COVID-19 pandemic had no impact on sleep duration or playtime in Javanese preschool children. Efforts should be intensified to promote the value of playtime and sleep duration among children in this age range so that the future of Indonesian children's can be ensured.

Measuring PROMIS® Physical Activity and Sleep Problems in Early Childhood

Objective

Physical activity (PA) and sleep are leading health indicators for individuals of all ages. Monitoring young children’s PA and sleep using psychometrically sound instruments could help facilitate timely interventions to promote healthy development. This article describes the development of the PROMIS® Early Childhood (EC) Parent Report Physical Activity (PA) and Sleep Problems (SP) measures for children aged 1–5 years.

Methods

Item pools were generated by interviewing parents, input from content experts, and literature review. Data from a U.S. general population sample were used to determine factor structures of item pools via factor analytic approaches, estimate item parameters via item response theory (IRT) models, and establish norms. Pearson correlations were used to evaluate across-domain associations. Analysis of variance was used and known-groups’ validity of PA and SP by comparing their scores to PROMIS EC Parent Report Global Health: child’s physical, emotional, and mental conditions.

Results

Initial item pools consisted of 19 and 26 items for PA and SP, respectively. Factor analyses’ results supported unidimensionality of 5 and 16 items measuring PA and SP, respectively, which were then calibrated using IRT. Norms were established by centering to a probability-based U.S. general population. Computerized adaptive testing algorithms were established. Some analyses supported initial measure validity.

Conclusions

The PROMIS EC PA calibrated scale and SP item banks are user-friendly and brief, yet produce precise scores. Both measures enable psychometrically sound assessment of PA behavior and sleep problems. Future studies to comprehensively evaluate the validity of these two measures are warranted.

Correlates of a caregiver-reported child sleep problem and variation by community disadvantage

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.

Development of a classifier to screen for severe sleep disorders in children

This study aimed to develop an automatic classifier for the identification of severe sleep disorders that require immediate intervention in children. Our study assessed 7,008 children (age: 0-83 months) in Japan, whose parents and nursery teachers recorded their 14-day sleep patterns. Sleep quality was assessed by pediatricians and scored as 1 (no severe sleep disorder) or 0 (severe sleep disorder). Discriminant analysis was performed for each age group using sleep quality (0 or 1) as the dependent variable and variables in the 14-day sleep log as independent variables. A stepwise method was used to select the independent variables to build the best model. The accuracy of the discriminant analysis for the age groups ranged from 71.3 to 97.3%. In summary, we developed an automatic classifier with sufficient application value to screen for severe sleep disorders in children. In the future, this classifier can be used to rapidly determine the presence or absence of severe sleep disorders in children based on their 14-day sleep logs, thus allowing immediate intervention.

A Systematic Review of the Relationships Between Physical Activity and Sleep in Early Childhood

The aim of this systematic review was to examine the associations between physical activity and sleep in children aged less than 6 years. Articles were included if participants were primarily aged less than 6 years and study designs were observational or experimental. Study characteristics were extracted, and the Grading Recommendations Assessment, Development and Evaluation framework was used to assess study quality. Thirty-six studies (16 sleep, 16 physical activity, and three fitness outcomes) from 18 countries reported in 29 articles were included. The majority of sleep and physical activity outcome studies reported mixed effects with very low to low quality of evidence. Fitness outcome studies were limited, and therefore, evidence was insufficient. The high prevalence of mixed and null results could be related to study limitations. Importantly, this review points to the critical need for higher quality studies of sleep and physical activity in young children, which would support health recommendations and intervention strategies for healthier child development.

Insufficient sleep during infancy is correlated with excessive weight gain in childhood: a longitudinal twin cohort study

STUDY OBJECTIVES

To examine total sleep duration in infancy and the associations of insufficient sleep duration with later weight gain and the risk of overweight in a longitudinal twin cohort study.

METHODS

The data for this study are from the Longitudinal Twin Study (LoTiS), a twin-pregnancy birth cohort study that was carried out in China (n = 186 pairs). The sleep data were collected at 6 months using the Brief Infant Sleep Questionnaire that was completed by parents with the assistance of a research assistant. Anthropometric data were obtained from the children's health clinic records at 6, 12, 18, and 24 months.

RESULTS

There were no significant differences between infants with insufficient sleep and those with sufficient sleep in terms of height, weight, body mass index, incidence of overweight, and body fat mass, while infants with insufficient sleep duration were predisposed to gain excessive weight from 6 to 12 and 6 to 18 months of age (all P < .05). After adjusting for confounding variables, insufficient sleep duration was found to be correlated with excessive weight gain from 6 to 18 months of age (odds ratio: 3.47; 95% confidence interval, 1.23-9.78). The relationship was more pronounced in monozygotic twins than in dizygotic twins.

CONCLUSIONS

Insufficient total sleep duration at the age of 6 months is correlated with the risk of excessive weight gain at 18 months of age in twins, particularly in monozygotic twins.

CLINICAL TRIAL REGISTRATION

Registry: Chinese Clinical Trial Register; Name: Unraveling the complex interplay between genes and environment in specifying early life determinants of illness in infancy: a longitudinal prenatal study of Chinese Twins. URL: http://www.chictr.org.cn/showproj.aspx?proj=13839; Identifier: ChiCTR-OOC-16008203.

CITATION

Yu J, Jin H, Wen L, et al. Insufficient sleep during infancy is correlated with excessive weight gain in childhood: a longitudinal twin cohort study. J Clin Sleep Med. 2021;17(11):2147-2154.

Sleep duration, physical activity, and caloric intake are related to weight status in Mexican American children: a longitudinal analysis

BACKGROUND

Obesity is a serious issue, spanning all ages, and, in the U.S., disproportionately affects Latinos and African Americans. Understanding sleep, physical activity and dietary behaviors that may predict childhood obesity can help identify behavioral intervention targets.

METHODS

Data were drawn from a U.S. cohort study of 323 Mexican American 8-10-year-old children and their mothers, who participated in a longitudinal study over a 2-year period. Measures were collected at baseline (BL; child mean age = 8.87, SD = 0.83), year 1 (FU1) and year 2 (FU2). Mothers reported on household income and acculturation at BL. Child height and weight were collected and BMI z-scores (BMIz) were calculated for weight status at BL, FU1, and FU2. Accelerometer-estimated sleep duration (hours) and moderate-to-vigorous physical activity (MVPA; minutes) were collected across 3 days at BL, FU1, and FU2. Two 24-h dietary recalls were performed at each time point; from these, average energy intake (EI, kcals/day) was estimated. Cross-lagged panel analysis was used to examine behavioral predictors on BMIz at each time point and across time.

RESULTS

At BL and FU1, longer sleep duration (β = - 0.22, p < 0.001; β = - 0.17, p < 0.05, respectively) and greater MVPA (β = - 0.13, p < 0.05; β = - 0.20, p < 0.01, respectively) were concurrently related to lower BMIz. At FU2, longer sleep duration (β = - 0.18, p < 0.01) was concurrently related to lower BMIz, whereas greater EI (β = 0.16, p < 0.01) was related to higher BMIz. Longer sleep duration at BL predicted lower BMIz at FU1 (β = - 0.05, p < 0.01).

CONCLUSIONS

Longer sleep duration was concurrently related to lower weight status at each time point from ages 8-10 to 10-12. Higher MVPA was concurrently related to lower weight status in earlier childhood (ages 8-10 and 9-11) and higher EI was concurrently related to higher weight status toward the end of childhood (ages 10-12 years). Furthermore, longer sleep in earlier childhood was protective of children's lower weight status 1 year later. These findings suggest that sleep duration plays a consistent and protective role against childhood obesity; in addition, MVPA and healthy EI remain important independent factors for obtaining a healthy weight.

Correlates of Sleep Duration in Early Childhood: A Systematic Review

OBJECTIVE

This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age.

METHODS

Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework.

RESULTS

One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time.

CONCLUSIONS

Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.

Weight Management Outcomes of Youth with Autism Spectrum Disorder Seeking Treatment from a Multidisciplinary Team

Youth with Autism Spectrum Disorder (ASD) are at an increased risk for developing obesity when compared to their typically developing peers. Given higher prevalence of obesity in youth with ASD, understanding factors relating to success in obesity treatment provides insight into implementing efficacious treatments for youth. The current study examines age, sleep, and metabolic factors potentially affecting success in 74 youth (M_age = 11.66) attending a multidisciplinary weight management treatment program over a year. Multilevel modeling indicated that higher baseline BMI class category, medications at baseline, and absence of sleep difficulties predicted greater reduction in BMI after a year of treatment.

Association between Home Environment in Infancy and Child Movement Behaviors

Introduction: An adequate balance of movement behaviors, including physical activity (PA), sleep, and screen time, is important for preventing excess weight gain in children. This study examined the relationship between the infant home environment and movement behaviors later in life. Methods: Pregnant women were recruited for a cohort study related to maternal and child development. The home environment was assessed for developmental stimulation, organization, and toys by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) questionnaire when the child was 6 months of age. At 2 years of age, mother-reported child screen time, and child PA and sleep duration were estimated by accelerometry. Child behaviors were compared with the 24-hour Movement Guidelines (≥180 minutes/day of total PA, 11-14 hours/day of sleep, and ≤1 hour/day of screen time). Logistic regression was used to assess the relationship between the home environment and movement behaviors, adjusting for maternal and child covariates. Results: Mother/child dyads (n = 141) were mainly white (84.4%), and middle (32.8%) or low income (48.9%). All children (100%) met the PA guideline, some met the sleep guideline (71.6%), fewer met the screen-time guideline (44.7%), and only one-third (34.0%) met all three guidelines. Children who met the screen-time guideline lived in homes with more developmental stimulation and toys (p < 0.05). Children who met all 3 guidelines lived in homes with more organization and toys (p < 0.05). Conclusion: The infant home environment was associated with appropriate amounts of movement behaviors at 2 years. Promoting organization (i.e., routines) and toys in infancy may help facilitate nonscreen-based habits and healthy development. The clinical trial registration number is NCT01131117.

The contributory role of the family context in early childhood sleep health: A systematic review

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.

Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families

BACKGROUND

Habits surrounding health behaviors (i.e., sleep, physical activity, diet) are developed in toddlerhood. Lack of consistent health habits may increase obesity risk among toddlers in low-income families.

PURPOSE

To compare the role of sleep onset consistency, physical activity and diet quality as mediators between household poverty and toddler weight.

METHODS

Two hundred and seven toddlers (mean age = 20.2 months, 46% female, 68.1% Black) participating in an obesity prevention trial were assessed at three time points over 12 months. Using Actical accelerometers, we assessed sleep and physical activity at each time point for up to 1 week. We defined sleep onset consistency as the standard deviation of sleep onset across all days. We calculated the Healthy Eating Index-2015 from a 24-hr dietary recall. We used WHO standards to calculate BMI-for-age z-scores from toddlers' weight/length, and calculated poverty ratio from parent-reported income and family size. Multilevel mediation models tested toddler sleep onset consistency, physical activity, and diet quality as mediators between household poverty and toddler BMI z-score.

RESULTS

Toddlers from households with higher poverty ratios had more inconsistent sleep onset times. Toddlers with more inconsistent sleep onset times had higher BMI z-scores across all timepoints, even when accounting for physical activity and diet quality. Sleep onset consistency indirectly explained the association between household poverty and BMI z-score.

CONCLUSIONS

Inconsistent sleep schedules could help explain the association between poverty and BMI. Future research should examine strategies to support low-income families to develop and maintain routines as a mechanism to prevent obesity and reduce disparities.

TRIAL REGISTRATION NUMBER

NCT02615158.

Cross-Sectional Associations of 24-Hour Sedentary Time, Physical Activity, and Sleep Duration Compositions with Sleep Quality and Habits in Preschoolers

Although some studies indicate physical activity and sleep quality are positively associated in children, most reports examined physical activity independent of other 24-h behaviors and focused on older children. The aim of this cross-sectional study was to examine the predicted changes in sleep efficiency and habits when reallocating time between movement behaviors using compositional isotemporal substitution in preschool-aged children. Accelerometers were worn by 288 participants (51.6 ± 9.5 months) for up to 16 days. Sleep outcomes included sleep efficiency, nap frequency, sleep disturbances, and bedtime resistance. Compositional isotemporal substitution analyses demonstrated that the combined effect of 24-h movement behaviors was associated with sleep efficiency (p < 0.001) and nap frequency (p < 0.003). When sleep increased by 30 min at the expense of stationary time or light physical activity, estimates of sleep efficiency and bedtime resistance decreased while nap frequency increased. When stationary time increased by 30 min from moderate to vigorous physical activity, estimated sleep efficiency increased and sleep disturbances decreased. Although this study presents preliminary evidence that 24-h movement behavior compositions in early childhood are associated with sleep quality and nap frequency, estimated effects from theoretical time reallocations across sleep outcomes were mixed.

Body Mass Index, Physical Activity, Sedentary Behavior, Sleep, and Gross Motor Skill Proficiency in Preschool Children From a Low- to Middle-Income Urban Setting

BACKGROUND

Limited research reports on the relationship between body mass index (BMI) and physical activity (PA), sedentary behavior (SB), sleep, and gross motor skills (GMS) in low- and middle-income countries. The aim of this study was to (1) describe BMI, PA, SB, sleep duration, and GMS proficiency in South African preschool children and (2) identify relationships between variables.

METHODS

BMI, including z scores for height, weight, and BMI were determined. Seven-day PA, SB, and sleep were measured using accelerometry. GMS were assessed using the Test of Gross Motor Development (second edition). Associations were explored by comparing sleep, PA, SB, and GMS between BMI tertiles using the Kruskal-Wallis test.

RESULTS

Most (86%) children (n = 78, 50% boys) had a healthy BMI (15.7 [1.3] kg/m2). Children spent 560.5 (52.9) minutes per day in light- to vigorous-intensity PA and 90.9 (30.0) minutes per day in moderate- to vigorous-intensity PA; most (83%) met the current PA guideline. Nocturnal sleep duration was low (9.28 [0.80] h/d). Although daytime naps increased 24-hour sleep duration (10.17 [0.71] h/d), 38% were classified as short sleepers. Around half (54.9%) of participants complied with both PA and sleep guidelines. No associations between variables were found.

CONCLUSION

Despite being lean, sufficiently active, and having adequate GMS, many children were short sleepers, highlighting a possible area for intervention.

Sleep health in young children living with socioeconomic adversity

Racially and ethnically diverse young children who live with socioeconomic adversity are at high risk for sleep deficiency, but few behavioral sleep interventions (BSIs) are tailored to their needs. To support the future development of a feasible, acceptable, and culturally relevant sleep intervention, we conducted a community-engaged, mixed-methods study with 40 low-income, racially, and ethnically diverse parents to describe sleep characteristics, sleep habits, and parental sleep knowledge of their 6-36-month-old children and to examine the associations between children's sleep characteristics and sleep habits. This report presents quantitative data from this mixed-methods study. We measured objective (actigraphy) and parent-reported sleep (Brief Infant Sleep Questionnaire) characteristics, sleep habits at bedtime, sleep onset, and during night awakenings, parental sleep knowledge, psychological function (Brief Symptom Inventory), and parenting stress (Parenting Stress Index). Children had low sleep duration (537.2 ± 54.7 nighttime and 111.2 ± 29.8 nap minutes), late bedtimes (22:36 ± 1.5 hr), and high bedtime variability (mean squared successive difference = 3.68 ± 4.31 hr) based on actigraphy. Parental knowledge about sleep recommendations was limited. Sleep habits before bedtime, at sleep onset, and during night awakenings were varied. Sixty-five percent of parents reported co-sleeping. Feeding near bedtime or during the night was associated with later bedtimes, more fragmented sleep, and increased bedtime variability. These findings suggest the need for BSIs to support earlier bedtimes and improve sleep duration and continuity by addressing modifiable behaviors. Tailored BSIs that consider socioecological influences on the development of sleep habits are needed.

Featured Article: Bidirectional Effects of Sleep and Sedentary Behavior Among Toddlers: A Dynamic Multilevel Modeling Approach

OBJECTIVE

To examine the bidirectional effects of objectively measured nighttime sleep and sedentary activity among toddlers.

METHOD

Actical accelerometer data were analyzed for 195 toddlers participating in an obesity prevention trial (mean age = 27 months). Toddlers wore the accelerometers for up to 7 consecutive days. Nighttime sleep was defined as the number of minutes asleep between the hours of 8 pm and 8 am the following morning. Sedentary behavior (in minutes) was defined using previously established Actical cut points for toddlers. Variables were lagged and parsed into latent within- and between-person components, using dynamic structural equation modeling (DSEM).

RESULTS

Toddlers spent an average of 172 min (∼3 hr) in sedentary activity and slept an average of 460 min (∼8 hr) per night. An autoregressive cross-lagged multilevel model revealed significant autoregression for both sleep and sedentary activity. Cross-lagged values revealed that decreased sleep predicted increased next-day sedentary activity, and sedentary activity predicted that night's sleep. For 89% of the sample, the within-person standardized cross-lagged effects of sleep on sedentary were larger than the cross-lagged effects of sedentary on sleep.

CONCLUSIONS

Results suggest that, on average, nighttime sleep is a stronger predictor of subsequent sedentary behavior (compared with the reverse), and this is the case for the majority of toddlers. Findings highlight the importance of interindividual associations between sleep and sedentary activity. The present study is an example of how DSEM methods can be used to ask questions about Granger-causal cross-lagged relations between variables, both within and between individuals.

Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis

Sleep is crucial to children's health and development. Reduced physical activity and increased screen time adversely impact older children's sleep, but little is known about these associations in children under 5 y. This systematic review examined the association between screen time/movement behaviors (sedentary behavior, physical activity) and sleep outcomes in infants (0-1 y); toddlers (1-2 y); and preschoolers (3-4 y). Evidence was selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and synthesized using vote counting based on the direction of association. Quality assessment and a Grading of Recommendations, Assessment, Development and Evaluation was performed, stratified according to child age, exposure and outcome measure. Thirty-one papers were included. Results indicate that screen time is associated with poorer sleep outcomes in infants, toddlers and preschoolers. Meta-analysis confirmed these unfavorable associations in infants and toddlers but not preschoolers. For movement behaviors results were mixed, though physical activity and outdoor play in particular were favorably associated with most sleep outcomes in toddlers and preschoolers. Overall, quality of evidence was very low, with strongest evidence for daily/evening screen time use in toddlers and preschoolers. Although high-quality experimental evidence is required, our findings should prompt parents, clinicians and educators to encourage sleep-promoting behaviors (e.g., less evening screen time) in the under 5s.

Sleep and Physical Activity Patterns in Urban American Indian Children

Objectives: In this study, we examined patterns of obesity, physical activity (PA), sleep, and screen time in urban American Indian (AI) youth in the 6th-8th grade. Methods: A youth sample (N = 36) from 3 middle schools was recruited to participate in this observational sample of convenience. Youth completed a demographic and screen time survey, measurements of height and weight, and wore a wrist accelerometer continuously for 7 days to assess PA and sleep. Results: Approximately 42% of participants were overweight or obese. Average weekday screen time was 254.7±98.1 minutes. Compared to weekdays, weekend sedentary activity increased (weekday, 159.2±81.1 minutes vs weekend, 204.3±91.7 minutes; p = .03) and vigorous PA (weekday, 20.9±19.1 minutes vs weekend, 5.7±8.1 minutes; p = .0001) and moderate-to-vigorous PA (weekday, 192.65±62.3 minutes vs weekend, 141±71.7 minutes; p = .002) decreased. Compared to weekdays, weekend total sleep time (weekday, 512.8±48.6 minutes vs weekend, 555.3±84.3 minutes; p = .007) and time in bed (weekday, 487.3±49.6 minutes vs weekend, 528.6±71.2 minutes; p = .01) increased. Conclusions: Weekday to weekend shifts in PA and sleep must be considered when designing targeted obesity prevention interventions.

Material Hardships and Infant and Toddler Sleep Duration in Low-Income Hispanic Families

OBJECTIVE

To assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families.

METHODS

We analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, and multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (eg, later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association.

RESULTS

In infants, financial difficulty and multiple hardships were associated with decreased night sleep (B = -0.59 hours, 95% confidence interval [CI]: -1.04, -0.14; and B = -0.54 hours, 95% CI: -1.00, -0.08). Housing disrepair was associated with decreased 24-hour sleep (B = -0.64 hours, 95% CI: -1.29, -0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B = -0.19 hours, 95% CI: -0.29, -0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (P < .001), with greater increases for those with food insecurity or multiple hardships.

CONCLUSION

Specific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices.

Sleep duration associates with moderate-to-vigorous intensity physical activity and body fat in 1- to 3-year-old children

Sleep during early childhood is important for many developmental outcomes and shows promise as an important correlate of both obesity risk and physical activity behaviors. This was a cross-sectional study concerning the relationships between sleep and moderate- to - vigorous intensity physical activity and body fat percentage in a sample of 1- to 3-year-old children (N = 50; ages 27.512 ± 10.363 months). Sleep was measured with a caregiver questionnaire. Sedentary time, light, moderate, vigorous, and moderate- to - vigorous intensity physical activity were measured with Actigraph wT3x-BT accelerometers. Body fat was measured using Air Displacement Plethysmography with the BodPod Pediatric Option. Moderate- to - vigorous intensity physical activity and body fat percentage both associated with sleep duration, controlling for age and accelerometer wear time. These factors combined explained 54.3 % of the variance in sleep duration present in the sample. These results suggest the presence of relationships between sleep and physical activity and body composition constructs in this sample. Sleep may be an important variable in efforts to both promote early childhood physical activity and healthy body composition.

Sleep duration and bedtime in preschool-age children with obesity: Relation to BMI and diet following a weight management intervention

BACKGROUND

Sleep duration is associated with obesity in preschoolers. Weight-management interventions may be an opportunity to incorporate sleep health recommendations.

OBJECTIVES

To examine changes in sleep in preschool-age children with obesity following a family-based weight-management intervention (Learning about Activity and Understanding Nutrition for Child Health [LAUNCH]) compared with motivational interviewing and standard care conditions. Additionally, we examined associations between sleep with body mass index (BMI) z score (BMIz) and diet.

METHODS

One hundred fifty-one children (4.6 ± 0.93 y) completed baseline (pretreatment) and posttreatment (week 24) assessments, including anthropometrics, 24-hour dietary recalls, and a 7-day sleep diary. Analysis of variance (ANOVA) and chi-squared tests compared sleep variables between groups; linear regression models examined effects of sleep on BMIz and dietary intake at posttreatment, controlling for baseline values.

RESULTS

Bedtime and sleep duration were not significantly different between treatment groups from baseline to posttreatment. After adjusting for baseline sleep, earlier bedtime was associated with lower BMIz (95% CI, 0.00-0.04; .03), intake of added sugars (95% CI, 0.70-4.32; .007), and sweet/dessert food servings (95% CI, 0.00-0.19; .04) at posttreatment. Longer night-time sleep duration was associated with fewer added sugars at posttreatment, adjusting for baseline sleep (95% CI, -3.79 to -0.35; .02).

CONCLUSIONS

More comprehensive sleep intervention incorporated into weight-management intervention may be necessary to promote positive changes for preschoolers with obesity. A focus on earlier bedtime and longer sleep duration appears to be important given associations between sleep duration and bedtime with BMIz and dietary intake.

The cross-sectional and prospective associations between sleep characteristics and adiposity in toddlers: Results from the GET UP! Study

BACKGROUND

The associations between sleep characteristics and adiposity in children under three years are not fully understood yet.

OBJECTIVE

The objective of the study is to examine the cross-sectional and prospective associations between sleep characteristics and adiposity in toddlers over a 12-month period.

METHODS

Participants were 202 toddlers from the GET-UP!

STUDY

Sleep duration, sleep timing, and sleep variability were assessed using 24-hour accelerometry for seven consecutive days. Height and weight were measured, and BMI z scores were calculated. Linear mixed models were performed to examine the cross-sectional and prospective associations between sleep characteristics and adiposity, with adjustments for clustering effects and demographic factors.

RESULTS

Total sleep duration was negatively associated with higher adiposity cross-sectionally (B = -0.12; 95% CI: -0.23, -0.01; .033) but not prospectively (B = 0.01; 95% CI: -0.13, 0.10; .843). Nap duration was prospectively associated with higher levels of adiposity (B = 0.41; 95% CI: 0.14, 0.68; .003). Sleep variability and sleep timing were not associated with concurrent or subsequent adiposity.

CONCLUSION

Although sleep duration is an important factor associated with obesity in toddlerhood, the potential effects of different types of sleep duration may vary. While longer total sleep duration may protect children from increasing adiposity, longer nap duration seems to be risk factor. As evidence in this age group is scarce, more research is needed to confirm this finding.

Associations of Infant Sleep Duration with Body Composition and Cardiovascular Health to Mid-Adolescence: The PEAS Kids Growth Study

Background: Short sleep duration in childhood has often been linked with obesity in later childhood or adolescence. However, whether infant sleep duration affects body composition trajectories and cardiovascular health through to mid-adolescence remains unknown. Methods: Participants were 336 adolescents from a community-based prospective birth cohort in Melbourne, Australia. Mothers completed 24-hour time diaries, including infant sleep in 5-minute intervals at ages 2, 4, and 12 months. BMI and body composition outcomes were measured 6-monthly between 4 and 6.5 years and at 10 and 14 years. Cardiovascular outcomes at 14 years comprised blood pressure, pulse wave velocity, retinal arteriole-to-venule ratio, and carotid intima-media thickness. We used multivariable linear regression and multinomial logistic regression analyses adjusted for sex, age, BMI at birth, gestational age, ethnicity, maternal education, maternal BMI, and neighborhood socioeconomic position. Results: At 2 months, infants slept on average 14.1 hours [standard deviation (SD) 1.9], decreasing to 13.4 hours (SD 2.0) by 12 months. We observed no associations between the different sleep duration time points in infancy and later BMI or body composition. Moreover, a shorter sleep duration did not increase the odds of being on a high body composition trajectory compared with longer sleep (e.g., odds ratio per hour of sleep at 4 months is 0.85, 95% confidence interval 0.65-1.11). Infant sleep duration was also not associated with cardiovascular function or large or small artery structure at 14 years of age. Conclusions: We found no evidence that sleep duration very early in life affects adolescent body composition or cardiovascular health.

The Combined Impact of Sleep and Diet on Adiposity in Infants, Toddlers, and Young Children: A Systematic Review

OBJECTIVE

Short sleep duration and poor dietary habits may contribute to increased adiposity; however, the impact of the interaction between these variables on adiposity is less understood. To evaluate research investigating the combined effects of sleep and diet on adiposity in infants, toddlers, and young children.

METHODS

Systematic searches of electronic databases (PubMed, CINAHL, and Web of Science) from inception through April 2017 were conducted. All studies published in English that had at least 1 sleep (e.g., sleep duration and night awakenings), diet (e.g., 24-hour diet recall and breastfeeding duration), and adiposity (e.g., body mass index z-score and weight-for-length) measure were eligible for inclusion. Abstract and full-text article reviews were conducted by 2 independent reviewers. Data were extracted into a standardized spreadsheet.

RESULTS

Of the 17 full-text articles reviewed, 14 studies were included. Mediation (n = 2) and moderation (n = 2) were seldom used. Investigation of the combined effects of sleep and diet on adiposity demonstrated a substantial lack of evidence. Synthesis of articles suggests that the relationship between sleep and diet may be interactive and their effects additive in their impact when targeted simultaneously within interventions.

CONCLUSION

Without consideration of interaction effects among variables of interest, a substantial gap in the literature persists. Both diet and sleep need to be assessed simultaneously and repetitively in future longitudinal research.

Associations between Sleep and Dietary Patterns among Low-Income Children Attending Preschool

BACKGROUND

Sleep disturbances and low-quality diets are prevalent among children in low-income settings, yet the nature of their relationship remains unclear. In particular, whether aspects other than sleep duration, including timing and quality, are associated with dietary patterns has rarely been examined, especially among preschool-aged children.

OBJECTIVE

To evaluate whether nightly and total sleep duration, sleep timing, differences in timing and duration from weekdays to weekends, and sleep quality were related to dietary patterns.

DESIGN

A cross-sectional analysis of children attending preschool. Parents completed questionnaires about children's sleep habits as well as a semiquantitative food frequency questionnaire.

PARTICIPANTS/SETTING

Three hundred fifty-four English-speaking children (49.9% boys) with no serious medical conditions aged 3 to 5 years who were enrolled in Head Start in Michigan (2009-2011) with complete information on sleep and diet.

MAIN OUTCOME MEASURES

Dietary pattern scores derived from food frequency questionnaire.

STATISTICAL ANALYSES PERFORMED

Principal component analysis was used to identify dietary patterns. Separate linear regression models with dietary pattern scores as the dependent variable and continuous sleep measures as independent variables were used to evaluate associations between sleep and diet, adjusting for sex, age, parent education level, and sleep hygiene.

RESULTS

Three dietary patterns were identified: Vegetables, Healthy Proteins, and Sides; Breads and Spreads; and Processed and Fried. Longer average weekend sleep duration and a greater difference in weekend-to-weekday sleep duration was related to lower Vegetables, Healthy Proteins, and Sides pattern scores. Later sleep midpoint during weekdays was related to lower Vegetables, Healthy Proteins, and Sides pattern scores, whereas later sleep midpoint on the weekend was associated with higher Processed and Fried pattern scores. Similarly, a larger weekend-weekday midpoint difference was associated with higher Processed and Fried pattern scores.

CONCLUSIONS

Later sleep timing and differences in sleep duration and timing from weekends to weekdays were related to less-optimal dietary pattern scores in young children.

Longer sleep duration during infancy and toddlerhood predicts weight normalization among high birth weight infants

Study Objectives

High birth weight (HBW; ≥ 4000 g) is strongly associated with later overweight, yet little is known about how to disrupt this trajectory. The current study examined sleep practices during infancy and toddlerhood among children born HBW or normal birth weight (NBW; 2500-3999 g).

Methods

Latent growth curve models were used to examine sleep during infancy and toddlerhood among 270 mother-child dyads enrolled in the Health Outcomes and Measures of the Environment Study. Total sleep duration in 24 hr, sleep maintenance, and restlessness/vocalizations were collected at 6 month intervals between ages 6 and 24 months. Height and weight were obtained at ages 24 or 36 months, and normal and overweight BMI were derived. Sleep was examined among children with a normal BMI during the preschool years who were either HBW (HBW-Normal, n = 36) or NBW (NBW-Normal, n = 184) compared with overweight preschoolers (Overweight, n = 50). It was predicted that the Overweight group would have poorer sleep across infancy and toddlerhood compared with HBW-Normal and NBW-Normal.

Results

HBW-Normal had the longest and Overweight had the shortest mean 24 hr sleep duration across all time points with NBW-Normal falling in-between the two groups. Compared with Overweight, HBW-Normal exhibited longer 24 hr sleep duration at age 6 months with this group difference maintained over infancy and toddlerhood. No group difference was found for NBW-Normal.

Conclusions

A longer sleep duration in the first several years of life is associated with development of normal BMI among HBW children. These findings suggest that longer sleep duration may protect HBW children from becoming overweight.

Sleep duration and quality are associated with eating behavior in low-income toddlers

OBJECTIVE

The present study examined whether different sleep health parameters (duration, timing, and quality) are associated with obesity-related eating behaviors including emotional overeating, food responsiveness, enjoyment of food, satiety responsiveness, and eating in the absence of hunger (EAH), during toddlerhood.

DESIGN

Among 134 low-income 33-month-old children, parents reported on child sleep parameters, including sleep quality (Children's Sleep Wake Scale; CSWS) and usual bedtimes and wake times on weekdays and weekends (weeknight sleep duration, weekday-to-weekend bedtime delay). Child eating behaviors were assessed using both observed and parent-report measures. Child Emotional Overeating, Food Responsiveness, Enjoyment of Food, and Satiety Responsiveness were measured by parent report using the Child Eating Behavior Questionnaire-Toddler. Observed child EAH was evaluated by measuring kilocalories of palatable foods consumed following a meal. Multivariable linear regression was used to examine the associations between sleep parameters and eating behaviors.

RESULTS

Poorer child sleep quality was associated with greater Emotional Overeating (standardized β = -0.20 (SE 0.09), p < .05) and greater Food Responsiveness (β = -0.18 (SE 0.09), p < .05). Shorter child nighttime sleep duration was associated with greater EAH kcal consumed (standardized β = -0.22 (SE 0.09), p < .05). Child bedtime delay was not associated with any of the eating behaviors, and no child sleep variables were associated with either Enjoyment of Food or Satiety Responsiveness.

CONCLUSIONS

Shorter nocturnal sleep duration and poorer sleep quality during toddlerhood were associated with some, but not all, of the obesity-related eating behaviors. Poor sleep health may promote childhood obesity risk through different eating behavior pathways. As children growing up in poverty may experience greater sleep decrements, sleep duration and sleep quality may be important targets for intervention among low-income families with young children.

Sleep matters: The association of race, bedtime, outdoor time, and physical activity with preschoolers' sleep

Sleep is necessary for optimal functioning. Little is known about the extent to which race and opportunities to be active influence sleep in preschool-aged children attending full-day child care. Participants (n = 359) in this cross-sectional study attended 30 randomly selected, childcare centers in Cincinnati, OH. Data collection occurred from November 2009 to January 2011. Hierarchical linear regression and generalized estimating equations tested for associations between nighttime sleep duration and race, outdoor/indoor active time, actual physical activity (PA), screen time, daytime nap, and bedtime after 9 pm. Participants slept a mean ± SD of 1.5 ± 0.8 h at childcare and 9.7 ± 1.0 h at bedtime. White children (β = 0.57 ± 0.14, p < 0.01) and children identifying as Other race (β = 0.40 ± 0.15, p < 0.01) slept more hours than Black children at nighttime. White children were less likely to nap at childcare than Black children. Inside PA time provided was associated with increased nighttime sleep duration (β = 0.092 ± 0.04 h per 30 min PA, p < 0.03). There was no association between outdoor time or moderate to vigorous PA and nighttime sleep. Black children slept less at night on average, but were more likely to engage in nap sleep at childcare resulting in similar overall sleep duration. Additional studies in diverse populations that explore the effects of nighttime versus nap time sleep on child health and well-being are needed.

Correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in toddlers: results from the GET UP! Study

OBJECTIVE

To explore the correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in a sample of Australian toddlers.

METHODS

Participants were 173 toddlers (average age 19.7 ± 4.1 months) from the GET UP!

STUDY

Nocturnal sleep duration, nocturnal sleep variability, nap(s) and physical activity were measured using 24-h accelerometry (Actigraph GT3X+) over seven consecutive days. Nocturnal sleep problems were assessed using the Tayside Children's Sleep Questionnaire. Screen time was reported by the parents. Logistic regression models were used to examine the associations between potential correlates (ie, age, sex, socio-economic status, weight status, physical activity, screen time, nap(s), bedtimes, and wake-up times) and nocturnal sleep characteristics.

RESULTS

Older children were more likely to have greater sleep variability (OR: 1.97; 95% CI: 1.08-3.61). Less physical activity (OR: 2.38; 95% CI: 1.27-4.45), shorter nap(s) (OR: 2.42, 95% CI: 1.29-4.55), and later wake-up times (OR: 4.42; 95% CI: 2.32-8.42) were associated with higher odds of having longer nocturnal sleep duration. Late bedtimes were associated with shorter nocturnal sleep duration (OR: 0.09; 95% CI: 0.04-0.18) and with greater nocturnal sleep variability (OR: 1.97; 95% CI: 1.06-3.68). None of the potential correlates were associated with nocturnal sleep problems.

CONCLUSION

The present study identifies several correlates of nocturnal sleep duration (total physical activity, nap(s), bedtime, and wake-up time) and nocturnal sleep variability (age and bedtime), whereas no correlates were identified for nocturnal sleep problems. The association between late bedtimes and shorter nocturnal sleep duration and greater nocturnal variability suggests that these may be modifiable targets for future sleep interventions in early childhood.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616000471482, 11/04/2016, retrospectively registered.

Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Their Preschool-Age Children's Sleep and Bedtime Routines: A Qualitative Study Conducted in the United States

In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers' beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children's healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families' lives such as parents' work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children's sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents' work schedules) and the environment (e.g., multi-family housing; neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.

[Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children]

INTRODUCTION

Although sleep disturbances in infants and toddlers are common, there is no suitable validated tool in Spanish to evaluate sleep disorders. The Brief Infant Sleep Questionnaire (BISQ) is a well-established multidimensional questionnaire widely used internationally.

OBJECTIVES

To adapt the BISQ questionnaire to Spanish and analyse its reliability and validity. To explore its feasibility, both in the clinical context, and in epidemiological research.

METHODS

Participants were parents of children between 3 and 30 months of age. The adaptation to Spanish (BISQ-E) was achieved by using both back translation and consensus, following the international guidelines.Reliability was determined by means of test-retest and measurement of agreement (Kappa value) between 2forms of administration of the questionnaire (self-administration and clinical interview). Construct validity was established by analysing its correlation with a sleep diary.

RESULTS

A total of 87 families/children participated. The test-retest reliability undertaken in 60 subjects was excellent; r = 0.848 (P<0.001). The kappa value was 0.939 (95% CI: 0.858-1.00, P<0.001).The agreement between BISQ-E and the sleep diary was analysed in 27 families/children, with statistically significant values being obtained for the following variables: bedtime (r = 0.731), hours of night sleep (r = 0.726), hours of daytime sleep (r = 0.867), and number of nocturnal awakenings (r = 0.888) (P < 0.001).

CONCLUSIONS

The Spanish adaptation of the BISQ shows overall adequate validity and reliability for the evaluation of sleep in infants and pre-school children. Its use as a clinical tool, or for clinical-epidemiological research studies, is feasible.

Environmental characteristics of early childhood education and care centres and young children's weight status: A systematic review

The aim of this systematic review was to summarize ECEC environmental correlates of weight status in children under the age of 6years. Six databases (PubMed, PsycINFO, CINAHL, SPORTDiscus, Scopus, and Web of Science) were searched until March 2017. Observational studies examining the relationship between ECEC environmental characteristics and weight status in children aged 0-6years were included. Data was extracted using a predesigned form. Eight studies, representing 4862 children, met the inclusion criteria. Twenty-two environmental characteristics were identified and classified into four domains (physical, political, economic, and sociocultural); of these, six correlates were found. 'Active environment' 'sedentary opportunities', 'active play time', 'high sugar and high fat served', 'educators' weight' and 'educators' habitual physical activity level' were associated with weight status in young children. However, for most environmental characteristics examined, strong evidence is not available yet, due to variations across studies on the measures of environmental characteristics and analytical methodologies. Stronger empirical evidence in greater quantity is needed. Future studies in this area are recommended to investigate the environmental influence using an ecological approach and to examine the potential mediators, with a focus on the settings of family-based centres and samples representing toddlers and/or infants.

Poor Sleep and Obesity: Concurrent Epidemics in Adolescent Youth

Poor sleep and obesity are both extraordinarily common in the US adolescent population and often occur simultaneously. This review explores the links between obesity and sleep, outlining what is known about the relationships between sleep characteristics, obesity, and cardiometabolic risk factors in youth. Sleep duration is less than optimal in teens, and decreases as age increases. This is detrimental to overall well-being and is associated with obesity in children, adolescents, and young adults. Accordingly, inadequate sleep duration is associated with poor diet quality, decreased insulin sensitivity, hyperglycemia, and prevalent cardiometabolic risk factors. Evidence suggests that poor sleep quality and altered circadian timing characterized by a preferred later sleep onset, known as "adolescent chronotype," contributes to shortened sleep duration. Obstructive sleep apnea (OSA) occurs more frequently among youth with obesity, and is associated with autonomic nervous system activity promoting higher blood pressure, increased markers of cardiovascular disease risk, and insulin resistance. While there is a clear association between OSA and type 2 diabetes in adults, whether or not this association is prevalent in youth is unclear at this time. Interventions to improve both sleep duration and quality, and obesity in adolescents are scarce and more evidence is needed to determine if such interventions can improve obesity-related health outcomes.

Systematic review of the relationships between sleep duration and health indicators in the early years (0-4 years)

Background

The objective of this systematic review was to examine for the first time the associations between sleep duration and a broad range of health indicators in children aged 0 to 4 years.

Methods

Electronic databases were searched with no limits on date or study design. Included studies (published in English or French) were peer-reviewed and met the a priori determined population (apparently healthy children aged 1 month to 4.99 years), intervention/exposure/comparator (various sleep durations), and outcome criteria (adiposity, emotional regulation, cognitive development, motor development, growth, cardiometabolic health, sedentary behaviour, physical activity, quality of life/well-being, and risks/injuries). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Due to high levels of heterogeneity across studies, narrative syntheses were employed.

Results

A total of 69 articles/studies (62 unique samples) met inclusion criteria. Data across studies included 148,524 unique participants from 23 countries. The study designs were randomized trials (n = 3), non-randomized interventions (n = 1), longitudinal studies (n = 16), cross-sectional studies (n = 42), or longitudinal studies that also reported cross-sectional analyses (n = 7). Sleep duration was assessed by parental report in 70% of studies (n = 48) and was measured objectively (or both objectively and subjectively) in 30% of studies (n = 21). Overall, shorter sleep duration was associated with higher adiposity (20/31 studies), poorer emotional regulation (13/25 studies), impaired growth (2/2 studies), more screen time (5/5 studies), and higher risk of injuries (2/3 studies). The evidence related to cognitive development, motor development, physical activity, and quality of life/well-being was less clear, with no indicator showing consistent associations. No studies examined the association between sleep duration and cardiometabolic biomarkers in children aged 0 to 4 years. The quality of evidence ranged from “very low” to “high” across study designs and health indicators.

Conclusions

Despite important limitations in the available evidence, longer sleep duration was generally associated with better body composition, emotional regulation, and growth in children aged 0 to 4 years. Shorter sleep duration was also associated with longer screen time use and more injuries. Better-quality studies with stronger research designs that can provide information on dose-response relationships are needed to inform contemporary sleep duration recommendations.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4850-2) contains supplementary material, which is available to authorized users.

Shorter sleep duration is associated with higher energy intake and an increase in BMI z-score in young children predisposed to overweight

BACKGROUND

Inadequate sleep has been shown to be a contributor to obesity in both children and adults. Less evidence is available for toddlers and among those with higher obesity risk. The objective of this study was to examine the relationship between sleep patterns and body weight development in a group of young obesity-predisposed children, and to assess whether intakes of energy or macronutrients mediate this relationship.

METHODS

Participants included 368 Danish children aged 2-6 years from the Healthy Start Study, a 1.3 year randomised controlled intervention trial. Sleep habits were measured using a 7-day sleep diary. Multivariate linear regression with adjustment for confounders was used to assess the association of sleep duration and sleep variability with 1.3 year changes (Δ) in body mass index (BMI) z-score from baseline to follow-up.

RESULTS

The average nighttime sleep duration was 10.7 h (range 8.8-12.5 h). After controlling for potential confounders, a significant inverse association between nighttime sleep duration and ΔBMI z-score (β=-0.090, P=0.046) was observed. This relationship was mediated by energy intake, with all macronutrients contributing to this mediation effect. No associations were found for sleep variability and ΔBMI z-score but baseline intake of added sugars and sugary beverages were positively associated with sleep variability.

CONCLUSION

Shorter sleep duration, mediated by energy intake in early in life, seems a risk factor for weight gain among young obesity-predisposed children.