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van de Sande M, Gerards S, L'Hoir MP, Gabrio A, Reijs RP, Tissen I, van Dam SW, Alberts F, Meertens RM. Promoting healthy sleep in 0-2-year-old infants: a study protocol for the development and mixed method evaluation of a sleep health program tailored to Dutch youth healthcare regions. BMC Public Health 2024; 24:1913. [PMID: 39014342 PMCID: PMC11253352 DOI: 10.1186/s12889-024-19258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Sleep problems are common among infants and can have a serious impact on the health and wellbeing of both child and parents. To sustainably promote infant sleep on a population level, it is necessary to develop evidence-based programs that can be implemented on a large scale. The Youth Health Care setting, with its focus on prevention, child health promotion and services widely available for parents, can be a suitable setting to do so. Currently however, sleep health promotion in this setting seems to be suboptimal. To promote healthy infant sleep on a population level, programs need to be accessible and comprehensible for all parents, including parents with limited (health) literacy. Therefore, this study aims to develop, implement and evaluate a program called 'Sleep on number 1', that is tailored to Dutch Youth Health Care, to sustainably promote healthy sleep in 0-2-year-old infants. METHODS The program was developed based on co-creation with parents and Youth Health Care professionals, evidence-based behaviour change theories and sleep health promotion methods. Program effectiveness is investigated with a quasi-experimental study design comparing the program group with the care as usual control group. Participants consist of parents of 0-2-year-old children. Primary outcome is infant sleep quality at the age of 10 weeks and 6, 9, 14 and 24 months, measured with a sleep diary. The primary data analysis focuses on night awakenings at 9 months. Secondary outcomes focus on parental behaviour regarding infant sleep, related behavioural determinants and parental satisfaction with Youth Health Care sleep advice. Program effectiveness is analysed using a linear mixed-model in case of data clustering, and an independent samples T-test or linear regression in case no substantial clustering effects are found. A mixed methods process evaluation is performed with parents and Youth Health Care professionals, assessing program reach, adoption, implementation, maintenance and working mechanisms. DISCUSSION The 'Sleep on number 1' program is an evidence-based sleep health program for 0-2-year-old children, tailored to Dutch Youth Health Care. If effective, this program has the potential to improve infant sleep on a population level. TRIAL REGISTRATION ISRCTN, ISRCTN27246394, registered on 10/03/2023. https://www.isrctn.com/ISRCTN27246394 .
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Affiliation(s)
- Mpw van de Sande
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
| | - Smpl Gerards
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - M P L'Hoir
- Department of Global Nutrition, Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, Wageningen, 6700 AA, The Netherlands
- Public Health Service North-East-Gelderland, P.O. Box 3, Zutphen, 7200 AA, The Netherlands
| | - A Gabrio
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - R P Reijs
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Youth Health Care, Public Health Service South Limburg, P.O. box 33, Heerlen, 6400 AA, The Netherlands
| | - I Tissen
- Public Health Service Limburg-North, P.O. box 1150, Venlo, 5900 BD, The Netherlands
| | - S W van Dam
- Department of Youth Health Care, Public Health Service South Limburg, P.O. box 33, Heerlen, 6400 AA, The Netherlands
| | - Fhgy Alberts
- Public Health Service Brabant-Southeast, P.O. box 8684, KR Eindhoven, 5605, The Netherlands
| | - R M Meertens
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
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de Sena S, Häggman M, Ranta J, Roienko O, Ilén E, Acosta N, Salama J, Kirjavainen T, Stevenson N, Airaksinen M, Vanhatalo S. NAPping PAnts (NAPPA): An open wearable solution for monitoring Infant's sleeping rhythms, respiration and posture. Heliyon 2024; 10:e33295. [PMID: 39027497 PMCID: PMC11255670 DOI: 10.1016/j.heliyon.2024.e33295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/13/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Study objectives To develop a non-invasive and practical wearable method for long-term tracking of infants' sleep. Methods An infant wearable, NAPping PAnts (NAPPA), was constructed by combining a diaper cover and a movement sensor (triaxial accelerometer and gyroscope), allowing either real-time data streaming to mobile devices or offline feature computation stored in the sensor memory. A sleep state classifier (wake, N1/REM, N2/N3) was trained and tested for NAPPA recordings (N = 16649 epochs of 30 s), using hypnograms from co-registered polysomnography (PSG) as a training target in 33 infants (age 2 weeks to 18 months; Mean = 4). User experience was assessed from an additional group of 16 parents. Results Overnight NAPPA recordings were successfully performed in all infants. The sleep state classifier showed good overall accuracy (78 %; Range 74-83 %) when using a combination of five features related to movement and respiration. Sleep depth trends were generated from the classifier outputs to visualise sleep state fluctuations, which closely aligned with PSG-derived hypnograms in all infants. Consistently positive parental feedback affirmed the effectiveness of the NAPPA-design. Conclusions NAPPA offers a practical and feasible method for out-of-hospital assessment of infants' sleep behaviour. It can directly support large-scale quantitative studies and development of new paradigms in scientific research and infant healthcare. Moreover, NAPPA provides accurate and informative computational measures for body positions, respiration rates, and activity levels, each with their respective clinical and behavioural value.
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Affiliation(s)
- Sofie de Sena
- BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Matias Häggman
- School of Science, Department of Mathematics and Systems Analysis, Aalto University, Espoo, Finland
| | - Jukka Ranta
- BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Oleksii Roienko
- BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elina Ilén
- Department of Materials Science and Engineering, Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain
| | - Natalia Acosta
- BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jonna Salama
- BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turkka Kirjavainen
- Department of Paediatrics, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Nathan Stevenson
- Brain Modelling Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Manu Airaksinen
- BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
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Ghazi MA, Zhou J, Havens KL, Smith BA. Accelerometer Thresholds for Estimating Physical Activity Intensity Levels in Infants: A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4436. [PMID: 39065833 PMCID: PMC11280506 DOI: 10.3390/s24144436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/18/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
Lack of physical activity (PA) at a young age can result in health issues. Thus, monitoring PA is important. Wearable accelerometers are the preferred tool to monitor PA in children. Validated thresholds are used to classify activity intensity levels, e.g., sedentary, light, and moderate-to-vigorous, in ambulatory children. No previous work has developed accelerometer thresholds for infancy (pre-ambulatory children). Therefore, this work aims to develop accelerometer thresholds for PA intensity levels in pre-ambulatory infants. Infants (n = 10) were placed in a supine position and allowed free movement. Their movements were synchronously captured using video cameras and accelerometers worn on each ankle. The video data were labeled by activity intensity level (sedentary, light, and moderate-to-vigorous) in two-second epochs using observational rating (gold standard). Accelerometer thresholds were developed for acceleration and jerk using two optimization approaches. Four sets of thresholds were developed for dual (two ankles) and for single-worn (one ankle) accelerometers. Of these, for a typical use case, we recommend using acceleration-based thresholds of 1.00 m/s to distinguish sedentary and light activity and 2.60 m/s to distinguish light and moderate-to-vigorous activity. Acceleration and jerk are both suitable for measuring PA.
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Affiliation(s)
- Mustafa A. Ghazi
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA;
| | - Judy Zhou
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Kathryn L. Havens
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Beth A. Smith
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA;
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Sinthong A, Ngernlangtawee D. Early sleep intervention for improving infant sleep quality: a randomized controlled trial, preliminary result. BMC Pediatr 2024; 24:306. [PMID: 38704536 PMCID: PMC11069131 DOI: 10.1186/s12887-024-04771-6] [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: 11/17/2023] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Healthy sleep issues should provide to family within first 6 months of infant's life. This study aimed to evaluate the effect of early sleep intervention on nighttime sleep quality. METHODS Eligible infants aged 4 months ± 2 weeks were randomized to receive early sleep intervention or usual care. Data on sleep variables were obtained via parental interview at baseline and 6 months of age. Using logistic regression to analyze the efficacy of early sleep intervention. RESULTS At baseline, 335 eligible infants were enrolled and randomized. In total, 306 participants were final analyzed: early sleep intervention group (n = 148) and the usual care group (n = 158). The early sleep intervention group had a significantly longer nighttime sleep duration and a shorter night waking duration than the usual care group (585.20 ± 80.38 min vs. 496.14 ± 87.78 min, p < .001 and 61.01 ± 36.38 min vs. 89.72 ± 45.54 min, p < .001). At 6 months of age, the early sleep intervention group had a longer night sleep duration (≥ 4 h/time) than the usual care group (adjusted odds ratio: 2.39, 95% confidence interval: 1.34-4.28). CONCLUSIONS Early sleep intervention should be recommended to infants at 4 months of age as a part of well childcare to improve infant sleep quality. TRIAL REGISTRATION Thai Clinical Trials Registry (thaiclinicaltrial.org). Retrospective registered TCTR20230117001 (17/01/2023).
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Affiliation(s)
- Auraya Sinthong
- Department of Pediatric, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand
| | - Dussadee Ngernlangtawee
- Department of Pediatric, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand.
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Syam A, Idrus HH, Iskandar I. Correlation Between Maternal Anxiety During Mid-Pregnancy and Subsequent Infant Sleep Issues [Letter]. Int J Gen Med 2024; 17:1323-1324. [PMID: 38596647 PMCID: PMC11001542 DOI: 10.2147/ijgm.s467453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Affiliation(s)
- Azniah Syam
- Nursing Department, Sekolah Tinggi Ilmu Kesehatan Nani Hasanuddin, MakassarSouth SulawesiIndonesia
| | - Hasta Handayani Idrus
- Center for Biomedical Research, Research Organization for Health, National Research and Innovation Agency (BRIN), Cibinong Science Center, Cibinong-Bogor, West Java, Indonesia
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Wang X, de Groot ER, Tataranno ML, van Baar A, Lammertink F, Alderliesten T, Long X, Benders MJNL, Dudink J. Machine Learning-Derived Active Sleep as an Early Predictor of White Matter Development in Preterm Infants. J Neurosci 2024; 44:e1024232023. [PMID: 38124010 PMCID: PMC10860564 DOI: 10.1523/jneurosci.1024-23.2023] [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: 06/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 12/23/2023] Open
Abstract
White matter dysmaturation is commonly seen in preterm infants admitted to the neonatal intensive care unit (NICU). Animal research has shown that active sleep is essential for early brain plasticity. This study aimed to determine the potential of active sleep as an early predictor for subsequent white matter development in preterm infants. Using heart and respiratory rates routinely monitored in the NICU, we developed a machine learning-based automated sleep stage classifier in a cohort of 25 preterm infants (12 females). The automated classifier was subsequently applied to a study cohort of 58 preterm infants (31 females) to extract active sleep percentage over 5-7 consecutive days during 29-32 weeks of postmenstrual age. Each of the 58 infants underwent high-quality T2-weighted magnetic resonance brain imaging at term-equivalent age, which was used to measure the total white matter volume. The association between active sleep percentage and white matter volume was examined using a multiple linear regression model adjusted for potential confounders. Using the automated classifier with a superior sleep classification performance [mean area under the receiver operating characteristic curve (AUROC) = 0.87, 95% CI 0.83-0.92], we found that a higher active sleep percentage during the preterm period was significantly associated with an increased white matter volume at term-equivalent age [β = 0.31, 95% CI 0.09-0.53, false discovery rate (FDR)-adjusted p-value = 0.021]. Our results extend the positive association between active sleep and early brain development found in animal research to human preterm infants and emphasize the potential benefit of sleep preservation in the NICU setting.
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Affiliation(s)
- Xiaowan Wang
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht 3584 EA, The Netherlands
| | - Eline R de Groot
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht 3584 EA, The Netherlands
| | - Maria Luisa Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht 3584 EA, The Netherlands
- Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
| | - Anneloes van Baar
- Child and Adolescent Studies, Utrecht University, Utrecht 3584 CS, The Netherlands
| | - Femke Lammertink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht 3584 EA, The Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht 3584 EA, The Netherlands
- Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
| | - Xi Long
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven 5612 AZ, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht 3584 EA, The Netherlands
- Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht 3584 EA, The Netherlands
- Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
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Klapp JM, Hall TA, Riley AR, Janzen D, Williams CN. Post-PICU sleep efficiency and quality of life in infants and toddlers with acquired brain injury. J Clin Sleep Med 2024; 20:75-83. [PMID: 37707302 PMCID: PMC10758560 DOI: 10.5664/jcsm.10798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
STUDY OBJECTIVES We aimed to investigate the use of sleep efficiency (SE) as a measure of sleep disturbance in infants and toddlers with acquired brain injury (ABI) and evaluate associations between SE and child health-related quality of life and family outcomes. METHODS Retrospective cohort study of 101 children ages 3-36 months who survived critical care for ABI. SE was quantified from the Brief Infant Sleep Questionnaire as a ratio of nighttime sleep to total time in bed; poor SE was defined as < 80%. Outcome measures included the Pediatric Quality of Life Inventory Core Total Score (health-related quality of life) and Family Impact Module Total Score. Spearman's correlation quantified associations between SE and outcomes. Multivariable linear regression tested association between poor SE and health-related quality of life controlling for significant covariates (age, diagnosis, comorbidities, worsening Functional Status Scale). RESULTS Following ABI, median SE was 91.7 (interquartile range = 83.3, 95.5). Nineteen (19%) children had poor SE (< 80%). SE correlated significantly with quality of life (Spearman's correlation = .307) and Family Impact Module (Spearman's correlation = .309; both P < .01). When controlling for covariates, poor SE significantly increased risk for lower health-related quality of life (β-coefficient = -7.0; 95% confidence interval= -13.4, -0.6). CONCLUSIONS One in five infants and young children with ABI have poor SE that is associated with poorer child and family health outcomes. Our study underscores the potential importance of sleep following ABI to optimize recovery and the need for additional investigation of SE in infants and young children. CITATION Klapp JM, Hall TA, Riley AR, Janzen D, Williams CN. Post-PICU sleep efficiency and quality of life in infants and toddlers with acquired brain injury. J Clin Sleep Med. 2024;20(1):75-83.
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Affiliation(s)
- Jamie M. Klapp
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Andrew R. Riley
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Darren Janzen
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health & Science University, Portland, Oregon
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Psihogios AM, King-Dowling S, Mitchell JA, McGrady ME, Williamson AA. Ethical considerations in using sensors to remotely assess pediatric health behaviors. AMERICAN PSYCHOLOGIST 2024; 79:39-51. [PMID: 38236214 PMCID: PMC10798216 DOI: 10.1037/amp0001196] [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: 01/19/2024]
Abstract
Sensors, including accelerometer-based and electronic adherence monitoring devices, have transformed health data collection. Sensors allow for unobtrusive, real-time sampling of health behaviors that relate to psychological health, including sleep, physical activity, and medication-taking. These technical strengths have captured scholarly attention, with far less discussion about the level of human touch involved in implementing sensors. Researchers face several subjective decision points when collecting health data via sensors, with these decisions posing ethical concerns for users and the public at large. Using examples from pediatric sleep, physical activity, and medication adherence research, we pose critical ethical questions, practical dilemmas, and guidance for implementing health-based sensors. We focus on youth given that they are often deemed the ideal population for digital health approaches but have unique technology-related vulnerabilities and preferences. Ethical considerations are organized according to Belmont principles of respect for persons (e.g., when sensor-based data are valued above the subjective lived experiences of youth and their families), beneficence (e.g., with sensor data management and sharing), and justice (e.g., with sensor access and acceptability among minoritized pediatric populations). Recommendations include the need to increase transparency about the extent of subjective decision making with sensor data management. Without greater attention to the human factors involved in sensor research, ethical risks could outweigh the scientific promise of sensors, thereby negating their potential role in improving child health and care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Alexandra M. Psihogios
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Sara King-Dowling
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jonathan A. Mitchell
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Meghan E. McGrady
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Ariel A. Williamson
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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Liu T, Benjamin-Neelon SE. A longitudinal study of infant 24-hour sleep: comparisons of sleep diary and accelerometer with different algorithms. Sleep 2023; 46:zsad160. [PMID: 37279933 PMCID: PMC10639156 DOI: 10.1093/sleep/zsad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
STUDY OBJECTIVES To longitudinally compare sleep/wake identification and sleep parameter estimation from sleep diaries to accelerometers using different algorithms and epoch lengths in infants. METHODS Mothers and other caregivers from the Nurture study (southeastern United States, 2013-2018) reported infants' 24-hour sleep in sleep diaries for 4 continuous days, while infants concurrently wore accelerometers on the left ankle at 3, 6, 9, and 12 months of age. We applied the Sadeh, Sadeh Infant, Cole, and Count-scaled algorithm to accelerometer data at 15 and 60 seconds epochs. For sleep/wake identification, we assessed agreement by calculating epoch-by-epoch percent agreement and kappas. We derived sleep parameters from sleep diaries and accelerometers separately and evaluated agreement using Bland-Altman plots. We estimated longitudinal trajectories of sleep parameters using marginal linear and Poisson regressions with generalized estimation equation estimation. RESULTS Among the 477 infants, 66.2% were black and 49.5% were female. Agreement for sleep/wake identification varied by epoch length and algorithm. Relative to sleep diaries, we observed similar nighttime sleep offset, onset, and total nighttime sleep duration from accelerometers regardless of algorithm and epoch length. However, accelerometers consistently estimated about 1 less nap per day using the 15 seconds epoch, 70 and 50 minutes' shorter nap duration per day using the 15 and 60 seconds epoch, respectively; but accelerometers estimated over 3 times more wake after nighttime sleep onset (WASO) per night. Some consistent sleep parameter trajectories from 3 to 12 months from accelerometers and sleep diaries included fewer naps and WASOs, shorter total daytime sleep, longer total nighttime sleep, and higher nighttime sleep efficiency. CONCLUSIONS Although there is no perfect measure of sleep in infancy, our findings suggest that a combination of accelerometer and diary may be needed to adequately measure infant sleep.
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Affiliation(s)
- Tiange Liu
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Williamson AA, Min J, Fay K, Cicalese O, Meltzer LJ, Mindell JA. A multimethod evaluation of bed provision and sleep education for young children and their families living in poverty. J Clin Sleep Med 2023; 19:1583-1594. [PMID: 37086055 PMCID: PMC10476044 DOI: 10.5664/jcsm.10614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES We evaluated the impact of bed provision and sleep education through the Beds for Kids (BfK) program on early childhood sleep and behavior and maternal mood and sleep. METHODS Twenty-seven mother-child dyads (childage= 2-5 years, 85.2% Black) living in poverty and without an individual child bed were randomly assigned (multimethod randomized waitlist control trial design) to BfK intervention ∼1 week postbaseline (initial intervention) or ∼2 weeks postbaseline (waitlist control), with follow-up at 1 month. BfK intervention (home bed delivery and written sleep health education) was provided to all families. Children wore actigraphs and mothers completed daily diaries to assess child and maternal sleep, child behavior, and maternal mood for the initial 1-week comparison period. Maternal-reported child sleep and behavior (internalizing and externalizing problems) were collected at 1 month after BfK participation for all families; 11 families completed a qualitative interview at 1-month follow-up. RESULTS At 1 week after BfK, mothers' sleep duration increased by 1 hour compared to that of waitlist controls. No changes were found in child sleep, child behavior, or maternal mood. However, at 1 month after BfK intervention, improvements were found in mother-reported child night awakenings, sleep quality, sleep problems, and behavior. Mothers qualitatively reported significant BfK benefits for child sleep and family well-being, although they noted challenges to transitioning young children to sleeping independently. CONCLUSIONS Bed provision and sleep education for families living in poverty has an immediate impact on maternal sleep and reported well-being. Child sleep and behavioral improvements are seen by 1 month, with children experiencing an initial adjustment period to sleeping independently. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Impact of Beds for Kids Program on Child Sleep; URL: https://www.clinicaltrials.gov/ct2/show/NCT03392844; Identifier: NCT03392844. CITATION Williamson AA, Min J, Fay K, Cicalese O, Meltzer LJ, Mindell JA. A multimethod evaluation of bed provision and sleep education for young children and their families living in poverty. J Clin Sleep Med. 2023;19(9):1583-1594.
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Affiliation(s)
- Ariel A. Williamson
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Beds for Kids Program, One House at a Time, Huntingdon Valley, Pennsylvania
| | - Jungwon Min
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kate Fay
- Beds for Kids Program, One House at a Time, Huntingdon Valley, Pennsylvania
| | - Olivia Cicalese
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Jodi A. Mindell
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Psychology, Saint Joseph’s University, Philadelphia, Pennsylvania
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Bindels-de Heus KGCB, Hooven-Radstaake MT, Legerstee JS, Hoopen LWT, Dieleman GC, Moll HA, Mous SE, de Wit MCY. Sleep problems in children with Angelman Syndrome: The effect of a behavioral intervention program. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104444. [PMID: 36753818 DOI: 10.1016/j.ridd.2023.104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to investigate the effect of a behavioral intervention on sleep problems, which are significant and an unmet clinical need in children with Angelman Syndrome (AS). METHODS & PROCEDURES Children (2-18 years) with AS and sleep problems were randomized to a behavioral intervention program or a control group. Intervention consisted of a standardized program including home visits, psycho-education, feedback based on direct observation of bedtime routine and video footage of the night and behavioral treatment techniques by a behavioral therapist. Change in sleep duration (primary) and parental sleep, nighttime visits, sleep hygiene, daytime behavior, parental stress and quality of life (secondary) were assessed post-intervention and at follow-up using questionnaires, diary, actigraphy and videosomnography. OUTCOMES & RESULTS The groups, 9 children in each, did not differ at baseline. We found a significant effect of intervention on wake after sleep onset with classical statistical analysis (videosomnography). With single case analysis we found a positive effect on total sleep time (diary and actigraphy) and wake after sleep onset (diary) with a persistent effect on total sleep time (actigraphy) and wake after sleep onset (diary). On secondary outcome there was a significant and persistent effect on sleep hygiene and several quality of life domains. CONCLUSIONS & IMPLICATIONS Behavioral intervention has a positive and persistent effect on sleep problems in children with AS. We advise psycho-education for all parents and use of videosomnography for both evaluation of and feedback on sleep behavior patterns, individual behavioral advice and specific behavioral techniques for children with sleep problems.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands.
| | - Maartje Ten Hooven-Radstaake
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Radboud University, Dept. of Social Sciences, Nijmegen, the Netherlands
| | - Jeroen S Legerstee
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Gwen C Dieleman
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Henriette A Moll
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Neurology and Pediatric Neurology, the Netherlands
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12
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Abstract
This article describes the changes in normal sleep regulation, structure, and organization and sleep-related changes in respiration from infancy to adolescence. The first 2 years of age are striking, with more time asleep than awake. With development, the electroencephalogram architecture has a marked reduction in rapid eye movement sleep and the acquisition of K-complexes, sleep spindles, and slow-wave sleep. During adolescence there is a reduction in slow-wave sleep and a delay in the circadian phase. Infants have a more collapsible upper airway and lower lung volumes than older children, which predisposes them to obstructive sleep apnea and sleep-related hypoxemia.
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13
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Gossé LK, Wiesemann F, Elwell CE, Jones EJH. Habitual night waking associates with dynamics of waking cortical theta power in infancy. Dev Psychobiol 2022; 64:e22344. [PMID: 36426793 PMCID: PMC9828365 DOI: 10.1002/dev.22344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/27/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022]
Abstract
The implications of the substantial individual differences in infant sleep for early brain development remain unclear. Here, we examined whether night sleep quality relates to daytime brain activity, operationalized through measures of EEG theta power and its dynamic modulation, which have been previously linked to later cognitive development. For this longitudinal study, 76 typically developing infants were studied (age: 4-14 months, 166 individual study visits) over the course of 6 months with one, two, three, or four lab visits. Habitual sleep was measured with a 7-day sleep diary and actigraphy, and the Brief Infant Sleep Questionnaire. Twenty-channel EEG was recorded while infants watched multiple rounds of videos of women singing nursery rhymes; oscillatory power in the theta band was extracted. Key metrics were average theta across stimuli and the slope of change in theta within the first novel movie. Both objective and subjective sleep assessment methods showed a relationship between more night waking and higher overall theta power and reduced dynamic modulation of theta over the course of the novel video stimuli. These results may indicate altered learning and consolidation in infants with more disrupted night sleep, which may have implications for cognitive development.
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Affiliation(s)
- Louisa K. Gossé
- Centre for Brain and Cognitive Development, BirkbeckUniversity of LondonLondonUK
| | - Frank Wiesemann
- Research & DevelopmentProcter & GambleSchwalbach am TaunusGermany
| | - Clare E. Elwell
- Department of Medical Physics and Biomedical Engineering, Biomedical Optics Research LaboratoryUniversity College LondonLondonUK
| | - Emily J. H. Jones
- Centre for Brain and Cognitive Development, BirkbeckUniversity of LondonLondonUK
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14
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Lettink A, Altenburg TM, Arts J, van Hees VT, Chinapaw MJM. Systematic review of accelerometer-based methods for 24-h physical behavior assessment in young children (0-5 years old). Int J Behav Nutr Phys Act 2022; 19:116. [PMID: 36076221 PMCID: PMC9461103 DOI: 10.1186/s12966-022-01296-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate accelerometer-based methods are required for assessment of 24-h physical behavior in young children. We aimed to summarize evidence on measurement properties of accelerometer-based methods for assessing 24-h physical behavior in young children. METHODS We searched PubMed (MEDLINE) up to June 2021 for studies evaluating reliability or validity of accelerometer-based methods for assessing physical activity (PA), sedentary behavior (SB), or sleep in 0-5-year-olds. Studies using a subjective comparison measure or an accelerometer-based device that did not directly output time series data were excluded. We developed a Checklist for Assessing the Methodological Quality of studies using Accelerometer-based Methods (CAMQAM) inspired by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). RESULTS Sixty-two studies were included, examining conventional cut-point-based methods or multi-parameter methods. For infants (0-12 months), several multi-parameter methods proved valid for classifying SB and PA. From three months of age, methods were valid for identifying sleep. In toddlers (1-3 years), cut-points appeared valid for distinguishing SB and light PA (LPA) from moderate-to-vigorous PA (MVPA). One multi-parameter method distinguished toddler specific SB. For sleep, no studies were found in toddlers. In preschoolers (3-5 years), valid hip and wrist cut-points for assessing SB, LPA, MVPA, and wrist cut-points for sleep were identified. Several multi-parameter methods proved valid for identifying SB, LPA, and MVPA, and sleep. Despite promising results of multi-parameter methods, few models were open-source. While most studies used a single device or axis to measure physical behavior, more promising results were found when combining data derived from different sensor placements or multiple axes. CONCLUSIONS Up to age three, valid cut-points to assess 24-h physical behavior were lacking, while multi-parameter methods proved valid for distinguishing some waking behaviors. For preschoolers, valid cut-points and algorithms were identified for all physical behaviors. Overall, we recommend more high-quality studies evaluating 24-h accelerometer data from multiple sensor placements and axes for physical behavior assessment. Standardized protocols focusing on including well-defined physical behaviors in different settings representative for children's developmental stage are required. Using our CAMQAM checklist may further improve methodological study quality. PROSPERO REGISTRATION NUMBER CRD42020184751.
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Affiliation(s)
- Annelinde Lettink
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands. .,Amsterdam Public Health, Methodology, Amsterdam, The Netherlands. .,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.
| | - Teatske M Altenburg
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Jelle Arts
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Vincent T van Hees
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands.,, Accelting, Almere, The Netherlands
| | - Mai J M Chinapaw
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
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15
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Camerota M, Wylie AC, Goldblum J, Wideman L, Cheatham CL, Propper CB. Testing a cascade model linking prenatal inflammation to child executive function. Behav Brain Res 2022; 431:113959. [PMID: 35690156 PMCID: PMC10652221 DOI: 10.1016/j.bbr.2022.113959] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023]
Abstract
Inflammation during pregnancy is beginning to be understood as a risk factor predicting poor infant health and neurodevelopmental outcomes. The long-term sequelae associated with exposure to prenatal inflammation are less well established. The current study examined associations between maternal inflammation during pregnancy, markers of infant neurodevelopment (general cognitive ability, negative affect, and sleep quality), and preschool executive function (EF) in a longitudinal sample of 40 African American mother-infant dyads. Mothers completed a blood draw in the third trimester of pregnancy to measure plasma levels of C-reactive protein (CRP) and pro-inflammatory cytokines (e.g., interleukin 6 [IL-6], tumor necrosis factor-alpha [TNF-α]). When infants were 6 months of age, we assessed general cognitive ability via the Bayley-III, negative affect via the Still-Face Paradigm, and sleep quality via actigraphy monitoring. When children were 4 years of age, we assessed their EF ability using four tasks from the EF Touch battery. Elevated levels of maternal CRP, IL-6, and TNF-α were associated with poorer infant general cognitive ability. Although there were no direct effects of prenatal inflammation on preschool EF, we observed an indirect relationship between IL-6 and preschool EF ability via infant general cognitive ability. Our findings suggest that prenatal inflammation may have long-lasting, cascading implications for child neurodevelopment. Implications of these findings for health disparities in women and children of color are discussed.
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Affiliation(s)
- Marie Camerota
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States
| | - Amanda C Wylie
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jessica Goldblum
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, United States
| | - Carol L Cheatham
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States; Nutrition Research Institute, University of North Carolina at Chapel Hill, United States
| | - Cathi B Propper
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, United States; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
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16
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Vadakkan AJ, Prabakaran V. Comparison of the Effect of Nesting and Swaddling on Sleep Duration and Arousal Frequency among Preterm Neonates: A Randomized Clinical Trial. J Caring Sci 2022; 11:126-131. [PMID: 36247038 PMCID: PMC9526794 DOI: 10.34172/jcs.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/14/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Sleep contributes a pivotal part in neurological improvement of new borns. New-borns admitted to neonatal intensive care unit (NICU) perceive many sounds of monitors and this disturb their rest period. To enhance the sleep duration of neonates many non-pharmacological methods are available like placing newborn in a nest made with rolled cotton bed sheet and wrapping the baby with white cotton cloth. In this research effect of these two positions were assessed. Methods: A randomized clinical trial was carried out on 76 preterm neonates in NICU of a tertiary care center. Neonates were included in the study by random method. Sleep duration and frequency of arousal was assessed through direct observation. Physiological parameters were assessed by using cardiac monitor. The information collected were analyzed using SPSS version 21. Results: Sleep duration of nesting group showed significantly higher than swaddling group, which mean (SD) was 206.4 (28), 183.1 (34.78) minutes, respectively. Additionally, waking up was observed less frequency in the nesting group. Conclusion: Nesting enhances the duration of sleep among preterm neonates and hence this can be given priority in NICU.
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Affiliation(s)
- Albrit. J. Vadakkan
- College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vetriselvi Prabakaran
- Department of Paediatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
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17
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Lim K, Quante M, Dijkstra TMH, Hilbert-Moessner G, Wiechers C, Dargaville P, Poets CF. Should obstructive hypopneas be included when analyzing sleep studies in infants with Robin Sequence? Sleep Med 2022; 98:9-12. [PMID: 35764010 DOI: 10.1016/j.sleep.2022.06.010] [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: 04/18/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We have used an obstructive apnea index of ≥3 as treatment indication for infants with Robin sequence (RS), while the obstructive apnea-hypopnea index (OAHI) and a threshold of ≥5 is often used internationally. We wanted to know whether these two result in similar indications, and what the interobserver variability is with either asessement. METHODS Twenty lab-based overnight sleep recordings from infants with isolated RS (median age: 7 days, range 2-38) were scored based on the 2020 American Academy of Sleep Medicine guidelines, including or excluding obstructive hypopneas. RESULTS Median obstructive apnea index (OAI) was 18 (interquartile range: 7.6-38) including only apneas, and 35 (18-54) if obstructive hypopneas were also considered as respiratory events (OAHI). Obstructive sleep apnea (OSA) severity was re-classified from moderate to severe for two infants when obstructive hypopneas were also considered, but this did not lead to a change in clinical treatment decisions for either infant. Median interobserver agreement was 0.86 (95% CI 0.70-0.94) for the OAI, and 0.60 (0.05-0.84) for the OAHI. CONCLUSION Inclusion of obstructive hypopneas when assessing OSA severity in RS infants doubled the obstructive event rate, but impaired interobserver agreement and would not have changed clinical management.
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Affiliation(s)
- Kathleen Lim
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mirja Quante
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany
| | - Tjeerd M H Dijkstra
- Department of Translational Bioinformatics, University of Tübingen, Tübingen, Germany; Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Gabriele Hilbert-Moessner
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Cornelia Wiechers
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Peter Dargaville
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christian F Poets
- Department of Neonatology and Pediatric Sleep Lab, Tübingen; University Children's Hospital, Tübingen, Germany; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.
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18
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Giurgiu M, Kolb S, Nigg C, Burchartz A, Timm I, Becker M, Rulf E, Doster AK, Koch E, Bussmann JBJ, Nigg C, Ebner-Priemer UW, Woll A. Assessment of 24-hour physical behaviour in children and adolescents via wearables: a systematic review of free-living validation studies. BMJ Open Sport Exerc Med 2022; 8:e001267. [PMID: 35646389 PMCID: PMC9109110 DOI: 10.1136/bmjsem-2021-001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Studies that assess all three dimensions of the integrative 24-hour physical behaviour (PB) construct, namely, intensity, posture/activity type and biological state, are on the rise. However, reviews on validation studies that cover intensity, posture/activity type and biological state assessed via wearables are missing. Design Systematic review. The risk of bias was evaluated by using the QUADAS-2 tool with nine signalling questions separated into four domains (ie, patient selection/study design, index measure, criterion measure, flow and time). Data sources Peer-reviewed validation studies from electronic databases as well as backward and forward citation searches (1970–July 2021). Eligibility criteria for selecting studies Wearable validation studies with children and adolescents (age <18 years). Required indicators: (1) study protocol must include real-life conditions; (2) validated device outcome must belong to one dimension of the 24-hour PB construct; (3) the study protocol must include a criterion measure; (4) study results must be published in peer-reviewed English language journals. Results Out of 13 285 unique search results, 76 articles with 51 different wearables were included and reviewed. Most studies (68.4%) validated an intensity measure outcome such as energy expenditure, but only 15.9% of studies validated biological state outcomes, while 15.8% of studies validated posture/activity type outcomes. We identified six wearables that had been used to validate outcomes from two different dimensions and only two wearables (ie, ActiGraph GT1M and ActiGraph GT3X+) that validated outcomes from all three dimensions. The percentage of studies meeting a given quality criterion ranged from 44.7% to 92.1%. Only 18 studies were classified as ‘low risk’ or ‘some concerns’. Summary Validation studies on biological state and posture/activity outcomes are rare in children and adolescents. Most studies did not meet published quality principles. Standardised protocols embedded in a validation framework are needed. PROSPERO registration number CRD42021230894.
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Affiliation(s)
- Marco Giurgiu
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Simon Kolb
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Carina Nigg
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.,Department of Sport Pedagogy, University of Bern, Bern, Switzerland
| | - Alexander Burchartz
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Irina Timm
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marlissa Becker
- Department of Orthopedics, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen Rulf
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ann-Kathrin Doster
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Elena Koch
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claudio Nigg
- Department of Health Science, University of Bern, Bern, Switzerland
| | - Ulrich W Ebner-Priemer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.,Department of Sports and Sports Science, Institute of Sports and Sports Science, Karlsruhe, Germany
| | - Alexander Woll
- Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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19
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McLaughlin K, Chandra A, Camerota M, Propper C. Relations between infant sleep quality, physiological reactivity, and emotional reactivity to stress at 3 and 6 months. Infant Behav Dev 2022; 67:101702. [PMID: 35158216 PMCID: PMC9306017 DOI: 10.1016/j.infbeh.2022.101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
The study examines the association between infant sleep, physiological, and emotional reactivity at 3 and 6 months of age in 89 African American infants and their caregivers. Infant sleep was objectively measured at 3 and 6months using actigraphy for 7 days and nights. At 6 months of age, dyads participated in the Still-Face Paradigm (SFP) (Tronick et al., 1978) to assess infants' physiological reactivity (via respiratory sinus arrhythmia (RSA)) and emotional reactivity. Findings revealed that infant night wakings at 3 months was positively correlated with baseline RSA at 6 months (β = .35, p < .001). Night wakings at 3 months marginally predicted negative affect during the recovery episode of SFP (β = -.26, p = .057). Further, night wakings at 6-months-old predicted more positive affect during the recovery episode of SFP (β = .34, p = .007). We discuss potential explanations for these findings such as an exuberant temperament style, parenting behavior, and lack of sleep consolidation at this early age to be the focus of future studies in this area. The current study adds to the limited research examining the relationship between sleep and reactivity in the earliest months of development. Findings reveal that it is critical to take developmental timing into account as all results were unexpected in relation to the childhood literature. Moreover, this is the first study of its kind to focus on an African American sample.
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20
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A systematic review of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in young children (aged 0-5 years). Int J Behav Nutr Phys Act 2022; 19:18. [PMID: 35164783 PMCID: PMC8845346 DOI: 10.1186/s12966-022-01251-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Background Accurate proxy-report questionnaires, adapted to the child’s developmental stage, are required to monitor 24-h movement behaviors in young children, especially for large samples and low-resource settings. Objectives This review aimed to summarize available studies evaluating measurement properties of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in children aged 0–5 years. Methods Systematic literature searches were carried out in the PubMed, Embase and SPORTDiscus databases, up to January 2021. For physical activity and sedentary behavior questionnaires this is a review update, whereas for sleep questionnaires we included all relevant studies published up to now. Studies had to evaluate at least one of the measurement properties of a proxy-report questionnaire assessing at least duration and/or frequency of physical activity, sedentary behavior and/or sleep in 0- to 5-year-old children. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to evaluate the quality of evidence. Results Thirty-three studies were included, examining a total of 37 questionnaires. Ten questionnaires were designed for infants, two for toddlers, 11 for preschoolers, and 14 for a broader age range targeting multiple of these age groups. Twenty questionnaires assessed constructs of sleep, four assessed constructs of physical activity, two assessed screen behavior, five assessed constructs of both physical activity and sedentary behavior, and six assessed constructs of all 24-h movement behaviors. Content validity was evaluated for six questionnaires, structural validity for two, internal consistency for three, test-retest reliability for 16, measurement error for one, criterion validity for one, and construct validity for 26 questionnaires. None of the questionnaires were considered sufficiently valid and/or reliable for assessing one or more movement behaviors in 0- to 5-year-old children, and the quality of evidence was mostly low or very low. Conclusions Valid and/or reliable questionnaires assessing 24-h movement behaviors in 0- to 5-year-olds are lacking. High-quality studies are therefore required, to develop proxy-report questionnaires and evaluate their measurement properties. PROSPERO registration number CRD42020169268. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01251-x.
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21
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Concordance between subjective and objective measures of infant sleep varies by age and maternal mood: Implications for studies of sleep and cognitive development. Infant Behav Dev 2021; 66:101663. [PMID: 34826651 PMCID: PMC8803548 DOI: 10.1016/j.infbeh.2021.101663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/22/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022]
Abstract
Infant habitual sleep has been proposed as an important moderator of development in domains such as attention, memory or temperament. To test such hypotheses, we need to know how to accurately and consistently assess habitual sleep in infancy. Common assessment methods include easy to deploy but subjective parent-report measures (diary/sleep questionnaire); or more labour-intensive but objective motor movement measures (actigraphy). Understanding the degree to which these methods provide converging insights is important, but cross-method agreement has yet to be investigated longitudinally. Moreover, it is unclear whether concordance systematically varies with infant or maternal characteristics that could represent confounders in observational studies. This longitudinal study (up to 4 study visits/participant) investigated cross-method concordance on one objective (7-day actigraphy) and three commonly used subjective (7-day sleep diary, Brief Infant Sleep Questionnaire, Sleep & Settle Questionnaire) sleep measures in 76 typically developing infants (age: 4–14 months) and assessed the impact of maternal characteristics (stress, age, education) and infant characteristics (age) on cross-method concordance. In addition, associations between objective and subjective sleep measures and a measure of general developmental status (Ages & Stages Questionnaire) were investigated. A range of equivalence analyses (tests of equivalence, correlational analyses, Bland-Altman plots) showed mixed agreement between sleep measures. Most importantly, cross-method agreement was associated with maternal stress levels and infant age. Specifically, agreement between different measures of night waking was better for mothers experiencing higher stress levels and was higher for younger than older infants; the reverse pattern was true for day sleep duration. Interestingly, objective and subjective measures did not yield the same patterns of association with developmental domains, indicating that sleep method choice can influence which associations are found between sleep and cognitive development. However, results converged across day sleep and problem-solving skills, highlighting the importance of studying day sleep in future studies. We discuss implications of sleep method choice for investigating sleep in the context of studying infant development and behaviour. A range of equivalence analyses showed mixed agreement between subjective and objective sleep measures. Cross-method agreement was associated with maternal stress levels and infant age. Objective and subjective measures did not yield the same patterns of association with developmental domains except for day sleep duration.
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22
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Unno M, Morisaki T, Kinoshita M, Saikusa M, Iwata S, Fukaya S, Yamashita Y, Nakayama M, Saitoh S, Iwata O. Validation of actigraphy in hospitalised newborn infants using video polysomnography. J Sleep Res 2021; 31:e13437. [PMID: 34263949 DOI: 10.1111/jsr.13437] [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] [Received: 03/22/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
Actigraphy has been established as a reliable sleep assessment tool in adults; however, its utility in newborns remains unknown. Validation of actigraphy in newborns may provide a significant insight into the physiological and pathological acquisition process of mature diurnal sleep patterns and subsequent morbidities in both newborns and their mothers. Thus, the present study aimed to evaluate the accuracy of sleep-wake detection by overnight actigraphy in a cohort of newborns. Simultaneous recording of polysomnography and actigraphy data was performed in 40 newborns admitted to a tertiary neonatal intensive care unit (NICU). A mixed-effects logistic regression model to explain the sleep state identified by polysomnography was employed using the actigraphic activity score as a fixed independent variable and the individual newborn's identity as a random effect. To evaluate the usefulness of the actigraphic activity score as a surrogate marker of sleep, a receiver operating characteristic (ROC) curve analysis was performed using the variables that were used in the mixed-effects logistic regression model, and the area under the curve (AUC) was assessed. The results showed that polysomnography-determined sleep epochs were associated with a smaller activity index on actigraphy (odds ratio per 10 activity indices increase 0.81, 95% confidence interval [CI] 0.79-0.84). The AUC for the ROC curve was 0.87 (95% CI 0.87-0.88, range 0.54-0.99). An activity score of 124 showed the maximum overall accuracy (90.2%, 95% CI 87.7-92.1). Our present study suggests that sleep-wake states of NICU-hospitalised newborns can be precisely determined using actigraphy on the ankle.
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Affiliation(s)
- Mitsuaki Unno
- Department of Neonatology, St. Mary's Hospital, Kurume, Japan
| | - Toshihiro Morisaki
- Department of Environmental Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Masahiro Kinoshita
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Mamoru Saikusa
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Sachiko Iwata
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.,Department of Pediatrics and Neonatology, Center for Human Development and Family Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoko Fukaya
- Department of Pediatrics and Neonatology, Center for Human Development and Family Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yushiro Yamashita
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Meiho Nakayama
- Department of Otolaryngology, Good Sleep Centre, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Center for Human Development and Family Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Osuke Iwata
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.,Department of Pediatrics and Neonatology, Center for Human Development and Family Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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23
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Tsai SY, Lee CC, Tsai HY, Tung YC. Bedtime routines and objectively assessed sleep in infants. J Adv Nurs 2021; 78:154-164. [PMID: 34245182 DOI: 10.1111/jan.14968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/28/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022]
Abstract
AIMS To examine the association of the timing and consistency of parent bedtime routines with infant night-time sleep duration and variability. DESIGN This was a prospective observational study conducted between November 2012 and November 2016. METHODS Three hundred and twenty healthy 6-month-old infants were recruited from the well-child clinics of a university-affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. RESULTS One hundred and ninety-seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night-time sleep duration (b = -23.55, p < 0.01). Infants with a bedtime routine of <3-4 nights per week were associated with more variable night-time sleep duration than a bedtime routine of 5-6 nights per week (b = -7.81, p < 0.05) or every night (b = -8.47, p < 0.05). CONCLUSION A bedtime routine of at least 5 nights a week and initiated no later than 9 PM was associated with longer and less variable night-time sleep in infancy. Findings suggest that a consistent bedtime routine implemented in accordance with age-appropriate bedtimes should be addressed as part of anticipatory guidance in the well-child clinics. Future studies should include infant sleep variability as an outcome in addition to the conventional mean-level sleep variable analyses to more thoroughly characterize bedtime routine effects.
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Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Yi Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Ching Tung
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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24
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Feng S, Huang H, Wang N, Wei Y, Liu Y, Qin D. Sleep Disorders in Children With Autism Spectrum Disorder: Insights From Animal Models, Especially Non-human Primate Model. Front Behav Neurosci 2021; 15:673372. [PMID: 34093147 PMCID: PMC8173056 DOI: 10.3389/fnbeh.2021.673372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/16/2021] [Indexed: 02/05/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder with deficient social skills, communication deficits and repetitive behaviors. The prevalence of ASD has increased among children in recent years. Children with ASD experience more sleep problems, and sleep appears to be essential for the survival and integrity of most living organisms, especially for typical synaptic development and brain plasticity. Many methods have been used to assess sleep problems over past decades such as sleep diaries and parent-reported questionnaires, electroencephalography, actigraphy and videosomnography. A substantial number of rodent and non-human primate models of ASD have been generated. Many of these animal models exhibited sleep disorders at an early age. The aim of this review is to examine and discuss sleep disorders in children with ASD. Toward this aim, we evaluated the prevalence, clinical characteristics, phenotypic analyses, and pathophysiological brain mechanisms of ASD. We highlight the current state of animal models for ASD and explore their implications and prospects for investigating sleep disorders associated with ASD.
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Affiliation(s)
- Shufei Feng
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Haoyu Huang
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
| | - Na Wang
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yuanyuan Wei
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yun Liu
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
| | - Dongdong Qin
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
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25
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Horger MN, Marsiliani R, DeMasi A, Allia A, Berger SE. Researcher Choices for Infant Sleep Assessment: Parent Report, Actigraphy, and a Novel Video System. The Journal of Genetic Psychology 2021; 182:218-235. [PMID: 33845712 DOI: 10.1080/00221325.2021.1905600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Incorporating infant sleep, either as a predictor or as an outcome variable, into interdisciplinary work has become increasingly popular. Sleep researchers face many methodological choices that have implications for the reliability and validity of the data. Here, the authors directly investigated the impact of design and measurement choices in a small, longitudinal sample of infants. Three sleep measurement techniques-parent-reported sleep diaries, actigraphy (Micromini Sleep Watch), and a commercial videosomnography (Nanit)-were included, using actigraphy as the baseline. Nine infants' sleep (4 girls) was measured longitudinally using all three measurement techniques. Nanit provided summary statistics, using a proprietary algorithm, for nightly sleep parameters. The actigraphy data were analyzed with both the Sadeh Infant and Sadeh algorithms. The extent to which measurements converged on sleep start and end time, number of wake episodes, sleep efficiency, and sleep duration was assessed. Measures were positively correlated. Difference scores revealed similar patterns of greater sleep estimation in parent reports and Nanit compared with actigraphy. Bland-Altman plots revealed that much of the data were within the limits of agreement, tentatively suggesting that Nanit and actigraphy may be used interchangeably. Graphs display significant variability within and between individual infants as well as across measurement techniques. Potential confounding variables that may explain the discrepancies between parent report, Sadeh Infant, Sadeh, and Nanit are discussed. The findings are also used to speak to the advantages and disadvantages of design and measurement choices. Future directions focus on the unique contributions of each measurement technique and how to capitalize on them.
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Affiliation(s)
- Melissa N Horger
- Department of Psychology, The Graduate Center, City University of New York, New York, New York, USA
| | - Ruth Marsiliani
- Department of Psychology, The College of Staten Island, City University of New York, New York, New York, USA
| | - Aaron DeMasi
- Department of Psychology, The Graduate Center, City University of New York, New York, New York, USA
| | - Angelina Allia
- Department of Psychology, The College of Staten Island, City University of New York, New York, New York, USA
| | - Sarah E Berger
- Department of Psychology, The Graduate Center, City University of New York, New York, New York, USA.,Department of Psychology, The College of Staten Island, City University of New York, New York, New York, USA
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26
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Quante M, Hong B, von Ash T, Yu X, Kaplan ER, Rueschman M, Jackson CL, Haneuse S, Davison K, Taveras EM, Redline S. Associations between parent-reported and objectively measured sleep duration and timing in infants at age 6 months. Sleep 2021; 44:zsaa217. [PMID: 33098646 PMCID: PMC8033447 DOI: 10.1093/sleep/zsaa217] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/08/2020] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVES To compare the estimates of sleep duration and timing from survey, diary, and actigraphy in infants at age 6 months, overall and by select demographics and other factors. METHODS In total, 314 infants participating in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort in Boston, MA, USA, wore an actigraph on their left ankle for 7 days. Parents concurrently completed a sleep diary and the expanded version of the Brief Infant Sleep Questionnaire. Concordance between parent-reported and objective sleep estimates was assessed using Bland-Altman plots, Spearman's rank correlations, intraclass correlations, and linear regression models. RESULTS Mean infant age was 6.4 (0.6 SD) months; 51% were female and 42% were Non-Hispanic white. Mean total sleep duration using actigraphy was 526 (67 SD) minutes per night, 143 (42 SD) minutes per day, and 460 (100 SD) minutes during the longest nighttime sleep period. Relative to actigraphy, parent-completed survey and diary overestimated total day (by 29 and 31 minutes, respectively) and night sleep duration (67 and 43 minutes, respectively) and underestimated the longest sleep (58 minutes), with the highest agreement for sleep onset and offset timing (differences < 30 minutes). There was a tendency toward greater bias among short- and long-sleeping infants. Self-reporting bias for diary-measured longest nighttime sleep and total night sleep duration was higher in infants of parents reporting a problem with their baby's night awakenings and in low-income families, respectively. CONCLUSIONS Our findings underscore the need to be cautious when comparing findings across studies using different sleep assessment methods.
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Affiliation(s)
- Mirja Quante
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Benjamin Hong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Tayla von Ash
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Xinting Yu
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Emily R Kaplan
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Michael Rueschman
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Chandra L Jackson
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
- Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Elsie M Taveras
- Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA
| | - Susan Redline
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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27
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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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28
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Kang EK, Kim SS. Behavioral insomnia in infants and young children. Clin Exp Pediatr 2021; 64:111-116. [PMID: 32683806 PMCID: PMC7940085 DOI: 10.3345/cep.2020.00052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022] Open
Abstract
In infants and young children, bedtime problems and night waking are common and the main presentations of insomnia. Poor sleep may critically impact the daytime functioning and mood of the child and their caregivers. A comprehensive sleep history, a sleep diary/log, and the BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) sleep screen are useful for diagnosing sleep problems in young children. Behavioral therapies for this type of insomnia include extinction, bedtime fading with positive routines, and scheduled awakening. Previous studies of behavioral interventions for young children showed significant improvements in sleep-onset latency, night waking frequency, and night waking duration. Parent education about their child's sleep, bedtime routines, and sleep hygiene is essential for treatment.
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Affiliation(s)
- Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seung Soo Kim
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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29
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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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30
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Schoch SF, Huber R, Kohler M, Kurth S. Which are the Central Aspects of Infant Sleep? The Dynamics of Sleep Composites across Infancy. SENSORS (BASEL, SWITZERLAND) 2020; 20:E7188. [PMID: 33333904 PMCID: PMC7765288 DOI: 10.3390/s20247188] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 02/07/2023]
Abstract
Sleep during infancy is important for the well-being of both infant and parent. Therefore, there is large interest in characterizing infant sleep with reliable tools, for example by combining actigraphy with 24-h-diaries. However, it is critical to select the right variables to characterize sleep. In a longitudinal investigation, we collected sleep data of 152 infants at ages 3, 6, and 12 months. Using principal component analysis, we identified five underlying sleep composites from 48 commonly-used sleep variables: Sleep Night, Sleep Day, Sleep Activity, Sleep Timing, and Sleep Variability. These composites accurately reflect known sleep dynamics throughout infancy as Sleep Day (representing naps), Sleep Activity (representing sleep efficiency and consolidation), and Sleep Variability (representing day-to-day stability) decrease across infancy, while Sleep Night (representing nighttime sleep) slightly increases, and Sleep Timing becomes earlier as one ages. We uncover interesting dynamics between the sleep composites and demonstrate that infant sleep is not only highly variable between infants but also dynamic within infants across time. Interestingly, Sleep Day is associated with behavioral development and therefore a potential marker for maturation. We recommend either the use of sleep composites or the core representative variables within each sleep composite for more reliable research.
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Affiliation(s)
- Sarah F. Schoch
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland; (S.F.S.); (M.K.)
- Department of Psychology, University of Zurich, 8006 Zurich, Switzerland
| | - Reto Huber
- Child Development Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland;
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland; (S.F.S.); (M.K.)
| | - Salome Kurth
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland; (S.F.S.); (M.K.)
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
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31
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Camerota M, Gueron-Sela N, Grimes M, Propper CB. Longitudinal links between maternal factors and infant cognition: Moderation by infant sleep. INFANCY 2020; 25:128-150. [PMID: 32749038 DOI: 10.1111/infa.12321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/21/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022]
Abstract
The current study examined the moderating role of infant sleep in the link between maternal factors (i.e., maternal education, depressive symptoms, sleep disturbance) and infant cognition. Data come from 95 African American parent-child dyads. At 3 months of age, infant sleep was objectively measured using videosomnography and actigraphy, from which measures of sleep regulation and consolidation were calculated. Mothers also self-reported their level of education, depressive symptoms, and sleep quality. At 6 months of age, infants completed cognitive assessments, including a measure of general cognitive ability and observed attention behavior. Findings revealed that infant sleep quality interacted with maternal education and sleep disturbances to predict cognition. Specifically, the link between maternal education and infants' attention behavior was significant and positive for infants with better regulated sleep, but not for infants with poorly regulated sleep. Similarly, the link between maternal sleep disturbance and infant cognition depended on infant sleep quality. For infants with poorer sleep consolidation, increased maternal sleep disturbance predicted poorer infant general cognitive ability. For infants with better sleep consolidation, maternal sleep disturbance was positively related to both general cognitive ability and attention behavior. These findings suggest that infant sleep quality moderates the impact of environmental factors on cognitive functioning.
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Affiliation(s)
- Marie Camerota
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noa Gueron-Sela
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melissa Grimes
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cathi B Propper
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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32
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Schoch SF, Kurth S, Werner H. Actigraphy in sleep research with infants and young children: Current practices and future benefits of standardized reporting. J Sleep Res 2020; 30:e13134. [PMID: 32638500 PMCID: PMC8244022 DOI: 10.1111/jsr.13134] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Actigraphy is a cost‐efficient method to estimate sleep–wake patterns over long periods in natural settings. However, the lack of methodological standards in actigraphy research complicates the generalization of outcomes. A rapidly growing methodological diversity is visible in the field, which increasingly necessitates the detailed reporting of methodology. We address this problem and evaluate the current state of the art and recent methodological developments in actigraphy reporting with a special focus on infants and young children. Through a systematic literature search on PubMed (keywords: sleep, actigraphy, child *, preschool, children, infant), we identified 126 recent articles (published since 2012), which were classified and evaluated for reporting of actigraphy. Results show that all studies report on the number of days/nights the actigraph was worn. Reporting was good with respect to device model, placement and sleep diary, whereas reporting was worse for epoch length, algorithm, artefact identification, data loss and definition of variables. In the studies with infants only (n = 58), the majority of articles (62.1%) reported a recording of actigraphy that was continuous across 24 hr. Of these, 23 articles (63.9%) analysed the continuous 24‐hr data and merely a fifth used actigraphy to quantify daytime sleep. In comparison with an evaluation in 2012, we observed small improvements in reporting of actigraphy methodology. We propose stricter adherence to standards in reporting methodology in order to streamline actigraphy research with infants and young children, to improve comparability and to facilitate big data ventures in the sleep community.
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Affiliation(s)
- Sarah F Schoch
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Salome Kurth
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Helene Werner
- Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland.,Division of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Zürich, Switzerland
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33
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Lerner RE, Camerota M, Tully KP, Propper C. Associations between mother-infant bed-sharing practices and infant affect and behavior during the still-face paradigm. Infant Behav Dev 2020; 60:101464. [PMID: 32650137 DOI: 10.1016/j.infbeh.2020.101464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/08/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
Parents in the United States increasingly report bed-sharing with their infants (i.e., sleeping on a shared sleep surface), but the relationship between bed-sharing and child socioemotional outcomes are not well understood. The current study examines the links between mother-infant bed-sharing at 3 months and infant affect and behavior during a dyadic challenge task at 6 months. Further, we examine nighttime mother-infant contact at 3 months as a possible mechanism that may mediate linkages between bed-sharing and infant outcomes. Using observational data from a sample of 63 mother-infant dyads, we found that infants who bed-shared for any proportion of the observation period at 3 months displayed significantly more self-regulatory behaviors during the still-face episode of the Still-Face Paradigm (SFP) at 6 months, compared to non-bed-sharing infants. Also, infants of mothers who bed-shared for the entire observation period displayed significantly less negativity during the reunion episode than non-bed-sharing infants. There was no evidence that the relations between mother-infant bed-sharing practices and infant affect and behavior during the SFP were mediated through nighttime mother-infant contact. Results suggest that infant regulation at 6 months postpartum may vary based on early nighttime experiences, with bed-sharing potentially promoting more positive and well-regulated behavior during dyadic interaction.
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Affiliation(s)
- Rachel E Lerner
- Frances L. Hiatt School of Psychology, Clark University, Worcester, MA, USA.
| | - Marie Camerota
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristin P Tully
- Center for Maternal and Infant Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Cathi Propper
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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34
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Montazeri M, Mirghafourvand M, Esmaeilpour K, Mohammad-Alizadeh-Charandabi S, Amiri P. Effects of journal therapy counseling with anxious pregnant women on their infants' sleep quality: a randomized controlled clinical trial. BMC Pediatr 2020; 20:229. [PMID: 32423396 PMCID: PMC7236485 DOI: 10.1186/s12887-020-02132-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep is especially important for infants, since it stimulates the development of neural connections in their brains. Psychological stress such as anxiety could affect sleep quality. This study investigated the effects of journal therapy counseling sessions on the infants' sleep quality based on mothers' perception (primary outcome), maternal anxiety, infants' anthropometric and developmental parameters, and the frequency of exclusive breastfeeding (secondary outcomes). METHODS A total of 70 healthy women with gestational age of 28-31 weeks participated in this randomized controlled trial. The participants were randomly allocated into intervention and control groups using randomized block design. Three in-person journal therapy sessions and three telephone counseling sessions (2 between in-person sessions and 1 one month postpartum) were provided to those in the intervention group, while the control group only received routine care. The Infant Sleep Questionnaire (ISQ), Exclusive Breastfeeding Checklist, and Infant Anthropometric Parameters Checklist were completed at two and four months postpartum. The Beck Anxiety Inventory (BAI) was completed during pregnancy, at the end of the intervention, and at two and four months postpartum, and the Ages and Stages Questionnaire (ASQ) was completed at 4 months postpartum. Data were analyzed using chi-square, independent t-test, ANCOVA and repeated measure ANOVA. RESULTS There was no significant difference between the two groups in demographic characteristics and baseline anxiety scores. The mean sleep quality score in infants two months of age (MD: -4.2; 95%CI: - 1.1 to - 7.2; P = 0.007) and four months of age (MD: -5.5; 95%CI: - 8.4 to - 2.7; P < 0.001) was significantly lower in the intervention group than that of those in the control group. Based on the repeated measure ANOVA results, the mean postpartum anxiety score of mothers in the intervention group was significantly lower than that of those in the control group (AMD: -7.7; 95%CI: - 5.5 to - 10.1; P < 0.001). There was no significant difference between the two groups regarding other outcomes including the frequency of exclusive breastfeeding, and anthropometric and developmental parameters (P > 0.05). CONCLUSION Journal therapy can decrease mothers' anxiety and improve the infants' sleep quality based on their perception. However, further studies are required before drawing any definitive conclusion. TRIAL REGISTRATION NUMBER Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N45. Date of registration: August 11, 2018. URL: https://en.irct.ir/trial/33211.
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Affiliation(s)
- Maryam Montazeri
- Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Centre, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | | | - Paria Amiri
- School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
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Quinlan CM, Tapia IE. Pediatric pulmonology year in review 2018: Sleep medicine. Pediatr Pulmonol 2019; 54:1501-1507. [PMID: 31197973 DOI: 10.1002/ppul.24415] [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: 03/29/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/05/2022]
Abstract
Pediatric Pulmonology publishes original research, case reports, and review articles on topics related to a wide range of children's respiratory disorders. In this article (Part 4 of a five-part series), we summarize the past year's publications in sleep medicine, in the context of selected literature in this area from other journals. Articles are highlighted on topics including infant sleep, diagnosis, and treatment of obstructive sleep apnea, and sleep disorders in chronic disease.
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Affiliation(s)
- Courtney M Quinlan
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ignacio E Tapia
- Division of Pulmonary Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Grimes M, Camerota M, Propper CB. Neighborhood deprivation predicts infant sleep quality. Sleep Health 2019; 5:148-151. [PMID: 30928114 PMCID: PMC6943834 DOI: 10.1016/j.sleh.2018.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/26/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The current study examined the relationship between neighborhood deprivation and infant sleep at 3 months of age. METHODS Neighborhood and sleep data were collected from 80 African American infants and their caregivers. A composite neighborhood deprivation score was created using census data. Infant sleep was measured via 7 nights of actigraphy monitoring when infants were 3 months of age. Current analyses considered the average number of infant night wakings as an index of sleep quality. Multilevel models were used, in which children (level 1) were nested within census tracts (level 2). RESULTS Controlling for level 1 covariates, greater neighborhood deprivation (b = 0.07, P < .01), was associated with poorer infant sleep, as characterized by a greater number of wakings during the nighttime sleep period. CONCLUSIONS Findings suggest that infants who reside in communities marked by higher deprivation experience poorer quality sleep, even after controlling for family-level factors.
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Affiliation(s)
- Melissa Grimes
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Campus Box 3270, 235 E. Cameron Street, Chapel Hill, NC 27599, USA.
| | - Marie Camerota
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Campus Box 3270, 235 E. Cameron Street, Chapel Hill, NC 27599, USA
| | - Cathi B Propper
- Center for Developmental Science, The University of North Carolina at Chapel Hill, East Franklin Street, Suite 200, CB#8115, Chapel Hill, NC 27599, USA
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