Effect of sleep duration on child development in Fortaleza, Northeastern Brazil

OBJECTIVE

The present study's objective is to assess whether sleep duration affects Early Childhood Development (ECD). A prospective cohort study was carried out with 278 mother-child dyads in the city of Fortaleza, northeastern Brazil, with data collection every 6 months.

METHOD

The data used in this study are from the third (18 months) and fourth (24 months) survey waves. Information on sleep duration was collected using the Brief Infant Sleep Questionnaire (BISQ) and information on ECD using the Caregiver Reported Early Development Instrument (CREDI). Crude and adjusted regression models were run for each CREDI domain as an outcome with 5 % significance.

RESULTS

The authors found that after adjusting for maternal age and schooling, family income, and the presence of other children in the house, night sleep duration was associated with better ECD scores (cognitive: coef. 0.14; 95 % CI 0.04,0.24; language: coef. 0.10; 95 % CI 0.01,0.19; motor: coef. 0.10; 95 % CI 0.03,0.18; socio-emotional: coef. 0.16; 95 % CI 0.06,0.25; overall: coef. 0.14; 95 % CI 0.04,0.24), and the time awake at night associated with worse scores (cognitive: coef. -0.12; 95 % CI -0.23,0.02; motor: coef. -0.09; 95 % CI -0.17,-0.01; socio-emotional: coef. -0.11; 95 % CI -0.21,-0.01; overall: coef. -0.11; 95 % CI -0.21,-0.01).

CONCLUSIONS

Nocturnal sleep duration affects ECD as expressed in all CREDI scores (cognitive, language, motor, social-emotional, and overall).

Sleep deprivation in adolescent mice impairs long-term memory till early adulthood via suppression of hippocampal astrocytes

Sleep deficiency is a rampant issue in modern society, serving as a pathogenic element contributing to learning and memory impairment, with heightened sensitivity observed in children. Clinical observations suggest that learning disabilities associated with insufficient sleep during adolescence can persist through adulthood, but experimental evidence for this is lacking. In this study, we examined the impact of early-life sleep deprivation (SD) on both short-term and long-term memory, tracking the effects sequentially into adulthood. We employed a modified multiple-platform method mouse model to investigate these outcomes. SD induced over a 14-day period, beginning on postnatal day 28 (PND28) in mice, led to significant impairment in long-term memory (while short-term memory remained unaffected) at PND42. Notably, this dysfunction persisted into adulthood at PND85. The specific impairment observed in long-term memory was elucidated through histopathological alterations in hippocampal neurogenesis, as evidenced by bromodeoxyuridine (BrdU) signals, observed both at PND42 and PND85. Furthermore, the hippocampal region exhibited significantly diminished protein expressions of astrocytes, characterized by lowered levels of aquaporin 4 (AQP4), a representative molecule involved in brain clearance processes, and reduced protein expressions of brain-derived neurotrophic factors. In conclusion, we have presented experimental evidence indicating that sleep deficiency-related impairment of long-term memory in adolescence can endure into adulthood. The corresponding mechanisms may indicate that the modification of astrocyte-related molecules has led to changes in hippocampal neurogenesis.

Sleep problems and duration in school-aged children at different levels of giftedness

OBJECTIVES

Optimal sleep is crucial for developing and maintaining gifted children's cognitive abilities. However, only a few studies have explored the sleep profiles of gifted children and overlooked their internal variations. This study aimed to investigate subjective and object sleep profiles in school-aged gifted children with different levels of giftedness.

METHODS

This study included 80 school-aged children (50 % male) aged 6-11 years. Giftedness was assessed using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Subjective and objective sleep were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) and Actiwatch 2.

RESULTS

The sample was divided into three groups based on their full scale intelligence quotient (IQ): 16 typically developing children (IQ < 130), 38 moderately gifted children (IQ: 130-145), and 26 highly gifted children (IQ > 145). The highly gifted children had the mildest sleep problems, particularly in sleep duration and daytime sleepiness. Moderately gifted children had the shortest subjective average sleep duration, while the three groups had no significant differences in Actiwatch-measured sleep variables. Furthermore, CSHQ total and daytime sleepiness subscale scores were negatively associated with the full scale IQ in gifted children after controlling for confounders including emotional and behavioral problems.

CONCLUSIONS

Children with higher levels of giftedness experience fewer subjective sleep problems but have similar objective sleep parameters. It is imperative to implement tailored sleep strategies for fostering intellectual development and nurturing young talents.

Remote data collection of infant activity and sleep patterns via wearable sensors in the HEALthy Brain and Child Development Study (HBCD)

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. Wearable and remote sensing technologies have advanced data collection outside of laboratory settings to enable exploring, in more detail, the associations of early experiences with brain development and social and health outcomes. In the HBCD Study, the Novel Technology/Wearable Sensors Working Group (WG-NTW) identified two primary data types to be collected: infant activity (by measuring leg movements) and sleep (by measuring heart rate and leg movements). These wearable technologies allow for remote collection in the natural environment. This paper illustrates the collection of such data via wearable technologies and describes the decision-making framework, which led to the currently deployed study design, data collection protocol, and derivatives, which will be made publicly available. Moreover, considerations regarding actual and potential challenges to adoption and use, data management, privacy, and participant burden were examined. Lastly, the present limitations in the field of wearable sensor data collection and analysis will be discussed in terms of extant validation studies, the difficulties in comparing performance across different devices, and the impact of evolving hardware/software/firmware.

LANMAO sleep recorder versus polysomnography in neonatal EEG recording and sleep analysis

BACKGROUND

The field of neonatal sleep analysis is burgeoning with devices that purport to offer alternatives to polysomnography (PSG) for monitoring sleep patterns. However, the majority of these devices are limited in their capacity, typically only distinguishing between sleep and wakefulness. This study aims to assess the efficacy of a novel wearable electroencephalographic (EEG) device, the LANMAO Sleep Recorder, in capturing EEG data and analyzing sleep stages, and to compare its performance against the established PSG standard.

METHODS

The study involved concurrent sleep monitoring of 34 neonates using both PSG and the LANMAO device. Initially, the study verified the consistency of raw EEG signals captured by the LANMAO device, employing relative spectral power analysis and Pearson correlation coefficients (PCC) for validation. Subsequently, the LANMAO device's integrated automated sleep staging algorithm was evaluated by comparing its output with expert-generated sleep stage classifications.

RESULTS

Analysis revealed that the PCC between the relative spectral powers of various frequency bands during different sleep stages ranged from 0.28 to 0.48. Specifically, the correlation for delta waves was recorded at 0.28. The automated sleep staging algorithm of the LANMAO device demonstrated an overall accuracy of 79.60 %, Cohen kappa of 0.65, and F1 Score of 76.93 %. Individual accuracy for Wake at 87.20 %, NREM at 85.70 %, and REM Sleep at 81.30 %.

CONCLUSION

While the LANMAO Sleep Recorder's automated sleep staging algorithm necessitates further refinement, the device shows promise in accurately recording neonatal EEG during sleep. Its potential for minimal invasiveness makes it an appealing option for monitoring sleep conditions in newborns, suggesting a novel approach in the field of neonatal sleep analysis.

Actigraphy-assessed sleep duration and quality and executive function in a sample of typically developing preschoolers

Sleep is essential for cognitive development and brain maturation during early childhood. Studies focused on preschool populations using objective measures of sleep are still scarce. The objective of this study was to examine the associations between objective measures of sleep duration and quality with executive functioning in a 133 non-clinical sample of Spanish participants (Mage = 60.33 months, SD = 9.04; ages 41-77 months; 51.1% girls). Sleep was assessed for five weeknights using actigraphy; Shape School task was applied to assess inhibition and cognitive flexibility; and Word Span task was used to assess working memory. The results revealed that relation between sleep and executive functioning was significant for inhibition and working memory. Preschoolers with higher sleep efficiency showed better results in executive functioning tasks after controlling for the effect of age. Additionally, age and sleep duration and quality variables were predictive of inhibition, working memory, and cognitive flexibility. These results suggest that the different dimensions of sleep could play an important role in the development of executive functions during preschool age. Therefore, improving sleep could lead to an improvement in children's executive functioning in both clinical and educational contexts.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Reducing Noise in the NICU

BACKGROUND

In the neonatal intensive care unit (NICU), elevated noise negatively impacts the neurodevelopmental environment, interrupts sleep, and can affect brain development in neonates. The American Academy of Pediatrics recommends that noise levels in the NICU should not exceed 45 dB.

PURPOSE

The project aims were to: (1) decrease average noise level by 10% from baseline and (2) decrease exposure to severe noise (>65 dB) to <5% of the time.

METHODS

This quality improvement project was conducted during 2021-2022 as a pre/post observational design in a Level IV NICU in New York City. We monitored sound levels for 20-24 h, 5 d/wk. Quality improvement interventions included: novel approaches to staff education, visual cues for when noise thresholds were exceeded, parent education, including access to personal decibel meters, technical improvements to vital sign monitors and entry doors, and defined quiet times (HUSH) for 2 h each 12-hour shift.

RESULTS

Education efforts and technical improvements successfully reduced median noise levels within the stepdown unit ( P < .001), though not in the acute care NICU. In contrast, the implementation of 2-hour periods of enforced "quiet time" every 12 h effectively reduced both median noise levels and the incidence of severe noise (>65 dB) in both locations.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The HUSH strategy may be a sustainable way to decrease noise in the NICU. Future projects should prioritize education and dedicated quiet times to align with recommended standards, while research should explore the long-term developmental impacts of excessive noise levels on neonatal growth.

Sleep EEG signatures in mouse models of 15q11.2-13.1 duplication (Dup15q) syndrome

BACKGROUND

Sleep disturbances are a prevalent and complex comorbidity in neurodevelopmental disorders (NDDs). Dup15q syndrome (duplications of 15q11.2-13.1) is a genetic disorder highly penetrant for NDDs such as autism and intellectual disability and it is frequently accompanied by significant disruptions in sleep patterns. The 15q critical region harbors genes crucial for brain development, notably UBE3A and a cluster of gamma-aminobutyric acid type A receptor (GABAAR) genes. We previously described an electrophysiological biomarker of the syndrome, marked by heightened beta oscillations (12-30 Hz) in individuals with Dup15q syndrome, akin to electroencephalogram (EEG) alterations induced by allosteric modulation of GABAARs. Those with Dup15q syndrome exhibited increased beta oscillations during the awake resting state and during sleep, and they showed profoundly abnormal NREM sleep. This study aims to assess the translational validity of these EEG signatures and to delve into their neurobiological underpinnings by quantifying sleep physiology in chromosome-engineered mice with maternal (matDp/ + mice) or paternal (patDp/ + mice) inheritance of the full 15q11.2-13.1-equivalent duplication, and mice with duplication of just the UBE3A gene (Ube3a overexpression mice; Ube3a OE mice) and comparing the sleep metrics with their respective wildtype (WT) littermate controls.

METHODS

We collected 48-h EEG/EMG recordings from 35 (23 male, 12 female) 12-24-week-old matDp/ + , patDp/ + , Ube3a OE mice, and their WT littermate controls. We quantified baseline sleep, sleep fragmentation, spectral power dynamics during sleep states, and recovery following sleep deprivation. Within each group, distinctions between Dup15q mutant mice and WT littermate controls were evaluated using analysis of variance (ANOVA) and student's t-test. The impact of genotype and time was discerned through repeated measures ANOVA, and significance was established at p < 0.05.

RESULTS

Our study revealed that across brain states, matDp/ + mice mirrored the elevated beta oscillation phenotype observed in clinical EEGs from individuals with Dup15q syndrome. Time to sleep onset after light onset was significantly reduced in matDp/ + and Ube3a OE mice. However, NREM sleep between Dup15q mutant and WT littermate mice remained unaltered, suggesting a divergence from the clinical presentation in humans. Additionally, while increased beta oscillations persisted in matDp/ + mice after 6-h of sleep deprivation, recovery NREM sleep remained unaltered in all groups, thus suggesting that these mice exhibit resilience in the fundamental processes governing sleep-wake regulation.

CONCLUSIONS

Quantification of mechanistic and translatable EEG biomarkers is essential for advancing our understanding of NDDs and their underlying pathophysiology. Our study of sleep physiology in the Dup15q mice underscores that the beta EEG biomarker has strong translational validity, thus opening the door for pre-clinical studies of putative drug targets, using the biomarker as a translational measure of drug-target engagement. The unaltered NREM sleep may be due to inherent differences in neurobiology between mice and humans. These nuanced distinctions highlight the complexity of sleep disruptions in Dup15q syndrome and emphasize the need for a comprehensive understanding that encompasses both shared and distinct features between murine models and clinical populations.

The Association Between Diets With High Inflammatory Potential and Sleep Quality and Its Parameters: A Systematic Review

CONTEXT

Dietary components or its overall properties can influence an individual's sleep status.

OBJECTIVE

The aim for this study was to critically search, appraise, and synthesize research evidence on the association between dietary inflammatory index (DII) and sleep quality and its parameters.

DATA SOURCES

Original published studies on adults were obtained from the PubMed, SCOPUS, ScienceDirect, Cochrane Library, and Google Scholar databases.

DATA EXTRACTION

The search was conducted without date limitation until April 2023. Duplicated and irrelevant investigations were screened out, and the results of the remaining articles were descriptively summarized, then critically appraised and analyzed. Possible mechanistic pathways regarding diet, systemic inflammation, and sleep status were discussed.

DATA ANALYSIS

Of the 102 studies searched, 23 articles (n = 4 cohort studies, 18 cross-sectional studies, and 1 intervention study) were included in the final review. The association between DII and sleep status was investigated subjectively in 21 studies and objectively in 6 studies. The main studied sleep outcomes were sleep quality, duration, latency, efficiency, apnea, disturbances, the use of sleeping medications, daytime dysfunctions, wakefulness after sleep onset, and rapid eye movement.

CONCLUSIONS

According to most of the evidence, DII may not be related to overall sleep quality, sleep duration, latency, efficiency, and the use of sleeping medications. The evidence of positive association was greater between a high DII score (pro-inflammatory diet) with daytime dysfunctions, wakefulness after sleep onset, and sleep apnea. There is insufficient evidence to make any conclusion regarding sleep disturbances and rapid eye movement.

Treatment for behavioral insomnia in young children with neurotypical development under 6 years of age: A systematic review

This literature review examines all treatments for behavioral insomnia in children under 6 years of age to determine which treatments have empirically demonstrated efficacy. Following PRISMA guidelines, three databases were investigated (Pubmed, Cochrane and Psychinfo) to select randomized controlled trials (RCTs) which assess treatments for behavioral insomnia in children under 6 years of age, all with neurotypical development. A total of 908 articles met the search criteria. 21 articles were selected and analyzed in their entirety for a total of 2363 children (ranging from 2 months to 6 years of age). Based on these studies, treatment of behavioral insomnia in young children under 6 years of age is primarily based on behavioral therapy. There is no evidence that pharmacological treatments are effective in the long term for neurotypical children. This review highlights the lack of RCTs in this field: new RCTs should be carried out among young children to refine and optimize the therapeutic approach and to address the risk of therapeutic abuse through the use of non-scientifically validated methods.

Sleep loss disrupts decision-making ability and neuronal cytomorphology in zebrafish and the effects are mediated by noradrenaline acting on α1-adrenoceptor

Sleep is an instinct behavior, and its significance and functions are still an enigma. It is expressed throughout one's life and its loss affects psycho-somatic and physiological processes. We had proposed that it might maintain a fundamental property of the neurons and the brain. In that context, it was shown that sleep, rapid eye movement sleep (REMS) in particular, by regulating noradrenaline (NA), maintains the brain excitability. It was also reported that sleep-loss affected memory, reaction time and decision-making ability among others. However, as there was lack of clarity on the cause-and-effect relationship as to how the sleep-loss could affect these basic behaviors, their association was questioned and it was difficult to propose a cure or at least ways and means to ameliorate the symptoms. Also, we wanted to conduct the studies in a simpler model system so that conducting future molecular studies might be easier. Hence, using zebrafish as a model we evaluated if sleep-loss affected the basic decision-making ability, a cognitive process and if the effect was induced by NA. Indeed, our findings confirmed that upon sleep-deprivation, the cognitive decision-making ability of the prey zebrafish was compromised to protect itself by running away from the reach of the exposed predator Tiger Oscar (TO) fish. Also, we observed that upon sleep-loss the axonal arborization of the prey zebrafish brain was reduced. Interestingly, the effects were prevented by prazosin (PRZ), an α1-adrenoceptor (AR) antagonist and when the zebrafish recovered from the lost sleep.

Postweaning intermittent sleep deprivation enhances defensive attack in adult female mice via the microbiota-gut-brain axis

Sleep is one of the most important physiological activities in life and promotes the growth and development of an individual. In modern society, sleep deprivation (SD), especially among adolescents, has become a common phenomenon. However, long-term SD severely affected adolescents' neurodevelopment leading to abnormal behavioral phenotypes. Clinical studies indicated that sleep problems caused increased aggressive behavior in adolescents. Aggressive behavior was subordinate to social behaviors, in which defensive attack was often the last line for survival. Meanwhile, increasing studies shown that gut microbiota regulated social behaviors by affecting specific brain regions via the gut-brain axis. However, whether postweaning intermittent SD is related to defensive attack in adulthood, and if so, whether it is mediated by the microbiota-gut-brain axis are still elusive. Combined with microbial sequencing and hippocampal metabolomics, the present study mainly investigated the long-term effects of postweaning intermittent SD on defensive attack in adult mice. Our study demonstrated that postweaning intermittent SD enhanced defensive attack and impaired long-term memory formation in adult female mice. Moreover, microbial sequencing and LC-MS analysis showed that postweaning intermittent SD altered the gut microbial composition and the hippocampal metabolic profile in female mice, respectively. Our attention has been drawn to the neuroactive ligand-receptor interaction pathway and related metabolites. In conclusion, our findings provide a new perspective on the relationship of early-life SD and defensive attack in adulthood, and also highlight the importance of sleep in early-life, especially in females.

SIRT6 Improves Hippocampal Neurogenesis Following Prolonged Sleep Deprivation Through Modulating Energy Metabolism in Developing rats

OBJECTIVE

Prolonged sleep deprivation is known to have detrimental effects on the hippocampus during development or in adulthood. Furthermore, it is well-established that sleep deprivation disrupts energy metabolism broadly. SIRT6 is a critical regulator of energy metabolism in both central and peripheral tissues. This study aims to investigate the role of SIRT6 in modulating hippocampal neurogenesis following sleep deprivation during development, and elucidate the underlying mechanism.

METHODS

Male Sprague-Dawley rats, aged three weeks, were subjected to 2 weeks of sleep deprivation using the modified multiple platform method. Metabolomic profiling was carried out using the liquid chromatography-electrospray ionization-tandem mass spectrometry (LC‒ESI‒MS/MS). To investigate the role of SIRT6 in energy metabolism, the rats were administered with either the SIRT6-specific inhibitor, OSS128167, or SIRT6-overexpressing adeno-associated virus (AAV). Hippocampal neurogenesis was assessed by immunostaining with markers for neural stem cells (SOX2), immature neurons [doublecortin (DCX)] and newborn cells (BrdU). Sparse labeling of adult neurons was used to determine the density of dendritic spines in the dentate gyrus (DG). The Y-maze and novel object recognition (NOR) tests were performed to evaluate the spatial and recognition memory. SIRT6 expression was examined using immunofluorescence and western blotting (WB). The inhibition of SIRT6 was confirmed by assessing the acetylation of histone 3 lysine 9 (aceH3K9), a well-known substrate of SIRT6, through WB.

RESULTS

Sleep deprivation for a period of two weeks leads to inhibited hippocampal neurogenesis, reduced density of dendritic spines in the DG, and impaired memory, accompanied by decreased SIRT6 expression and disrupted energy metabolism. Similar to sleep deprivation, administration of OSS128167 significantly decreased energy metabolism, leading to reduced neurogenesis and memory dysfunction. Notably, the abnormal hippocampal energy metabolism, neurogenetic pathological changes and memory dysfunction caused by sleep deprivation were alleviated by SIRT6 overexpression in the DG.

CONCLUSION

Our results suggest that SIRT6 plays a critical role in maintaining energy metabolism homeostasis in the hippocampus after sleep deprivation, promoting hippocampal neurogenesis and enhancing memory during development.

Sleep duration in preschool age and later behavioral and cognitive outcomes: an individual participant data meta-analysis in five European cohorts

Short sleep duration has been linked to adverse behavioral and cognitive outcomes in schoolchildren, but few studies examined this relation in preschoolers. We aimed to investigate the association between parent-reported sleep duration at 3.5 years and behavioral and cognitive outcomes at 5 years in European children. We used harmonized data from five cohorts of the European Union Child Cohort Network: ALSPAC, SWS (UK); EDEN, ELFE (France); INMA (Spain). Associations were estimated through DataSHIELD using adjusted generalized linear regression models fitted separately for each cohort and pooled with random-effects meta-analysis. Behavior was measured with the Strengths and Difficulties Questionnaire. Language and non-verbal intelligence were assessed by the Wechsler Preschool and Primary Scale of Intelligence or the McCarthy Scales of Children's Abilities. Behavioral and cognitive analyses included 11,920 and 2981 children, respectively (34.0%/13.4% of the original sample). In meta-analysis, longer mean sleep duration per day at 3.5 years was associated with lower mean internalizing and externalizing behavior percentile scores at 5 years (adjusted mean difference: - 1.27, 95% CI [- 2.22, - 0.32] / - 2.39, 95% CI [- 3.04, - 1.75]). Sleep duration and language or non-verbal intelligence showed trends of inverse associations, however, with imprecise estimates (adjusted mean difference: - 0.28, 95% CI [- 0.83, 0.27] / - 0.42, 95% CI [- 0.99, 0.15]). This individual participant data meta-analysis suggests that longer sleep duration in preschool age may be important for children's later behavior and highlight the need for larger samples for robust analyses of cognitive outcomes. Findings could be influenced by confounding or reverse causality and require replication.

Is the association between sleep and socio-emotional development mediated by weight in toddlers aged 12 to 36 months?

Introduction

Childhood is an important stage for socio-emotional development. Understanding the associations of lifestyle habits with the healthy development of social and emotional skills is crucial for better interventions early in life. This study aims to analyze the association between sleep and socio-emotional development in toddlers aged 12 to 36 months and examine whether weight mediated these associations.

Methods

This study is part of a cluster randomized controlled trial developed in Portuguese childcare centers. A sample of 344 children (176 females) enrolled in the study. Participants' anthropometrics were measured while at childcare centers using standardized procedures. Body mass index (BMI) was computed as the body weight/height2 (kg/m2) ratio. Sleep quality was collected with the Tayside Children's Sleep Questionnaire, a 10-item scale that evaluates the child's ability to initiate and maintain sleep. Two additional questions regarding sleep duration were added. Parental questionnaires assessed the child's sex and date of birth, socioeconomic status, and total energy intake (TEI). Motor (fine and gross) was assessed using Bayley-III scales and socio-emotional (SE) by the Greenspan Social-Emotional Growth Chart questionnaire. Linear regression models were used to examine the associations between sleep (duration and quality) and SE with adjustments for sex, age, BMI, mothers' education, motor development, and TEI. Mediation analysis was conducted using path analysis.

Results

SE development was significantly associated with nighttime sleep duration even when adjusted for confounders (β = 0.223; 95% CI: 0.001, 0.004 and β = 0.168; 0.0003, 0.003; respectively). Sleep quality was not significantly associated with SE development, and the weight did not explain the associations between sleep and SE development.

Conclusion

This study supports that sleep duration is directly associated with SE development in toddlers. From a public health perspective, sleep duration should be prioritized in intervention programs to improve socio-emotional development early in life.

Association of early bedtime at 3 years of age with higher academic performance and better non-cognitive skills in elementary school

This study investigated the relationship between sleep habits in early childhood and academic performance and non-cognitive skills in the first grade. We retrospectively analyzed a longitudinal population-based cohort from birth through early childhood, up to elementary school, in Amagasaki City, Japan. The primary outcome was academic performance in the first grade. Other outcomes were self-reported non-cognitive skills. Overall, 4395 children were enrolled. Mean national language scores for children with bedtimes at 18:00-20:00, 21:00, 22:00, and ≥ 23:00 were 71.2 ± 19.7, 69.3 ± 19.4, 68.3 ± 20.1, and 62.5 ± 21.3, respectively. Multiple regression analysis identified bedtime at 3 years as a significant factor associated with academic performance. However, sleep duration was not significantly associated with academic performance. Bedtime at 3 years also affected non-cognitive skills in the first grade. Diligence decreased with a later bedtime (21:00 vs. 18:00-20:00; odds ratio [OR]: 1.98, 95% confidence interval [CI] 1.27-3.09; 22:00 vs. 18:00-20:00; OR: 2.15, 95% CI 1.37-3.38; ≥ 23:00 vs. 18:00-20:00; OR: 2.33, 95% CI 1.29-4.20). Thus, early bedtime at 3 years may be associated with a higher academic performance and better non-cognitive skills in the first grade. Optimum early-childhood sleep habits may positively impact academic future.

The unified theory of sleep: Eukaryotes endosymbiotic relationship with mitochondria and REM the push-back response for awakening

The Unified Theory suggests that sleep is a process that developed in eukaryotic animals from a relationship with an endosymbiotic bacterium. Over evolutionary time the bacterium evolved into the modern mitochondrion that continues to exert an effect on sleep patterns, e.g. the bacterium Wolbachia establishes an endosymbiotic relationship with Drosophila and many other species of insects and is able to change the host's behaviour by making it sleep. The hypothesis is supported by other host-parasite relationships, e.g., Trypanosoma brucei which causes day-time sleepiness and night-time insomnia in humans and cattle. For eukaryotes such as Monocercomonoids that don't contain mitochondria we find no evidence of them sleeping. Mitochondria produce the neurotransmitter gamma aminobutyric acid (GABA), and ornithine a precursor of the neurotransmitter GABA, together with substances such as 3,4dihydroxy phenylalanine (DOPA) a precursor for the neurotransmitter dopamine: These substances have been shown to affect the sleep/wake cycles in animals such as Drosophilia and Hydra. Eukaryote animals have traded the very positive side of having mitochondria providing aerobic respiration for them with the negative side of having to sleep. NREM (Quiet sleep) is the process endosymbionts have imposed upon their host eukaryotes and REM (Active sleep) is the push-back adaptation of eukaryotes with brains, returning to wakefulness.

Prenatal depressive symptoms are associated with altered structural brain networks in infants and moderated by infant sleep

BACKGROUND

The prevalence of prenatal depressive symptoms has more than doubled during the COVID-19 pandemic, raising substantial concerns about child outcomes including sleep problems and altered brain development. The objective of this work was to determine relationships between prenatal depressive symptoms, infant brain network structure, and infant sleep.

METHODS

Pregnant individuals were recruited as part of the Pregnancy during the Pandemic (PdP) study. Maternal depressive symptoms were measured in pregnancy and postpartum. When infants of those participants were 3 months of age (n=66; 26 females), infants underwent diffusion magnetic resonance imaging and infant sleep was evaluated. Using tractography, we calculated structural connectivity matrices for the default mode (DMN) and limbic networks. We examined associations between graph theory metrics of infant brain networks and prenatal maternal depressive symptoms, with infant sleep as a moderator.

RESULTS

Prenatal depressive symptoms were negatively related to average DMN clustering coefficient and local efficiency in infant brains. Infant sleep duration was related to DMN global efficiency and moderated the relationship between prenatal depressive symptoms and density of limbic connections such that infants who slept less had a more negative relationship between prenatal depressive symptoms and local brain connectivity.

CONCLUSIONS

Prenatal depressive symptoms appear to impact early topological development in brain networks important for emotion regulation. In the limbic network, sleep duration moderated this relationship, suggesting sleep may play a role in infant brain network development.

Exposure to secondhand smoke is associated with poor sleep quality among non-smoking university students in Bangladesh: a cross-sectional survey

Although secondhand smoke (SHS) exposure is predominant in Bangladesh, the adverse effect of SHS exposure on health-related behaviors, such as sleep quality, have remained an under-investigated area of the country's public health landscape. Therefore, the purpose of this study was to examine the association between SHS exposure and poor sleep quality among non-smoking university students in Bangladesh. A cross-sectional survey was carried out between May and September 2022. SHS exposure (main predictor variable) and other covariates (e.g., age, sex, etc.) were measured using a self-reported questionnaire and sleep quality (outcome variable) was measured via the Pittsburgh Sleep Quality Index. Multiple logistic regression models investigated the association between SHS exposure and poor sleep quality. The study included 390 students (mean age: 22 years, 53.8% male). Approximately 41.8% of the participants reported SHS exposure, and 50.5% had poor sleep quality. Students exposed to SHS were more likely to have poor sleep quality compared to their counterparts (AOR = 1.61; 95% CI 1.01, 2.58). Subgroup analysis revealed poor sleep quality was 2-times higher among male students exposed to SHS than those male students without SHS exposure (AOR = 2.03; 95% CI 1.05, 3.93). No association was found in female students. Findings from this study warrant increased awareness and public health initiatives on the implications of SHS on health behaviors, such as sleep quality, in non-smoking Bangladeshi university students.

Sleep and psychiatric symptoms in young child psychiatric outpatients - a Follow-up study

BACKGROUND

Knowledge of the continuity of sleep problems and the associations between sleep and psychiatric symptoms in child psychiatric patients is scarce.

OBJECTIVES

To investigate the persistency of sleep problems and how sleep at preschool age predicts sleep problems and psychiatric symptoms at school age in child psychiatric patients.

METHODS

Participants (n = 68) were child psychiatry outpatients at Helsinki University Hospital in 2015-2017. Caregivers evaluated sleep with the Sleep Disturbance Scale for Children (SDSC) and psychiatric symptoms with the Child Behavior Checklist (CBCL) at baseline (age 4-7 years) and again at follow-up (age 8-13 years). Family background information was collected at both time points.

RESULTS

Sleep problems at preschool age predicted sleep problems at school age (R2Adjusted = .48, p < .001). Persistent sleep problems associated strongly with the intensity of psychiatric symptoms (p = .001). Internalizing symptoms were predicted by sleep problems (p = .038) even after controlling for age, sex, and psychiatric symptoms at preschool age.

CONCLUSION

Sleep problems are prevalent and persistent and relate to psychiatric symptoms in children treated at child psychiatry clinics. These results emphasize the need for identification and treatment of sleep problems in these children.

REM-OSA as a Tool to Understand Both the Architecture of Sleep and Pathogenesis of Sleep Apnea-Literature Review

Sleep is a complex physiological state, which can be divided into the non-rapid eye movement (NREM) phase and the REM phase. Both have some unique features and functions. This difference is best visible in electroencephalography recordings, respiratory system activity, arousals, autonomic nervous system activity, or metabolism. Obstructive sleep apnea (OSA) is a common condition characterized by recurrent episodes of pauses in breathing during sleep caused by blockage of the upper airways. This common condition has multifactorial ethiopathogenesis (e.g., anatomical predisposition, sex, obesity, and age). Within this heterogenous syndrome, some distinctive phenotypes sharing similar clinical features can be recognized, one of them being REM sleep predominant OSA (REM-OSA). The aim of this review was to describe the pathomechanism of REM-OSA phenotype, its specific clinical presentation, and its consequences. Available data suggest that in this group of patients, the severity of specific cardiovascular and metabolic complications is increased. Due to the impact of apneas and hypopneas predominance during REM sleep, patients are more prone to develop hypertension or glucose metabolism impairment. Additionally, due to the specific function of REM sleep, which is predominantly fragmented in the REM-OSA, this group presents with decreased neurocognitive performance, reflected in memory deterioration, and mood changes including depression. REM-OSA clinical diagnosis and treatment can alleviate these outcomes, surpassing the traditional treatment and focusing on a more personalized approach, such as using longer therapy of continuous positive airway pressure or oral appliance use.

The Influence of Emotional Regulation and Cognitive Flexibility on Sleep Habits in Spanish Children and Adolescents through the Lens of Parents

BACKGROUND

Previous research studies have suggested the importance of studying the relationship between emotional regulation and sleep habits. Some investigations have especially focused on how emotional regulation could impact sleep habits in children and adolescents. Therefore, these researchers have stated there exists a two-way direction in this relationship.

OBJECTIVE

This study aimed to analyze the influence of emotional regulation on sleep habits in Spanish children and adolescents and the mediating role of anxiety in this relationship.

METHOD

Participants were 953 Spanish parents who completed the assessment protocol according to their children and adolescents' information.

RESULTS

The results revealed moderate-strong correlations between emotional regulation problems and sleep habit disturbances (r = 0.375, p < 0.001), trait (r = 0.488, p < 0.001) anxiety, and state (r = 0.589, p < 0.001) anxiety. Additionally, emotional regulation showed a direct impact on sleep habits (β = 0.011, p = 0.005). Trait and state anxiety demonstrated a significant mediating role in the relationship between emotional regulation and sleep habits.

CONCLUSIONS

Emotional regulation may have an impact on sleep habits during childhood and adolescence, suggesting the importance of early intervention focused on the emotions management and the prevention of sleep habit disturbances.

Consensus statement on Singapore integrated 24-hour activity guide for early childhood

Introduction

Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health.

Method

The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases.

Results

Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results.

Conclusion

This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.

Association of Breastfeeding Practices During the First 3 Months with Infant Sleep Trajectories: A Prospective Cohort Study

BACKGROUND

Breastfeeding has numerous effects on maternal and child health. The effect of breastfeeding on infant sleep remains inconclusive.

OBJECTIVES

We aimed to examine whether full breastfeeding (FBF) during the first 3 mo is associated with longitudinal infant sleep trajectories in their first 2 y of life.

METHODS

The study was embedded in the Tongji Maternal and Child Health Cohort study. Information on infant feeding practices was collected at 3 mo of age, and maternal/child pairs were assigned to the FBF or the non-FBF group (including partially breastfeeding and exclusive formula feeding) on the basis of feeding practices during the first 3 mo of life. Sleep data of infants were obtained at 3, 6, 12, and 24 mo. Total, night, and day sleep trajectories across 3 to 24 mo were estimated with group-based models. Each sleep trajectory was differentiated on the basis of sleep duration at 3 mo (long/moderate/short) and the interval from 6 to 24 mo (moderate/short). Multinomial logistic regression was used to investigate the association of breastfeeding practices with infant sleep trajectories.

RESULTS

Among the 4056 infants studied, 2558 (63.1%) received FBF for 3 mo. When compared with FBF infants, non-FBF infants had shorter sleep duration at 3, 6, and 12 mo (P < 0.01). Non-FBF infants were more likely to experience Moderate-Short (OR: 1.31; 95% CI: 1.06, 1.61) and Short-Short (OR: 1.56; 95% CI: 1.12, 2.16) total sleep trajectories and more likely to experience Moderate-Short (OR: 1.84; 95% CI: 1.22, 2.77), and Short-Moderate (OR: 1.40; 95% CI: 1.06, 1.85) night sleep trajectories than FBF infants.

CONCLUSIONS

Full breastfeeding for ≥3 mo were positively associated with longer infant sleep duration. Infants fully breastfed were more likely to experience better sleep trajectories characterized by longer duration in their first 2 y of life. Full breastfeeding may benefit infants through healthy sleep.

Sleep state organisation of moderate to late preterm infants in the neonatal unit

BACKGROUND

Sleep supports neurodevelopment and sleep architecture reflects brain maturation. This prospective observational study describes the nocturnal sleep architecture of healthy moderate to late preterm (MLP) infants in the neonatal unit at 36 weeks post menstrual age (PMA).

METHODS

MLP infants, in the neonatal unit of a tertiary hospital in Ireland from 2017 to 2018, had overnight continuous electroencephalography (cEEG) with video for a minimum 12 h at 36 weeks PMA. The total sleep time (TST) including periods of active sleep (AS), quiet sleep (QS), indeterminate sleep (IS), wakefulness and feeding were identified, annotated and quantified.

RESULTS

A total of 98 infants had cEEG with video monitoring suitable for analysis. The median (IQR) of TST in the 12 h period was 7.09 h (IQR 6.61-7.76 h), 4.58 h (3.69-5.09 h) in AS, 2.02 h (1.76-2.36 h) in QS and 0.65 h (0.48-0.89 h) in IS. The total duration of AS was significantly lower in infants born at lower GA (p = 0.007) whilst the duration of individual QS periods was significantly higher (p = 0.001).

CONCLUSION

Overnight cEEG with video at 36 weeks PMA showed that sleep state architecture is dependent on birth GA. Infants with a lower birth GA have less AS and more QS that may have implications for later neurodevelopment.

IMPACT

EEG provides objective information about the sleep organisation of the moderate to late preterm (MLP) infant. Quantitative changes in sleep states occur with each week of advancing gestational age (GA). Active sleep (AS) is the dominant sleep state that was significantly lower in infants born at lower GA. MLP infants who were exclusively fed orally had a shorter total sleep time and less AS compared to infants who were fed via nasogastric tube.

The Architecture of Early Childhood Sleep Over the First Two Years

INTRODUCTION

The architecture and function of sleep during infancy and early childhood has not been fully described in the scientific literature. The impact of early sleep disruption on cognitive and physical development is also under-studied. The aim of this review was to investigate early childhood sleep development over the first two years and its association with neurodevelopment.

METHODS

This review was conducted according to the 2009 PRISMA guidelines. Four databases (OVID Medline, Pubmed, CINAHL, and Web of Science) were searched according to predefined search terms.

RESULTS

Ninety-three studies with approximately 90,000 subjects from demographically diverse backgrounds were included in this review. Sleep is the predominant state at birth. There is an increase in NREM and a decrease in REM sleep during the first two years. Changes in sleep architecture occur in tandem with development. There are more studies exploring sleep and early infancy compared to mid and late infancy and early childhood.

DISCUSSION

Sleep is critical for memory, learning, and socio-emotional development. Future longitudinal studies in infants and young children should focus on sleep architecture at each month of life to establish the emergence of key characteristics, especially from 7-24 months of age, during periods of rapid neurodevelopmental progress.

Perinatal Physiological and Psychological Risk Factors and Childhood Sleep Outcomes: A Systematic Review and Meta-analysis

OBJECTIVES

The purpose of this study was to investigate the influence of maternal physiological and psychological factors during pregnancy and after birth on infant and children's sleep outcomes.

METHODS

Six databases were searched from inception to April 2021. Longitudinal studies that investigated the association of risk factors during and after pregnancy and children's sleep-related outcomes were included. Hedge's g and odds ratio were pooled as effect size with random effects model.

RESULTS

A total of 32 articles were included. Both prenatal maternal alcohol use (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.04-3.28) and tobacco smoking (OR = 1.28, 95% CI: 1.01-1.62) were associated with shorter child sleep duration. Prenatal and postnatal maternal depression symptoms were associated with increased child sleep problems at age 6 months (OR = 1.97, 95% CI: 1.19-3.24, and 2.05, 95% CI: 1.37-3.07, respectively). Prenatal and postnatal maternal major depression disorders were associated with shorter sleep duration (Hedge's g = -0.97, 95% CI: -1.57 to -0.37) and lower sleep efficiency (Hedge's g = -1.44, 95% CI: -1.93 to -0.95). Prenatal anxiety had no impact on child sleep problems (OR = 1.34, 95% CI: 0.86-2.10).

CONCLUSION

Maternal pregnancy and obstetric factors and psychological factors are potential risk factors of poor child sleep health. Future research is warranted to better understand the impact of these risk factors on long-term child sleep outcomes and their potential mediating mechanisms.

Prenatal alcohol exposure and child sleep problems: A family-based quasi-experimental study

Background

We examine whether associations between prenatal exposure to hazardous maternal alcohol consumption during the first trimester of pregnancy and sleep problems in young children represent a causal association.

Methods

The population-based sample consists of 15,911 mothers with 30,395 offspring from the Norwegian Mother, Father, and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). Women self-reported pre-pregnancy alcohol consumption and consumption during the first trimester of pregnancy twice: at gestational weeks 17 and 30. Mothers reported their children's sleep problems, when they were 1.5 and 3 years (mean = 50; SD = 10). We tested models adjusting for (1) measured confounders, (2) unmeasured familial risk factors by sibling design, and (3) maternal hazardous drinking in the 3 months prior to pregnancy as an instrumental variable within the sibling design.

Results

Children of mothers with hazardous drinking during the first trimester were at increased risk of sleep problems at 1.5 (β = 1.14, 95%CI 0.04-2.25) and 3 (β = 2.86, 95%CI 1.85-3.87) years of age. These associations were reduced to close to zero and non-significant at 1.5 (β = -0.32, 95%CI -1.91-1.26) and 3 (β = 0.06, 95%CI -1.56-1.64) years when controlling for both familial and measured environmental risk factors.

Conclusions

There is a moderate association between maternal hazardous drinking during pregnancy and offspring sleep problems up to age three. This association is explained by risk factors differing between families and does not reflect a cause-effect relationship.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Sleep architecture in neonatal and infantile onset epilepsies in the first six months of life: A scoping review

AIM

Epilepsy occurs in approximately 80 per 100,000 infants in the first year of life, ranging in severity from self-limited and likely to spontaneously resolve, to severe developmental and epileptic encephalopathies. Sleep plays a key role in early brain development and the reciprocal relationship between sleep and seizures is not yet fully understood, particularly in young children. We conducted a Scoping Review to synthesise current knowledge of sleep architecture in neonates and infants with epilepsy.

METHOD

Peer-reviewed publications from 2005 to 2022 describing sleep architecture in infants up to six months of age with unprovoked seizures were included. The analysis set was derived from EMBASE, Web of Science and PubMED using key terms "sleep, epilepsy and infant" and related descriptors. Inclusion criteria were prospectively described in a Scoping Review protocol. Sleep architecture was assessed as macro- and micro-structural elements.

RESULTS

21 publications were included in the qualitative analysis. In self-limited familial and genetic epilepsy, sleep macrostructure was generally preserved. In DEEs and in epileptic encephalopathies of genetic or structural aetiology, sleep architecture was significantly disrupted.

INTERPRETATION

Early identification of infants with epilepsy is important to ensure early and effective treatment. In the DEE spectrum, sleep architecture is significantly impacted, and abnormal sleep architecture may be associated with compromised developmental outcome. Further research is needed to identify the sequence of events in abnormal brain development, epilepsy and sleep disruption and potentially help to predict the course of epilepsy towards a self-limited epilepsy versus a DEE.

Effects of a Sleep Health Education Program for Children and Parents on Child Sleep Duration and Difficulties: A Stepped-Wedge Cluster Randomized Clinical Trial

IMPORTANCE

Preschool-aged children often lack sufficient sleep and experience sleep difficulties. A consistent bedtime routine, falling asleep alone, and other sleep practices reduce difficulties and increase sleep duration.

OBJECTIVE

To evaluate the effects of a preschool-based sleep health literacy program on children's sleep duration and difficulties and on parent sleep knowledge, attitudes, self-efficacy, and beliefs 9 and 12 months after the program.

DESIGN, SETTING, AND PARTICIPANTS

This stepped-wedge cluster randomized clinical trial was implemented across the 2018-2019 school year. Head Start preschool personnel delivered interventions and collected outcomes data at baseline and 4 follow-ups. Seven Head Start agencies across New York State were randomized to implement interventions in either fall 2018 or winter and spring 2019. Outcomes were ascertained at 9- and 12-month follow-up. From March 19 through September 28, 2018, Head Start staff recruited (a) English- or Spanish-speaking parents (b) of children 3 years of age on or about September 2018 (c) who planned to remain at the site through the school year. Altogether, 519 parent-child (aged 3 years) dyads completed baseline and (any) follow-up data.

INTERVENTIONS

A 2-week classroom curriculum for children, a 1-hour parent workshop, and 1-on-1 parent discussions at home or school.

MAIN OUTCOMES AND MEASURES

Outcomes were the pre- vs postintervention differences measured at baseline and 9-month follow-up for parent-reported child school-night sleep duration per sleep logs, mild or moderate sleep difficulties per a validated questionnaire, and the total and domain scores for parent sleep knowledge, attitudes, self-efficacy, and beliefs. A modified intention-to-treat analysis excluding participants with only baseline data was used.

RESULTS

The mean (SD) age at enrollment of 519 children was 2.7 (0.1) years, 264 (50.9%) were girls, 196 (37.8%) lived in Spanish-speaking households, and 5 (0.9%) identified as Alaskan Native or American Indian, 17 (3.2%) as Asian American or Pacific Islander, 57 (10.8%) as Black, 199 (37.8%) as White, and 63 (12.0%) as other. Mean sleep durations increased nonsignificantly from baseline by 5.6 minutes (95% CI, -2.3 to 13.6 minutes; P = .17) at 9-month follow-up and by 6.8 minutes (95% CI, 0.2-13.7 minutes; P = .06) at 12-month follow-up. There was a slight improvement in parental knowledge (1.13 unit increase from baseline; 95% CI, 0.13-2.12 units), but no significant outcomes for parent sleep attitudes (0.16 unit increase from baseline; 95% CI, -0.46 to 0.77 units), self-efficacy (-0.13 unit decrease from baseline; 95% CI, -1.02 to 0.76 units) and beliefs (-0.20 unit decrease from baseline; 95% CI, -0.56 to 0.16 units). Intervention effects for child sleep difficulties were not significant (odds ratio, 1.13; 95% CI, 0.62-2.09). Fewer than 1 in 4 parents accurately perceived their child's sleep difficulty at 12 months.

CONCLUSIONS AND RELEVANCE

The findings of this large pragmatic, stepped-wedge cluster randomized clinical trial, albeit largely negative, may have implications for the sustained impact, focus, and potential population-level effects of sleep education programs. Future research should evaluate the effects of more recurrent programming that emphasizes recognition of sleep problems and whether small increments of sleep across months and years in early childhood have meaningful effects.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03556462.

Early childhood sleep trajectories and association with maternal depression: a prospective cohort study

STUDY OBJECTIVES

To investigate trajectories of early childhood sleep in the first 3 years and their association with maternal depressive symptoms.

METHODS

Data were from 243 Chinese mother-child dyads. Children's sleep duration and night-waking were assessed using the Brief Infant Sleep Questionnaire (BISQ) at 42 days, 3, 6, 9, 12, 18, 24, and 36 months postpartum. The Center for Epidemiological Survey-Depression Scale (CES-D), Edinburgh Postnatal Depression Scale (EPDS), and Profile of Mood States (POMS) were used to assess maternal depressive symptoms at late pregnancy, 42 days, and 36 months postpartum, respectively. Early childhood sleep trajectories were estimated with group-based trajectory models. The association between early childhood sleep trajectories and maternal depressive symptoms was examined with binary and multinomial logistic regression models and linear regression models.

RESULTS

Three trajectories of daytime sleep duration ("short", 14.4%; "medium", 60.4%; "long", 25.2%), nighttime sleep duration ("increasing", 17.6%; "stable", 76.3%; "decreasing", 6.1%), and total sleep duration ("short", 21.5%; "medium", 59.9%; "long",18.6%), and two trajectories of night-waking ("resolving", 22.9%; "persistent", 77.1%) were identified. Controlling for confounding factors, maternal depression at 42 days postpartum was associated with higher risks for short daytime sleep duration and persistent night-waking in children. Persistent night-waking in children was associated with increased maternal depressive symptoms at 36 months postpartum.

CONCLUSION

Early childhood sleep follows distinct trajectories in the first 3 years of life. The trajectories of short daytime sleep duration and persistent night-waking are associated with maternal depression. The findings indicate tailored interventions should target both unfavorable early childhood sleep trajectories and maternal depression.

A Longitudinal Approach to the Relationships Among Sleep, Behavioral Adjustment, and Maternal Depression in Preschoolers

This study aimed to investigate the longitudinal associations between children’s sleep duration (SD) and problems (SPs), behavioral adjustment [externalizing behaviors (EB) and internalizing behaviors (IB)], and maternal depressive symptoms (MDS) in preschoolers over a period of 3 years (4–6 years of age). For this purpose, latent growth modeling (LGM) was conducted using 2012(W₅) to 2014(W₇) data from the National Panel Study on Korean Children (PSKC), while controlling for family contextual factors (i.e., responsive parenting, developmental stimulations, and marital conflict) and child temperament (children’s negative emotionality). First, children who slept longer at four were concurrently associated with lower levels of EB, while more SPs were associated with higher levels of EB and IB, concurrently. Second, greater decreases in SPs were associated with greater decline in EB and IB. Higher levels of MDS at four were associated with higher levels of child EB, IB, and SPs, concurrently. However, no longitudinal associations were found between the rates of change in MDS and children’s sleep and adjustment (EB and IB). Finally, the magnitude of the associations among the variables was greater overall in the SPs models than in the SD models. These findings suggest that addressing sleep problems, rather than sleep duration, seem to be more important in predicting and preventing young children’s adjustment problems and also that more attention should be paid to MDS during preschool years as much as during the postpartum period for better child adjustment outcomes.

Early Life Sleep Deprivation and Brain Development: Insights From Human and Animal Studies

Adequate sleep especially during developmental stages of life, is considered essential for normal brain development and believed to play an important role in promoting healthy cognitive and psychosocial development, while persistent sleep disturbances and/or sleep deprivation during early life are believed to trigger many mental ailments such as anxiety disorders, depression, and cognitive impairment. Initially it was suggested that adverse mental health conditions adversely affect sleep, however, it is now accepted that this association is bidirectional. In fact, sleep disturbances are listed as a symptom of many mental health disorders. Of special interest is the association between early life sleep deprivation and its negative mental health outcomes. Studies have linked persistent early life sleep deprivation with later life behavioral and cognitive disturbances. Neurobiological underpinnings responsible for the negative outcomes of early life sleep deprivation are not understood. This is a significant barrier for early therapeutic and/or behavioral intervention, which can be feasible only if biological underpinnings are well-understood. Animal studies have provided useful insights in this area. This article focusses on the knowledge gained from the research conducted in the area of early life sleep deprivation, brain development, and behavioral function studies.

The role of daytime napping on salivary cortisol in children aged 0-5 years: a systematic review and meta-analysis

Cortisol levels are implicated in emotional and cognitive development in children. However, it is not clear whether daytime napping influences cortisol levels in early childhood. This systematic review and meta-analysis aimed to synthesize the available evidence regarding the association between daytime napping and salivary cortisol in early childhood. The Medline, Embase, Web of Science, PsycINFO, and Cochrane Collaboration databases were searched for observational and experimental studies reporting data about napping behavior and salivary cortisol in children 0-5 years of age. Salivary cortisol levels were analyzed in three situations: CAR, cortisol awakening response from nap awakening; PRE-POST, before and after a daytime nap; and DIURNAL, from morning awakening to bedtime. Five studies showed a significant CAR after napping (mean difference, MD: 0.11μg/mL; 95% confidence interval, CI: 0.04, 0.18). In the PRE-POST analysis, a small decrease was observed for at-home naps (MD: -0.05 μg/mL; 95% CI: - 0.09, - 0.02) but not for at-childcare naps (MD: 0.04 μg/mL; 95% CI: - 0.01, 0.09). A similar pattern of DIURNAL salivary cortisol decrease was observed when children took a nap (MD: - 0.34 μg/mL; 95% CI: - 0.41, - 0.28) and when they did not sleep during the day (MD: - 0.28 μg/mL; 95% CI: - 0.38, - 0.19).

CONCLUSIONS

Daytime napping plays a minor role in the fluctuation of salivary cortisol levels during the day. The conditions of the home or the childcare environment under which napping occurs might have a greater influence on cortisol levels than daytime napping itself in early childhood. PROSPERO Identifier: CRD42020212249.

WHAT IS KNOWN

• The regulation of sleep involves circadian rhythmicity of cortisol secretion via activation of the HPA axis and a subsequent release of cortisol upon morning awakening followed by a decline throughout the day.

WHAT IS NEW

• The available evidence supports the occurrence of a cortisol awakening response after a daytime nap. • A small decrease in cortisol after napping was observed when the nap occurred at home but not at childcare. • The conditions of the home or childcare environment under which the nap occurs and the activities before and after napping may have a greater influence on cortisol levels than napping itself.

Sleep and the gut microbiota in preschool-aged children

Sleep plays a significant role in the mental and physical development of children. Emerging evidence in animals and human adults indicates a relationship between sleep and the gut microbiota; however, it is unclear whether the sleep of preschoolers during a key developmental period, associates with features of their gut microbiota. The objective of this study was to assess the relationship between sleep and gut microbiota in preschool-aged children (4.37 ± 0.48 years, n = 143). Sleep measures included total night-time sleep (TST), sleep efficiency (SE), and wake-time after sleep onset (WASO) assessed using actigraphy. Beta-diversity differences between children with low and high TST (p = .048) suggest gut microbiota community differences. Particularly, relative abundance of Bifidobacterium was higher in the high TST group and Bacteroides, was higher in children who had greater SE and less WASO (LDA score >2). In contrast, some Lachnospiraceae members including Blautia and Coprococcus 1 were associated with shorter night-time sleep duration and less efficiency, respectively. We also found a group of fecal metabolites, including specific neuroactive compounds and immunomodulating metabolites were associated with greater sleep efficiency and less time awake at night. Notably, tryptophan and its metabolizing products were higher in children who had higher SE or lower WASO (LDA score >2); concentration of propionate was higher in children with less WASO (p = .036). Overall, our results reveal a novel association between sleep and gut microbiota in preschool-aged children. Longer night-time sleep and greater sleep efficiency were associated with specific commensal bacteria that may regulate sleep through modulating neurotransmitter metabolism and the immune system.

Association of nighttime sleep with behaviors in Japanese early childhood

BACKGROUND

Preschool children in Asian countries, including Japan, sleep for a shorter duration at night than those in Europe and the USA. We examined the effects of the nighttime sleep duration on behavioral development in early childhood in Japan.

METHODS

We used data from a large Japanese nationwide, population-based, longitudinal survey that began in 2001. We restricted the study participants to children born after 37 gestational weeks, with a birth weight ≥ 2500 g and singleton births (n = 41 890). The nighttime sleep duration was examined at 2.5 years old. Responses to survey questions regarding age-appropriate behavior at 5.5 years old were used as indicators of behavioral development. We conducted logistic regression analyses with adjustment for confounding factors, with ≥11 h of nighttime sleep as the reference group.

RESULTS

The odds ratios for children who had ≤9 h of nighttime sleep, which was associated with being unable to listen with fidgeting and being unable to remain patient, were 1.26 (95% confidence interval, 1.14-1.39) and 1.27 (1.16-1.38), respectively. Children who had an irregular nighttime sleep duration were associated with age-appropriate behavioral inabilities. These results were similar in children who usually and sometimes took naps to those before stratification by the frequency of napping.

CONCLUSION

A short nighttime sleep duration especially affects hyperactivity and impulsivity. An irregular nighttime sleep duration increases the inability to perform overall age-appropriate behaviors more than a short sleep duration. Ensuring a regular and sufficient nighttime sleep duration in early childhood is important for healthy behavioral development.

Gender difference in functional activity of 4-months-old infants during sleep: A functional near-infrared spectroscopy study

Sex differences emerge early in infancy. A number of earlier studies have investigated the resting-state network of infant sleep states, and there have been many studies using functional near-infrared spectroscopy (fNIRS) to examine the effects of infant language learning on changes in oxyhemoglobin and deoxyhemoglobin levels. However, studies examining sex differences from the resting-state network of infant sleep states are scarce. This study uses an open access dataset of task-free hemodynamic activity in 4-month-old infants during sleep by fNIRS, to identify some difference between male and female infants. We used Power Spectral Density showing at which frequencies the data variation/variance is high. We have also analyzed some gender differences by analyzing the relationship between individual channels, the degree of activation, etc. The results of this study showed that female and male infants had different Power Spectral Density for oxyhemoglobin and deoxyhemoglobin at rest, showing stronger differences at frontoparietal network, somatomotor network, visual network and dorsal network. This may be due to the differences in the timing or extent of development of those networks. These differences will provide some assistance in future studies of the early education of male and female infants.

The association between sleep and empathy in young preschoolers: A population study

Sleep is vital for children's early socio-emotional development, particularly empathy. This study aimed to explore the associations between sleep and empathy in young preschoolers. A sample of 23,259 preschoolers (4.3 ± 0.3 years) at the entry year of preschool was recruited as part of the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study. Caregivers reported on child sleep, affective empathy, and cognitive empathy through the Children's Sleep Habits Questionnaire and the Griffith Empathy Measure. Ordinary least-square regression and quantile regression were performed for the associations between sleep and empathy. Sex differences were also investigated. Night sleep duration was negatively associated with affective empathy (β = -0.35, p < 0.001), and positively associated with cognitive empathy (β = 0.41, p < 0.001). Longer nap duration was associated with higher affective empathy (β = 0.28, p < 0.001). Sleep disturbances were positively associated with affective empathy (β = 0.04, p < 0.001) and negatively associated with cognitive empathy (β = -0.09, p < 0.001). These associations were generally stronger in children at higher empathy quantiles and also those at the 10^th cognitive empathy quantile. The associations between sleep and affective empathy were mainly contributed by girls, and were more common in boys in terms of cognitive empathy, particularly at the 10^th and the 30^th quantiles. In conclusion, longer night sleep duration and fewer sleep disturbances are associated with a more mature empathy pattern in young preschoolers. The associations are more prominent in children at the higher end of the empathy spectrum, and vary by sex. These findings highlight the importance to promote sleep health in young children for optimal socio-emotional development.

Effects of Touchscreen Media Use on Toddlers' Sleep: Insights from Longtime ECG Monitoring

Wearable biomedical sensor technology enables reliable monitoring of physiological data, even in very young children. The purpose of the present study was to develop algorithms for gaining valid physiological indicators of sleep quality in toddlers, using data from an undisturbing and easy-to-use wearable device. The study further reports the application of this technique to the investigation of potential impacts of early touchscreen media use. Toddlers' touchscreen media use is of strong interest for parents, educators, and researchers. Mostly, negative effects of media use are assumed, among them, disturbances of sleep and impairments of learning and development. In 55 toddlers (32 girls, 23 boys; 27.4 ± 4.9 months; range: 16-37 months), ECG monitoring was conducted for a period of 30 (±3) h. Parents were asked about their children's touchscreen media use and they rated their children's sleep quality. The use of touchscreen media predicted the physiologically determined quality of sleep but not parent-reported sleep quality (such as sleep onset latency). Greater heart rate differences between restless sleep phases and restful sleep indicated poorer nighttime recovery in children with more frequent use of touchscreen media. The study demonstrates that the expert analysis of the ECG during sleep is a potent tool for the estimation of sleep quality in toddlers.

Sleep Measurement in Children-Are We on the Right Track?

Sleep plays a critical role in the development of healthy children. Detecting sleep and sleep disorders and the effectiveness of interventions for improving sleep in children require valid sleep measures. Assessment of sleep in children, in particular infants and young children, can be a quite challenging task. Many subjective and objective methods are available to evaluate various aspects of sleep in childhood, each with their strengths and limitations. None can, however, replace the importance of thorough clinical interview with detailed history and clinical examination by a sleep specialist.

Sleep duration and obesity in children and adolescents: evidence from an updated and dose-response meta-analysis

BACKGROUND AND OBJECTIVES

The association between sleep duration and obesity in children and adolescents has been widely evaluated, whereas the current findings are mixed and prospective studies are limited. To shed more light on this issue and explore the dose-response relationship, we performed the present updated meta-analysis by synthesizing the results of prospective cohorts.

METHODS

Literature retrieval, study selection and data extraction were completed independently and in duplicate. Effect-size estimates are expressed as relative risk (RR) with 95% confidence interval (CI) or standardized regression coefficient (β) with standard error.

RESULTS

Data from 33 articles, involving 57,848 children and adolescents, were meta-analyzed. Overall analyses revealed statistically significant associations of short (adjusted RR = 1.57, 95% CI: 1.36 to 1.81, P < 0.001) and long sleep duration (0.83, 0.75 to 0.93, 0.001) with obesity. Short sleep duration was also associated with significant changes in body mass index z-score (mean difference = -0.06; 95% CI: -0.09 to -0.04; P < 0.001). By contrast, long sleep duration was identified as a protective factor for childhood obesity. In dose-response analyses, short sleep duration was significantly associated with obesity in toddlers (1-2 years) (adjusted RR = 1.20, 95% CI: 1.07 to 1.34, P = 0.001), preschool-aged (3-5 years) children (1.58, 1.36 to 1.83, <0.001), and school-aged (6-13 years) children (1.82, 1.51 to 2.21, <0.001). In subgroup analyses, geographic region, sleep duration assessment, age, and follow-up interval were possible sources of heterogeneity.

CONCLUSIONS

Our findings indicate that short sleep duration can increase the risk of obesity in children and adolescents, especially within 3-13 years of age, and long sleep duration seemed beneficial in preventing obesity.

Impact of Early Nutrition, Physical Activity and Sleep on the Fetal Programming of Disease in the Pregnancy: A Narrative Review

Early programming is the adaptation process by which nutrition and environmental factors alter development pathways during prenatal growth, inducing changes in postnatal metabolism and diseases. The aim of this narrative review, is evaluating the current knowledge in the scientific literature on the effects of nutrition, environmental factors, physical activity and sleep on development pathways. If in utero adaptations were incorrect, this would cause a mismatch between prenatal programming and adulthood. Adequate caloric intake, protein, mineral, vitamin, and long-chain fatty acids, have been noted for their relevance in the offspring brain functions and behavior. Fetus undernutrition/malnutrition causes a delay in growth and have detrimental effects on the development and subsequent functioning of the organs. Pregnancy is a particularly vulnerable period for the development of food preferences and for modifications in the emotional response. Maternal obesity increases the risk of developing perinatal complications and delivery by cesarean section and has long-term implications in the development of metabolic diseases. Physical exercise during pregnancy contributes to overall improved health post-partum. It is also interesting to highlight the relevance of sleep problems during pregnancy, which influence adequate growth and fetal development. Taking into account these considerations, we conclude that nutrition and metabolic factors during early life play a key role of health promotion and public health nutrition programs worldwide to improve the health of the offspring and the health costs of hospitalization.