Sleep practices, attitudes, and beliefs in inner city middle school children: a mixed-methods study

Racial and ethnic sleep health disparities in adolescents and risk for type 2 diabetes: a narrative review

INTRODUCTION

Sleep is an essential factor for health and wellbeing in people across the age spectrum; yet many adolescents do not meet the recommended 8-10 h of nightly sleep. Unfortunately, habitually insufficient sleep, along with the metabolic changes of puberty, puts adolescents at increased risk for a host of adverse health outcomes such as obesity and type 2 diabetes (T2D). Furthermore, individuals from historically minoritized racial and ethnic groups (e.g. Hispanic/Latinx, African American/Black) are more likely to experience shorter sleep duration compared to adolescents of White/European origin, placing them at even greater risk for disparities in T2D risk.

METHODS

We conducted a literature review on the role of race and ethnicity in adolescent sleep health and its relation to cardiometabolic outcomes, specifically T2D. We use the minority stress model and the stress and coping theory as guiding theoretical frameworks to examine individual and societal level factors that may contribute to sleep health disparities and their downstream effects on T2D risk.

RESULTS

This review highlights that the unique race-related stressors adolescents from minoritized groups face may play a role in the sleep and T2D connection on a biological, psychological, and social level. However, although there has been advancement in the current research on adolescent racial and ethnic sleep health disparities in relation to T2D, mechanisms underlying these disparities in sleep health need further investigation. Addressing these gaps is crucial for identifying and mitigating sleep health disparities and T2D among racial and ethnic minority youth.

CONCLUSION

We conclude with a discussion of the implications and future research directions of racial and ethnic disparities in sleep health and T2D prevention research. A comprehensive understanding of adolescent sleep health disparities has potential to better inform preventative and educational programs, interventions, and policies that promote sleep health equity and improve cardiometabolic outcomes like T2D.

A qualitative systematic review of adolescent's perceptions of sleep: Awareness of, barriers to and strategies for promoting healthy sleep patterns

AIMS

To consolidate adolescents' perspectives regarding various aspects of sleep and offer insights to promote healthier sleep habits during their critical developmental years.

METHODS/DATA SOURCES

Six electronic databases (PubMed, CINAHL, Embase, Scopus, PsycINFO and Web of Science) were searched from their inception dates to June 2023. Data were extracted and meta-summarised using Sandelowski and Barroso's approach and synthesised using Thomas and Harden's thematic analysis framework.

RESULTS

Meta-synthesis from 11 peer-reviewed published studies identified four main themes: (1) Awareness and understanding of sleep's significance, (2) The shadows and radiance of slumber, (3) Traversing the sleepscape: trouble bubbles and (4) Illuminating the path: Guiding lights to enhanced sleep.

CONCLUSION/IMPLICATIONS

Our review findings suggest a lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Identified barriers to adequate sleep encompass various factors, including overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. Strategies to improve adolescents' sleep health involve multiple sleep strategies, including sleep education, workshops/seminars, parental involvement, incorporating digital well-being practices, the promotion of relaxation techniques and the provision of essential resources. Prioritising sleep health and implementing targeted interventions are key steps to empower adolescents, create supportive environments and shape a healthier future generation. Future research endeavours should focus on evaluating the effectiveness of interventions and exploring the influence of cultural factors.

IMPACT

There exists a notable lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Barriers to achieving adequate sleep among adolescents include overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. The collaboration between healthcare institutions, professionals and educational institutions is crucial to facilitate (1) the implementation of sleep education workshops/seminars targeting adolescents, (2) increased parental involvement and role-modelling to instil good sleep practices among adolescents and (3) enhanced integration of digital well-being practices, the promotion of relaxation techniques and accessibility to essential sleep hygiene resources.

REPORTING METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

TRIAL AND PROTOCOL REGISTRATION

This review was registered on the Prospective Register of Systematic Reviews (CRD42023403775).

Passing on the Zzz's: Adolescent sleep attitudes are associated with sleep behaviors and parental prioritization of sleep

OBJECTIVES

The purpose of this study is to examine adolescent attitudes about the importance of sleep and how they relate to adolescent sleep behaviors and parent sleep attitudes.

METHODS

Participants included families with adolescents aged 10-17years and a parent (N = 170 dyads) who completed a virtual assessment. Adolescents reported on their sleep impairment and sleep hygiene behaviors, and all participants completed a newly developed scale to assess attitudes toward the importance of prioritizing sleep over other activities/responsibilities.

RESULTS

Results suggest that older adolescents reported more negative sleep attitudes, and adolescents reported more negative sleep attitudes compared to adult/parent participants. More negative sleep attitudes were associated with poorer sleep hygiene behaviors. Parent sleep attitudes significantly predicted their adolescent's sleep attitudes, even after adjusting for family income, education, and adolescent age and sex.

CONCLUSIONS

This is the first study to our knowledge to quantitatively examine adolescent sleep attitudes. Findings suggest that sleep attitudes are important for adolescent sleep, and may develop within the family system via parental socialization. Future research and implications for intervention are discussed.

Adolescent sleep myths: Identifying false beliefs that impact adolescent sleep and well-being

OBJECTIVE

Commonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents.

METHOD

We identified myths with a panel of adolescent sleep health experts (n = 12) using the Delphi method in three sequential steps: (1) focus groups; (2) online discussion; and (3) closed-ended questionnaires with which the experts rated myths on: (1) falseness and (2) public health significance using 5-point Likert scales ranging from 1 (not at all false/important for public health) to 5 (extremely false/important for public health). Next, we explored the prevalence of the myths among a demographically diverse sample of parents/caregivers of adolescents in the United States. Finally, we report the counterevidence to refute each myth.

RESULTS

Ten myths about adolescent sleep were identified by the experts using the Delphi method. The most prevalent myths were the beliefs that (1) "Going to bed and waking up late on the weekends is no big deal for adolescents, as long as they get enough sleep during that time," reported by 74% of parents/caregivers; (2) "If school starts later, adolescents will stay up that much later," reported by 69% of parents/caregivers; and (3) "Melatonin supplements are safe for adolescents because they are natural," reported by 66% of parents/caregivers.

CONCLUSION

Parents/caregivers have the potential to serve as sleep health advocates for their adolescent and support their adolescent's sleep health behaviors. Our study found that many parents/caregivers endorse myths about adolescent sleep that may hinder their ability to support their adolescent's sleep health. Future research may explore methods for promoting evidence-based beliefs about adolescent sleep among parents/caregivers.

Association of Electronic Media Use and Sleep Habits Among Secondary School Students in Al-Madinah

Objectives: To ascertain the relationship between electronic media use and sleep patterns among secondary school students in Al-Madinah, Saudi Arabia.

Methods: This was a descriptive cross-sectional study, conducted from July 2021 to December 2021. This study examined eight female secondary high schools, in Al-Madinah, Saudi Arabia. The sampling technique used was the stratification of governmental schools according to their location in the north, south, east, and west. According to the WHO sample size calculator, the sample size was 375. The Statistical Package for the Social Sciences version 26 (SPSS version 26) (SPSS Incl., Chicago, IL) was used for the analysis of data.

Results: A total of 388 female students were recruited, from the age group 12 to 40 years, with a mean age group of 16.45 ± 4.25 years. The majority of participants in our research utilized various types of electronic devices before going to bed. Some 335 individuals reported using electronic devices on a daily basis while at school, while 357 reported using electronic devices prior to sleeping on weekends. The more time spent on electronic gadgets, the more sleep is interrupted (p-value = 0.005). This condition was more prevalent among older children: 55% of third-year children and 41% of second-year children reported having it (p = 0.01). More than 20% had difficulty sleeping. Around 5% of respondents reported experiencing frequent nightly awakenings, whereas 23% reported feeling drowsy/sleepy feeling at school. After 10:00 p.m., 43% of the population (mostly the young) headed to bed, while older children remained awake (p = 0.001). Having a mobile phone (odds ratio, OR = 2.5; p = 0.01) or tablet (OR = 2.5; p = 0.05) was a significant predictor of sleep issues in the logistic regression model.

Conclusion: The use of electronic media and the amount of time secondary school children spend on it can significantly alter sleep quality, through interrupted rest, and time, from a reduced duration of sleep. Parents and care providers can help by creating awareness about the negative effects of using electronic media on sleep and health among children.

Designing adolescent sleep interventions with stakeholder input

OBJECTIVE

Few sleep promotion programs for adolescents have involved stakeholders as part of the intervention development, which may contribute to their limited accessibility, scalability, acceptability, and feasibility. Specifically asking stakeholders for their input on how to modify factors impacting sleep is critical, as is identifying strategies for motivating sleep behavior change. We report qualitative feedback from stakeholders interested in improving adolescent sleep, data collected specifically to inform the development of an adolescent sleep promotion program.

PARTICIPANTS

We conducted 9 focus groups (3 each for young adults (n = 8, ages 21-25), parents of adolescents (n = 12), and healthcare providers working with adolescents (n = 29) following a semistructured approach.

DESIGN

Participants reported on contributors to good and poor sleep; motivators for improving sleep; strategies for promoting and sustaining behavior change; and feasibility of a proposed sleep promotion program. We coded and thematically analyzed focus group transcripts using inductive and deductive approaches.

RESULTS

Moderate engagement in activities (eg, a job, sports) was seen as a contributor to good sleep, while having too many or too few activities was thought to contribute to poor sleep. Linking improved sleep with personalized outcomes of interest can enhance motivation for changing sleep. Strategies for behavior change should rely on increasing internal motivation, personalizing intervention content, and having parents model desired behaviors.

CONCLUSIONS

Key stakeholders are critical to the development of acceptable interventions that can be implemented effectively in real-world settings. Future work should test whether the identified themes contribute to increased feasibility, scalability, and effectiveness of sleep programs.

Neighborhood environments and sleep among children and adolescents: A systematic review

Understanding salient environmental determinants of pediatric sleep is essential for informing interventions and public health initiatives. Emerging evidence suggests that the neighborhood environment can impact pediatric sleep, but this evidence has not yet been systematically reviewed. We conducted a systematic review of the scientific literature on associations between neighborhood environments and sleep in young children (0-5 y), school-aged children (6-12 y) and adolescents (13-18 y). We reviewed 85 articles published between 2003 and 2020. The most commonly examined neighborhood exposure was low socioeconomic status (40 studies), which was associated with sleep outcomes in 58% of studies (primarily shorter sleep duration, later sleep timing, or obstructive sleep apnea). Evidence was stronger for neighborhood safety/crime/violence (21 studies), with 86% of studies reporting associations with sleep outcomes (primarily self- or caregiver-reported sleep problems). Fewer studies examined associations of neighborhood physical environment exposures, including noise (15 studies), the built environment (seven studies), and air pollution (six studies). Limitations of the current body of evidence include 1) limited examination of neighborhood exposures other than socioeconomic status or safety, 2) use of primarily cross-sectional observational study designs, 3) lack of objective sleep outcome assessment, and 4) limits of current exposure assessment methods.

Sleep patterns and its relation to lifestyle habits: a study of secondary high school students in Sharjah, United Arab Emirates

Objectives

Sleep is a fundamental element in the growth and development of adolescents. Sleep undergoes significant changes during adolescence due to physiological and environmental factors. It has been scientifically shown that the required sleep duration in adolescence is more than 8 hours per day. The aim of this study is to understand sleep patterns and sleep-wake cycle of Sharjah adolescents, and identify lifestyle habits affecting those sleep patterns, and to assess the prevalence of sleep problems.

Methods

The study was a cross-sectional survey of 519 high-school students, ages 14–21 years, in Sharjah city, United Arab Emirates. It was conducted using a self-filled questionnaire that included questions about demographic data, sleep and lifestyle habits and sleep problems of adolescents.

Results

The mean age of our sample was 16.24. Most students (64.5%) were reported to sleep between 5 and 8 hours on school nights. The average time to go to bed on weekdays was 11:25 PM. The average time to wake up on weekdays was 6:12 AM. Frequent arousals with difficulty getting back to sleep was the most encountered sleep problem among our sample.

Conclusion

A large proportion of adolescents in our study had insufficient sleep duration and suffer from some sleep disturbances. Smoking was found to be associated with sleep as non-smokers obtained longer sleep durations. There was no association between physical activity or usage of electrical devices and sleep. Therefore, it is necessary to intervene by organizing awareness programs to improve sleep patterns among adolescent students.

Association between socioeconomic status and the trajectory of insufficient sleep: Maternal emotional support as a moderator

OBJECTIVE

To examine the association between SES and the trajectory of insufficient sleep among children aged 0.5-8 years and to investigate whether these associations vary by age. The moderating role of maternal emotional support was further explored.

METHOD

Data were obtained from 20,874 children participating in the Taiwan Birth Cohort Study. Multilevel models were conducted to explore the association between SES and the trajectory of insufficient sleep. The moderating role of maternal emotional support was examined by testing the significance of the interaction between SES and emotional support.

RESULTS

Low parental education and poverty contributed to increased risk of insufficient sleep, and the observed associations varied by age. Specifically, the influences of parental education increased with age, and the effects of poverty were significant only among preschoolaged children. Poverty dynamics were also significantly associated with an elevated risk of insufficient sleep, but the association was mitigated by maternal emotional support.

CONCLUSIONS

Children with low SES exhibited increased risk of insufficient sleep. Furthermore, the relationship between SES and insufficient sleep differed by age, with varying patterns emerging for different SES indicators. However, the negative influences of low SES could be mitigated by increasing maternal emotional support. Interventions that reduce SES disparity or enhance maternal emotional support could decrease the risk of insufficient sleep among children living with an SES disadvantage.

Facilitators and Barriers of Sleep in Young Adults With Type 1 Diabetes

PURPOSE

The purpose of this study was to explore the perceived facilitators and barriers for obtaining sufficient sleep in young adults with type 1 diabetes (T1D).

METHODS

A qualitative descriptive approach was used to generate data. In-depth semi-structured interviews with 30 young adults with T1D (66.7% female, mean age = 22.1 years) were conducted. Interviews were transcribed verbatim and coded using NVivo.

RESULTS

Young adults with T1D reported feeling challenged at bedtime and overnight by the demands of a complex disease management regimen. General and diabetes-specific barriers and facilitators to obtaining sufficient sleep were the overarching themes in the present study. Young adults perceived that electronic device use was a facilitator for relaxation before bed and a barrier to sleep by some participants. Delays in bedtime or disruptions in sleep were common diabetes-specific barriers.

CONCLUSIONS

When designing sleep-promoting interventions for young adults with T1D, researchers should consider diabetes-specific challenges and solutions in addition to those present in the general young adult population.

Short Sleep Duration and Extremely Delayed Chronotypes in Uruguayan Youth: The Role of School Start Times and Social Constraints

During adolescence, biological, psychosocial, and contextual factors converge in a “perfect storm” and have been put forward to explain the delay in chronotype observed at this age and the prevalence of disrupted sleep. This study provides evidence to support that chronotype and sleep patterns (particularly sleep duration) are socially constrained and to identify novel significant social predictors. Uruguayan public school activities are arranged in up to 4 shifts, creating a natural experiment to examine the effect of school timing on questionnaire-based assessments of sleep and chronotype. In this study, 268 high school students (15-18 years old) who attended school either on morning (0730 to 1130 h) or afternoon shifts (1130 h to 1530 h) responded to an adapted School Sleep Habits Survey. Students attending afternoon shifts had later chronotypes (a 1.5-h later midpoint of sleep on free days adjusted for sleep debt) than those attending the morning shift. Besides shift, evening social activities (including dinner time) were further identified as key predictors of late chronotypes, whereas age and gender were not. Sleep on school days was overall advanced and reduced with respect to weekends, and these effects were stronger in morning-shift students. Weekend sleep duration was similar between shifts, which probably caused the prevalence of reduced sleep durations (average weekly sleep duration, SDweek <8 h) to be higher in morning-shift students (almost 80%) than in afternoon-shift ones (34%). Reduced sleep duration was significantly higher in morning-shift students. In addition, age, chronotype, and dinner time became relevant determinants of sleep deficit only in the morning-shift students. Besides the important social constraint of early school start time, this is the first study to confirm the significance of other types of social pressures on both adolescents’ chronotype and sleep deficit, which can be useful as potential new targets for effective policies to protect adolescent sleep.

So Much to Do Before I Sleep: Investigating Adolescent-Perceived Barriers and Facilitators to Sleep

Adolescent sleep deprivation is a pressing public health issue in the United States as well as other countries. The contexts of adolescents' lives are changing rapidly, but little is known about the factors that adolescents themselves believe affect their sleep. This study uses a social-ecological framework to investigate multiple levels of perceived influence on sleep patterns of urban adolescents. Data were drawn from interviews and surveys conducted in three California public high schools. Most participants identified homework as their primary barrier to sleep, particularly those engaged in procrastinating, multitasking, or those with extracurricular demands. Results indicate that the home context has important implications for adolescent sleep, including noise, household rules, and perceived parent values. These findings identify important areas for future research and intervention, particularly regarding the roles of parents.

"Let's talk about sleep": a qualitative examination of levers for promoting healthy sleep among sleep-deprived vulnerable adolescents

OBJECTIVE

Deficient sleep is highly prevalent in disadvantaged adolescents and contributes to a range of adverse health and behavioral outcomes. We examined mediating mechanisms and strategies that adolescents adopt to improve sleep, and possible levers for promoting sleep in this population.

METHODS

We conducted three focus groups (N = 27 total, age 14-18 years) in adolescents living in low- and middle-income racially/ethnically diverse neighborhoods of Boston, Massachusetts. Participants completed a survey on their sleep and health habits prior to the moderator-led discussions. Discussions were audio-recorded, transcribed, and thematically analyzed.

RESULTS

The study population did not meet the minimum sleep recommendations, and we found a high prevalence of "social jet-lag." We also identified a disconnect between the acknowledgment of the importance of sleep and actual behavior, especially for electronic use. Phone use and screen time were the most commonly cited barriers to a good night's sleep, along with caffeine consumption, which was also high in this sample. There was also a general lack of awareness of sleep hygiene practices and recommendations. Participants reported regulating food intake and physical activity, using allopathic sleep aids, creating a comfortable sleeping environment, and a routine as some strategies to improve sleep.

CONCLUSION

Results from this study suggest facilitating the linkage between participant-generated mediating factors and strategies for better-designed interventions. These include making the negative impact of sleep on health more explicit, improving youth awareness about sleep hygiene, targeting caffeine consumption and electronic use, and introducing sleep recommendations through appropriate and effective channels.

Sleep Disturbances in Individuals with Alcohol-Related Disorders: A Review of Cognitive-Behavioral Therapy for Insomnia (CBT-I) and Associated Non-Pharmacological Therapies

Sleep disturbances are common among alcohol-dependent individuals and are often associated with relapse. The utility of behavioral therapies for sleep disturbances, including cognitive-behavioral therapy for insomnia (CBT-I), among those with alcohol-related disorders is not well understood. This review systematically evaluates the evidence of CBT-I and related behavioral therapies applied to those with alcohol-related disorders and accompanying sleep disturbances. A search of four research databases (PubMed, PsycINFO, Embase, and CINAHL Plus) yielded six studies that met selection criteria. Articles were reviewed using Cochrane's Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. A majority of the studies demonstrated significant improvements in sleep efficiency among behavioral therapy treatment group(s), including but not limited to CBT-I. While behavioral sleep interventions have been successful in varied populations, they may not be utilized to their full potential among those with alcohol-related disorders as evidenced by the low number of studies found. These findings suggest a need for mixed-methods research on individuals' sleep experience to inform interventions that are acceptable to the target population.

Sleep patterns are associated with common illness in adolescents

This prospective, field-based study examined the association between actigraphically measured total sleep time and incident illness including cold, flu, gastroenteritis and other common infectious diseases (e.g., strep throat) in adolescents during the course of a school semester. Participants were 56 adolescents ages 14-19 years (mean = 16.6, standard deviation = 1.2, 39% male) from five high schools in Rhode Island. Beginning in late January, adolescents wore actigraphs [mean 91 (19) days, range 16-112 days] and were assigned post-hoc to longer or shorter sleep groups based on median splits. Adolescents were interviewed weekly across as many as 16 weeks (modal number of interviews = 13) using a structured protocol that included 14 health event questions. Illness events and illness-related school absences were coded for 710 completed interviews, with 681 illness events and 90 school absences reported. Outcomes (illness bouts, illness duration and absences) were compared among sex, sleep and academic year groups using non-parametric regression. In a subset of 18 subjects, mean actigraphically estimated total sleep time six nights before matched illness/wellness events was compared using multivariate analysis of variance (manova). Longer sleepers and males reported fewer illness bouts; total sleep time effects were more apparent in males than females. A trend was found for shorter total sleep time before ill events. The present findings in this small naturalistic sample indicate that acute illnesses were more frequent in otherwise healthy adolescents with shorter sleep, and illness events were associated with less sleep during the previous week than comparable matched periods without illness.

Sleeping patterns of Afghan unaccompanied asylum-seeking adolescents: a large observational study

Unaccompanied asylum-seeking children (UASC) have experienced multiple traumas and are a high-risk group for posttraumatic stress disorder (PTSD). The effects of trauma are known to be associated with sleep problems; indeed sleeping problems are core features of PTSD. However, there has been no systematic research examining the sleep of this high risk group of children. This study presents the first evidence on the sleeping patterns of Afghan UASC living in the UK. A total of 222 male Afghan children, aged 13–18, were interviewed using validated self-report questionnaires measuring sleeping patterns and PTSD. Overall, UASC patterns for bed time and rise time appear acculturated to the country of asylum. Mean UASC sleep onset latency scores were approximately 20 minutes greater compared with normative scores, which may be a reflection of UASC pre-migration and post-migration experiences. As expected, UASC who screened above the clinical cut-off for PTSD reported significantly greater sleep onset latency, increased nightmares, and less total sleep time compared to the non-PTSD group. The results may be of particular interest to clinicians given that, compared to screening for PTSD, screening for sleep problems may be a less culturally disputed form of initial assessment indicating distress in UASC. Similarly, the field of UASC and refugee child interventions is largely focused on trauma, yet sleep may provide a novel avenue for equally or more effective treatment.

Sleep-related behaviors and beliefs associated with race/ethnicity in women

Explore how social factors influence sleep, especially sleep-related beliefs and behaviors. Sleep complaints, sleep hygiene behaviors, and beliefs about sleep were studied in 65 black/African American and white/European American women. Differences were found for snoring and discrepancy between sleep duration and need. Sleep behaviors differed across groups for napping, methods for coping with sleep difficulties, and nonsleep behaviors in bed. Beliefs also distinguished groups, with differences in motivation for sleep and beliefs about sleep being important for health and functioning. These findings have important public health implications in terms of developing effective sleep education interventions that include consideration of cultural aspects.

Morningness: protective factor for sleep-related and emotional problems in childhood and adolescence?

The relationship between morningness/eveningness, sleep, and psychological problems is well documented in adults as well as in adolescents. However, research on the circadian orientation and its concomitants in younger children is scarce. The authors investigated the distribution of morningness/eveningness and its connection to sleeping and psychological problems in 91 children and 151 adolescents in Austria. The authors found that morning (M) types had less sleep-related and psychological problems than intermediate (I) and evening (E) types, respectively. Among children, M-types suffered less from daytime sleepiness (females: χ(2)((2)) = 8.1, p = .017; males: χ(2)((2)) = 14.8, p = .001). Among adolescents, M-types showed fewer sleep-wake problems (females: χ(2)((2)) = 17.5, p < .001; males: χ(2)((2)) = 19.8, p < .001), and female M-types showed less externalizing (χ(2)((2)) = 8.7, p = .013) as well as internalizing problem behavior (χ(2)((2)) = 9.0, p = .011). In conclusion, these findings indicate that morningness may act as a protective factor against the development of sleep-related problems in childhood and sleep-related and psychological problems in adolescence, especially in females.

Family socioeconomic status and sleep patterns of young adolescents

This study examined associations among socioeconomic status (SES), SES-related variables, and sleep in young middle school adolescents. Participants included 155 seventh-graders attending two urban New England middle schools. Aspects of the SES environment included parent demographic variables (e.g., income and education), neighborhood environment, and family home environment. Students completed 1 week of actigraphy to estimate sleep patterns. Results demonstrated that the timing and consistency of school-night sleep were associated with demographic and behavioral aspects of SES, whereas weekend sleep schedules were associated with demographic, behavioral, and neighborhood aspects of SES. Finally, regularity in school-night and weekend sleep schedules were associated with demographic and neighborhood aspects of SES.

Sleep duration or bedtime? Exploring the relationship between sleep habits and weight status and activity patterns

STUDY OBJECTIVES

To assess the effects of early and late bedtimes and wake up times on use of time and weight status in Australian school-aged children.

DESIGN

Observational cross-sectional study involving use of time interviews and pedometers.

SETTING

Free-living Australian adolescents.

PARTICIPANTS

2200 9- to 16-year-olds from all states of Australia

INTERVENTIONS

NA.

MEASUREMENTS AND RESULTS

Bedtimes and wake times were adjusted for age and sex and classified as early or late using median splits. Adolescents were allocated into 4 sleep-wake pattern groups: Early-bed/Early-rise; Early-bed/Late-rise; Late-bed/Early-rise; Late-bed/Late-rise. The groups were compared for use of time (screen time, physical activity, and study-related time), sociodemographic characteristics, and weight status. Adolescents in the Late-bed/Late-rise category experienced 48 min/d more screen time and 27 min less moderate-to-vigorous physical activity (MVPA) (P<0.0001) than adolescents in the Early-bed/Early-rise category, in spite of similar sleep durations. Late-bed/Late-rise adolescents had a higher BMI z-score (0.66 vs. 0.45, P=0.0015). Late-bed/Late-rise adolescents were 1.47 times more likely to be overweight or obese than Early-bed/Early-rise adolescents, 2.16 times more likely to be obese, 1.77 times more likely to have low MVPA, and 2.92 times more likely to have high screen time. Late-bed/Late-rise adolescents were more likely to come from poorer households, to live in major cities, and have fewer siblings.

CONCLUSIONS

Late bedtimes and late wake up times are associated with an unfavorable activity and weight status profile, independent of age, sex, household income, geographical remoteness, and sleep duration.

Approaches to measure sleep-wake disturbances in adolescents with cancer

Sleep-wake disturbances commonly occur in healthy adolescents. Although diminished sleep and sleepiness seem normal for healthy adolescents, adolescents with chronic illnesses face additional disruption in the quantity and quality of their sleep as a result of the disease process, ongoing treatment, and associated symptoms. Little is known about how sleep in adolescents is affected by cancer, cancer treatment, and concurrent symptoms or about the consequences of sleep disruption for these patients. Although there is limited evidence to guide sleep measurement in adolescents with cancer, researchers may learn effective strategies from sleep studies completed with adolescents with other conditions. This systematic review examines how researchers have measured sleep using actigraphy, diary, and/or self-report questionnaires in diverse samples of healthy and ill adolescents. Psychometric properties are reported for nine self-report sleep questionnaires that were used in studies with mostly healthy adolescent samples. Nineteen studies provide evidence that actigraphy can be successfully and reliably used as an effective objective method to measure sleep in adolescents, including those with chronic illness. Daily sleep diaries were used less frequently to collect data from adolescents. The suitability of these techniques for the study of cancer-related sleep-wake disturbances in adolescents as well as strategies to enhance the reliability, validity, and feasibility of these measures will be discussed. Future sleep research in adolescents affected by cancer can be strengthened by the consistent use of sleep terminology, measurement of key sleep parameters, and efforts to develop and use psychometrically sound instruments. Oncology clinicians should be ready to add emerging evidence from sleep research to their care of adolescents with cancer.

Children's attachment to parents and their academic functioning: sleep disruptions as moderators of effects

OBJECTIVE

We investigated the amount and quality of children's sleep as a moderator of relations between attachment to parents and child academic functioning.

METHOD

Data were from a sample of 166 third graders in the Southeastern USA. Children reported on the security of their attachments to both mothers and fathers, and standard assessments of academic achievement were obtained from schools. Children completed questionnaire measures of subjective sleep problems and their sleep was assessed objectively via actigraphs worn for seven consecutive nights.

RESULTS

Attachment insecurity was associated with lower math achievement for children with objective sleep problems (lower quantity and efficiency).

CONCLUSION

Findings suggest that better sleep ameliorates the risk for academic performance difficulties associated with insecure attachments to parents, and functions as a protective factor in this context.