Sleep physiology and sleep disorders in childhood

The enigma of sleep: Implications of sleep neuroscience for the dental clinician and patient

BACKGROUND

Sleep disturbances have been shown to result in considerable morbidity and mortality. It is important for dental clinicians to understand the neuroscience behind sleep disorders.

TYPES OF STUDIES REVIEWED

The authors conducted a search of the literature published from January 1990 through March 2024 of sleep medicine-related articles, with a focus on neuroscience. The authors prioritized articles about the science of sleep as related to dental medicine.

RESULTS

The authors found a proliferation of articles related to sleep neuroscience along with its implications in dental medicine. The authors also found that the intricate neuroscientific principles of sleep medicine are being investigated robustly. The salient features of, and the differences between, central and obstructive sleep apneas have been elucidated. Sleep genes, such as CRY, PER1, PER2, and CLOCK, and their relationship to cancer and neurodegeneration are also additions to this rapidly developing science.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The dental clinician has the potential to be the first to screen patients for possible sleep disorders and make prompt referrals to the appropriate medical professionals. This can be lifesaving as well as minimize potential future morbidity for the patient.

Childhood unpredictability and sleep quality in adulthood: the mediating roles of life history strategy and perceived stress

Background

Early environmental risk have been found to be related to lifelong health. However, the impact of childhood unpredictability, a type of early environmental risk, on health, especially on sleep quality in adulthood, has not been adequately studied. The present study aimed to examine the relationship between childhood unpredictability and sleep quality in adulthood and to explore the possible mediating roles of life history strategy and perceived stress.

Methods

A cross-sectional study was conducted on 472 participants from a university in Zhejiang Province, China. The questionnaire inquired about demography, childhood unpredictability, life history strategy (Mini-K), perceived stress (14-item Perceived Stress Scale), and Sleep Quality (Pittsburgh Global Sleep Quality Index).

Results

Higher childhood unpredictability was significantly associated with worse sleep quality in adulthood. Moreover, the link between higher childhood unpredictability and worse sleep quality in adulthood was explained by the chain mediation of life history strategy and perceived stress.

Conclusion

In line with the life history theory, individuals who have experienced higher unpredictability in childhood tend to develop a faster life history strategy and become more sensitive to stress in adulthood, and subsequently suffer a decrease in sleep quality.

Sleep Problems in Autism Spectrum Disorder

Sleep problems are common in children with autism spectrum disorder (ASD), with 40% to 80% prevalence. Common disorders include insomnia, parasomnias, and circadian rhythm sleep-wake disorders. These problems have a multifactorial etiology and can both exacerbate and be exacerbated by core ASD symptoms. Sleep problems also impact the health and quality of life of both patients and their caregivers. All children with autism should be regularly screened for sleep problems and evaluated for co-occurring medical contributors. Behavioral interventions with caregiver training remain first-line treatment for sleep disorders in both neurotypical and neurodiverse youth.

Factors Associated With Poor Sleep Quality Among Primary Healthcare Workers During the SARS-CoV-2 Pandemic

INTRODUCTION

Sleep is one of the most important activities for health and the processes related to the central nervous system. Healthcare workers commonly present alterations in the sleep-wake cycle due to complex work schedules because 24-hour attention to the population is required in public health institutions. The increase in care needs caused by the COVID-19 pandemic caused changes in work schedules; as in Mexico, the number of patients requiring consultation in all public health units increased. Chronic partial sleep deprivation (< 7 hours of sleep in the 24-hour cycle) is the most frequent sleep alteration in Mexican health workers. However, it has not been explored whether work modifications due to the pandemic had an impact on the sleep quality of workers.

OBJECTIVE

We aimed to describe the prevalence of poor sleep quality and the associated factors in workers (clinical and non-clinical) of a primary care medical unit.

MATERIAL AND METHODS

We conducted an analytical and cross-sectional study during November and December 2022. We used the following tools for studying clinical and non-clinical staff working at a family medicine primary care unit: Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, Beck Depression Inventory, Maslach Burnout Inventory, and Graffar-Méndez-Castellanos socioeconomic level scale, as well as a data collection sheet and a survey of workers' knowledge, attitudes, fears, and needs regarding COVID-19.

RESULTS

A total of 233 workers were surveyed. The prevalence of poor sleep quality was 56.7%. A higher score on the Beck Depression Inventory (OR: 1.21, CI 95%: 1.13-1.29), being a doctor (OR: 3.48, CI 95%: 1.5-8.01), and frequent alcohol consumption (OR: 2.4, CI 95%: 1.13-5.2) were identified as risk factors for poor sleep quality. A lower score in the depersonalization dimension of the Maslach Burnout Inventory (OR: 0.5, CI 95%: 0.26-0.99) was identified as a protective factor for poor sleep quality.

CONCLUSIONS

During the pandemic, the stress of health workers increased due to work alterations that were necessary to treat the greatest number of patients, so their quality of sleep decreased. Unfortunately, the mental health of healthcare workers is often under-assessed in many institutions. Thus, it is relevant to identify risk factors for alterations (especially those of sleep), since by identifying the target population, comprehensive interventions can be carried out, which can reduce the prevalence of burnout, anxiety, and depression, but if not addressed, the alterations can lead to inadequate care for users of health units.

Multi-Scale Evaluation of Sleep Quality Based on Motion Signal from Unobtrusive Device

Sleep disorders are a growing threat nowadays as they are linked to neurological, cardiovascular and metabolic diseases. The gold standard methodology for sleep study is polysomnography (PSG), an intrusive and onerous technique that can disrupt normal routines. In this perspective, m-Health technologies offer an unobtrusive and rapid solution for home monitoring. We developed a multi-scale method based on motion signal extracted from an unobtrusive device to evaluate sleep behavior. Data used in this study were collected during two different acquisition campaigns by using a Pressure Bed Sensor (PBS). The first one was carried out with 22 subjects for sleep problems, and the second one comprises 11 healthy shift workers. All underwent full PSG and PBS recordings. The algorithm consists of extracting sleep quality and fragmentation indexes correlating to clinical metrics. In particular, the method classifies sleep windows of 1-s of the motion signal into: displacement (DI), quiet sleep (QS), disrupted sleep (DS) and absence from the bed (ABS). QS proved to be positively correlated (0.72±0.014) to Sleep Efficiency (SE) and DS/DI positively correlated (0.85±0.007) to the Apnea-Hypopnea Index (AHI). The work proved to be potentially helpful in the early investigation of sleep in the home environment. The minimized intrusiveness of the device together with a low complexity and good performance might provide valuable indications for the home monitoring of sleep disorders and for subjects’ awareness.

Sleep Complaints Among School Children

Sleep complaints are common among children. These include both night-time and daytime symptoms, such as trouble falling asleep, problems in maintaining sleep, snoring, and unusual events during sleep and daytime functioning impairment. However, sleep complaints in children are often overlooked and undertreated in clinical practice. Untreated sleep problems may further impact on children's development and will persist into adulthood in some cases. This review summarizes the common sleep complaints and disorders in school children, and provides an overview of the epidemiology, clinical features, consequences, and treatment of the sleep problems.

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.

Examining the Relationship Between Sleep Quality, Social Functioning, and Behavior Problems in Children with Autism Spectrum Disorder: A Systematic Review

Over forty percent of autistic children experience poor sleep quality, and social interaction difficulties are a core characteristic of autism. However, the relationship between sleep quality and social functioning and behavior remains poorly understood. This systematic review examined the evidence concerning the impact of sleep quality on the social functioning and behavior problems in autistic children and adolescents. It also identified key related factors and evaluated how this issue has been researched to date. Seven key journals were hand-searched and five databases were systematically searched, using keywords. Titles and abstracts of 4123 items were screened against eligibility criteria by two researchers. Relevant studies were retained if they were peer-reviewed empirical papers, published in English between 2000 and 2021. Then, the full text of 97 papers was screened and if they met the eligibility criteria, their reference lists were hand-searched. Forty-six studies were included in the final review. Data were systematically extracted and two authors critically appraised the strengths and weaknesses of studies using Critical Appraisal Skills Programme tools. Key themes were identified, because a meta-analysis was not possible due to the studies' heterogeneity. The review identified that sleep quality and social functioning are associated with one another and there is a small amount of evidence that a bi-directional causal relationship may exist. Evidence suggests that several nights of suboptimal sleep duration and a lack of deep continuous sleep negatively impact externalizing and internalizing behavior. Sleep quality is also reduced by anxiety and sensory sensitivity. However, longitudinal studies with larger samples are needed to establish causality. Future research needs to examine confounding factors and to develop consensus regarding best-practice processes for the objective measurement of sleep with autistic children. Additional research also needs to further examine the consequences of poor sleep quality on internalizing behavior, and the impact of socio-cultural practices.

A lightweight automatic sleep staging method for children using single-channel EEG based on edge artificial intelligence

With the development of telemedicine and edge computing, edge artificial intelligence (AI) will become a new development trend for smart medicine. On the other hand, nearly one-third of children suffer from sleep disorders. However, all existing sleep staging methods are for adults. Therefore, we adapted edge AI to develop a lightweight automatic sleep staging method for children using single-channel EEG. The trained sleep staging model will be deployed to edge smart devices so that the sleep staging can be implemented on edge devices which will greatly save network resources and improving the performance and privacy of sleep staging application. Then the results and hypnogram will be uploaded to the cloud server for further analysis by the physicians to get sleep disease diagnosis reports and treatment opinions. We utilized 1D convolutional neural networks (1D-CNN) and long short term memory (LSTM) to build our sleep staging model, named CSleepNet. We tested the model on our childrens sleep (CS) dataset and sleep-EDFX dataset. For the CS dataset, we experimented with F4-M1 channel EEG using four different loss functions, and the logcosh performed best with overall accuracy of 83.06% and F1-score of 76.50%. We used Fpz-Cz and Pz-Oz channel EEG to train our model in Sleep-EDFX dataset, and achieved an accuracy of 86.41% without manual feature extraction. The experimental results show that our method has great potential. It not only plays an important role in sleep-related research, but also can be widely used in the classification of other time sequences physiological signals.

Longitudinal association between movement behaviours and depressive symptoms among adolescents using compositional data analysis

BACKGROUND

Research examining the associations between movement behaviours and mental health indicators within a compositional framework are sparse and limited by their cross-sectional study design. This study has three objectives. First, to describe the change in movement behaviour composition over time. Second, to explore the association between change in movement behaviour composition and change in depressive symptoms. Third, to explore how reallocations of time between movement behaviours are associated with changes in depressive symptoms.

METHODS

Longitudinal data of 14,620 students in grades 9-12 (mean age: 14.9 years) attending secondary schools in Canada (Ontario, British Columbia, Alberta, Quebec) were obtained from two waves (2017/18, 2018/19) of the COMPASS study. Moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep duration were self-reported. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (Revised)-10 (CESD-R-10). Compositional data analyses using pivot coordinates and compositional isotemporal substitution for longitudinal data were used to analyse the data. Analyses accounted for school clustering, were stratified by gender and age (< or ≥ 15 years), and were adjusted for race/ethnicity, body mass index z-score, baseline movement behaviour composition, and baseline depressive symptoms.

RESULTS

There were significant differences in movement behaviour composition over time across all subgroups. For example, the relative contributions of MVPA and sleep duration to the movement behaviour composition decreased over time while screen time increased among younger boys and girls and older girls. Increasing sleep duration relative to the remaining behaviours (i.e. screen time and MVPA) was associated with lower depressive symptoms among all subgroups. Increasing screen time relative to the remaining behaviours (i.e. MVPA and sleep duration) was associated with higher depressive symptoms among all subgroups. Increasing MVPA relative to the remaining behaviours (i.e. screen time and sleep duration) was associated with lower depressive symptoms in older girls only. Isotemporal substitution estimates indicated that decreasing screen time by 60 minutes/day and replacing that time with 60 minutes of additional sleep is associated with the largest change in depressive symptoms across all subgroups.

CONCLUSIONS

Findings from this prospective analysis suggest that increased sleep duration and reduced screen time are important determinants of lower depressive symptoms among adolescents.

Sleep Pattern and Problems in Young Children Visiting Outpatient Department of a Tertiary Level Hospital in Kathmandu, Nepal

Background

Sleep is an important parameter of a child's growth and development. The pattern and duration of sleep varies with age. Sleep problems are a common occurrence during childhood days, and these problems that establish in childhood are presumed to continue later in life. Many times, parental concerns regarding their child's sleep problems like difficulty in putting to sleep, frequent night time awakening, and waking up early are overlooked during their visits to the hospital.

Objective

The aim of this study was to find out the sleep patterns and problems of children aged six to thirty-six months. Methodology. A cross-sectional study was conducted at the pediatric outpatient department of Kathmandu Medical College Teaching Hospital from October, 2019 till March, 2020. Two hundred and forty-nine respondents were chosen purposively and were given questionnaires to be filled out. Research instrument was a standard, Nepali version of a structured questionnaire called Brief Infant Sleep Questionnaire (BISQ) which contained questions related to sleep parameters and sleep problems existing among young children of 6-36 months. Mean, standard deviation, frequencies, and Kruskal Wallis test were used for statistical analysis.

Results

The mean duration of total sleep was 12.12 ± 2.00 hours, while that of night sleep was 9.22 ± 1.19 hours and mean daytime nap was 2.90 ± 1.66 hours. Most of the children (96%) coslept with their parents, and 55% of the children had feeding as a bedtime ritual. Overall, 19.6% of the children had sleep problems as identified by BISQ although only 5.6% of the parents perceived that their children had it.

Conclusions

Sleep problems were present among young Nepalese children included in our study, and sleep assessment should be a part of every health checkup for children.

Live fast, die young and sleep later: Life history strategy and human sleep behavior

Background and objectives

Life History Theory (LHT) describes trade-offs that organisms make with regard to three investment pathways: growth, maintenance and reproduction. In light of the reparative functions of sleep, we examine sleep behaviors and corresponding attitudes as proximate manifestations of an individual's underlying relative prioritization of short-term reproduction versus long-term maintenance.

Methodology

We collected survey data from 568 participants across two online studies having different participant pools. We use a mixture of segmented and hierarchical regression models, structural equation modeling and machine learning to infer relationships between sleep duration/quality, attitudes about sleep and biodemographic/psychometric measures of life history strategy (LHS).

Results

An age-mediated U- or V-shaped relationship appears when LHS is plotted against habitual sleep duration, with the fastest strategies occupying the sections of the curve with the highest mortality risk: < 6.5 hr (short sleep) and > 8.5 hr (long sleep). LH 'fastness' is associated with increased sleepiness and worse overall sleep quality: delayed sleep onset latency, more wakefulness after sleep onset, higher sleep-wake instability and greater sleep duration variability. Hedonic valuations of sleep may mediate the effects of LHS on certain sleep parameters.

Conclusions and implications

The costs of deprioritizing maintenance can be parameterized in the domain of sleep, where 'life history fastness' corresponds with sleep patterns associated with greater senescence and mortality. Individual differences in sleep having significant health implications can thus be understood as components of lifelong trajectories likely stemming from calibration to developmental circumstances. Relatedly, hedonic valuations of sleep may constitute useful avenues for non-pharmacological management of chronic sleep disorders.Lay Summary: Sleep is essential because it allows the body to repair and maintain itself. But time spent sleeping is time that cannot be spent doing other things. People differ in how much they prioritize immediate rewards, including sociosexual opportunities, versus long-term goals. In this research, we show that individual differences in sleep behaviors, and attitudes toward sleep, correspond with psychological and behavioral differences reflecting such differing priorities. Orientation toward sleep can thus be understood as part of the overall lifetime strategies that people pursue.

The importance of specialized sleep investigations in children with a suprasellar tumor

PURPOSE

Disruption of sleep has great impact on quality of life. In children with a suprasellar tumor and hypothalamic-pituitary dysfunction, the circadian rhythm may be disturbed causing sleep problems. However, also other factors may influence sleep. Awareness of these different etiologies and careful history taking with appropriate additional diagnostics will aid in restoring sleep quality.

METHODS

We present the workup of 4 cases with a suprasellar tumor and disturbances of sleep initiation, sleep maintenance, and daytime sleepiness. In parallel, we developed a flowchart, to aid clinicians in the diagnostics of sleep problems in children after treatment for a (supra) sellar brain tumor.

RESULTS

All four patients, known with hypopituitarism, presented with sleep complaints and increased daytime sleepiness. In all four, the cause of sleep problems showed to be different. In the first case, sleep evaluation revealed a severe obstructive sleep apnea, whereupon nocturnal ventilation was started. The second case revealed poor sleep hygiene in combination with an obsessive compulsive disorder. Sleep hygiene was addressed and psychiatric consultation was offered. Dexamphetamine treatment was started to reduce her obsessive compulsive complaints. The third case showed a delayed sleep phase syndrome, which improved by educational support. The fourth case revealed a secondary organic hypersomnia for which modafinil treatment was started.

CONCLUSION

Sleep disturbances in children with hypopituitarism due to a (supra) sellar tumor can have different entities which require specific therapy. Awareness of these different entities is important to enable appropriate counseling. Referral to an expertise sleep center may be advised, if standard educational support is insufficient.

Sleep stage classification for child patients using DeConvolutional Neural Network

Studies from the literature show that the prevalence of sleep disorder in children is far higher than that in adults. Although much research effort has been made on sleep stage classification for adults, children have significantly different characteristics of sleep stages. Therefore, there is an urgent need for sleep stage classification targeting children in particular. Our method focuses on two issues: The first is timestamp-based segmentation (TSS) to deal with the fine-grained annotation of sleep stage labels for each timestamp. Compared to this, popular sliding window approaches unnecessarily aggregate such labels into coarse-grained ones. We utilize DeConvolutional Neural Network (DCNN) that inversely maps features of a hidden layer back to the input space to predict the sleep stage label at each timestamp. Thus, our DCNN can yield better classification performances by considering labels at numerous timestamps. The second issue is the necessity of multiple channels. Different clinical signs, symptoms or other auxiliary examinations could be represented by different Polysomnography (PSG) recordings, so all of them should be analyzed comprehensively. We therefor exploit multivariate time-series of PSG recordings, including 6 electroencephalograms (EEGs) channels, 2 electrooculograms (EOGs) channels (left and right), 1 electromyogram (chin EMG) channel and two leg electromyogram channels. Our DCNN-based method is tested on our SDCP dataset collected from child patients aged from 5 to 10 years old. The results show that our method yields the overall classification accuracy of 84.27% and macro F1-score of 72.51% which are higher than those of existing sliding window-based methods. One of the biggest advantages of our DCNN-based method is that it processes raw PSG recordings and internally extracts features useful for accurate sleep stage classification. We examine whether this is applicable for sleep data of adult patients by testing our method on a well-known public dataset Sleep-EDFX. Our method achieves the average overall accuracy of 90.89% which is comparable to those of state-of-the-art methods without using any hand-crafted features. This result indicates the great potential of our method because it can be generally used for timestamp-level classification on multivariate time-series in various medical fields. Additionally, we provide source codes so that researchers can reproduce the results in this paper and extend our method.

Sex differences in the relationship between social media use, short sleep duration, and body mass index among adolescents

OBJECTIVES

The main objectives of this study were to (1) determine whether sex moderates the association between social media use and body mass index (BMI) and (2) assess whether sleep duration mediates the association between social media use and BMI.

DESIGN

A cross-sectional province-wide and school-based survey of 7^th to 12^th graders (mean age: 15.1 years).

PARTICIPANTS

The sample consisted of 4,991 students from the 2015 cycle of the Ontario Student Drug Use and Health Survey (Canada).

MEASUREMENTS

Participants self-reported time spent using social media, total screen time, physical activity, sleep duration, and body weight and height. Multiple linear regression analyses were used to examine the association between social media use and BMI z-scores. Given that the sex by social media use interaction term was significant, analyses were stratified by sex.

RESULTS

After adjusting for age, ethnic background, subjective socioeconomic status, frequency of breakfast consumption, and physical activity, heavy social media use (>2 hours/day) was associated with higher BMI z-scores among males (β=0.323, 95% CI: 0.094; 0.551) than among females (β=0.036, 95% CI: -0.292; 0.364). This association remained significant after further adjusting for total screen time. Results also showed that sleep duration mediates the association between social media use and BMI z-scores among men.

CONCLUSION

Our results showed that short sleep duration is a concurrent mediator of the relationship between social media use and BMI z-scores among males. Reducing time spent using social media may be a good behavioral target to promote adequate sleep duration, which is considered as a component in childhood obesity prevention efforts.

Sleep Training

Adequate sleep in infancy and beyond is important for development; however, many children are not sleeping the recommended amount. During the first few years of childhood, infants are frequently seen in the pediatric office for well-visits and a myriad of other concerns, including sleep difficulties. As such, pediatricians should be adequately prepared to address these concerns. This article aims to provide clinicians with a basic knowledge of sleep physiology, sleep patterns and development, and current guidelines and options available for parents to address these issues. [Pediatr Ann. 2020;49(3):e101-e105.].

Update on Insomnia after Mild Traumatic Brain Injury

Sleep disturbance after traumatic brain injury (TBI) has received growing interest in recent years, garnering many publications. Insomnia is highly prevalent within the mild traumatic brain injury (mTBI) population and is a subtle, frequently persistent complaint that often goes undiagnosed. For individuals with mTBI, problems with sleep can compromise the recovery process and impede social reintegration. This article updates the evidence on etiology, epidemiology, prognosis, consequences, differential diagnosis, and treatment of insomnia in the context of mild TBI. This article aims to increase awareness about insomnia following mTBI in the hopes that it may improve diagnosis, evaluation, and treatment of sleeping disturbance in this population while revealing areas for future research.

Use of social media is associated with short sleep duration in a dose-response manner in students aged 11 to 20 years

AIM

This study examined the association between social media and sleep duration among Canadian students aged 11-20.

METHODS

Data from 5242 students were obtained from the 2015 Ontario Student Drug Use and Health Survey, a province-wide, school-based survey that has been conducted every two years since 1977. We measured the respondents' sleep duration against the recommended ranges of 9-11 h per night at 11-13 years of age, 8-10 h at 14-17 and 7-9 h per night for those aged 18 years or more.

RESULTS

Overall, 36.4% of students met or exceeded the recommended sleep duration and 63.6% slept less than recommended, with 73.4% of students reporting that they used social media for at least one hour per day. After adjusting for various covariates, the use of social media was associated with greater odds of short sleep duration in a dose-response manner (p for linear trend <0.001). Odds ratios ranged from 1.82 for social media use of at least one hour per day to 2.98 for at least five hours per day.

CONCLUSION

Greater use of social media was associated with shorter sleep duration in a dose-response fashion among Canadian students aged 11-20.

Sleep problems in children with autism spectrum disorder and intellectual disability without autism spectrum disorder

OBJECTIVE

The objective of this study was to evaluate the sleep problems and their correlations in children with autism spectrum disorder (ASD), intellectual disability without ASD (ID), and typically developing children (TDC).

METHODS

This study included 142 children (48 with ASD, 46 with ID, 48 with TDC) aged between 2 and 18 years old. Parents of the children completed the Childhood Sleep Habits Questionnaire (CSHQ) in order to evaluate sleep disturbances. The sociodemographic and clinical information were noted on a data form for each child.

RESULTS

The mean total score of CSHQ was 41.56, 47.89 and 51.78 respectively in TDC, ASD and ID groups. While the total CSHQ score was significantly lower in TDC, there was no significant difference between ID and ASD groups (p = 0.09). It was revealed that children having a neurodevelopmental disorder had a 2.8-fold increased risk of sleep disturbance, history of sleep disorder in the parents had a 3.1-fold increased risk, psychiatric comorbidity in the child had a 3.3-fold increased risk, and co-sleeping with parents had 13.1-fold increased risk. However, in the binary regression analysis, co-sleeping with parents and family history of sleep problems significantly increased the risk of sleep disturbance.

CONCLUSION

Sleep disturbances are more frequent in children with ASD and ID than TDC. Co-sleeping with parents and family history of sleep problems increase the risk of sleep disturbances. Thus, behavioral techniques especially focusing on co-sleeping problems and focusing on parents' sleep habits may improve the sleep disturbances in children with ID and ASD.

Putting Children's Sleep Problems to Bed: Using Behavior Change Theory to Increase the Success of Children's Sleep Education Programs and Contribute to Healthy Development

Sleep is critical for the healthy development of children, yet most children simply don’t get enough. Whilst school based sleep education programs have been developed for parents and their children, they have had mixed success. We consider how existing school-based sleep education programs can be improved by applying a broader model to behaviour change theory. We find that the mixed success of school-based sleep education programs may be due to a plausible but misleading assumption that simply increasing information about the importance of sleep and the risks of insufficient and/or inefficient sleep, will necessarily result in improved sleep behaviours. We identify the potential benefits of using a more inclusive behavior change theory in the development of sleep education programs with a particular need for theories that incorporate the multiple biological, environmental and social impacts on children’s sleep. Bronfenbrenner’s Bioecological model is presented to illustrate how one such inclusive behavior change theory could significantly improve the success of sleep education programs and ultimately support the healthy development of children.

Parent-child bed-sharing: The good, the bad, and the burden of evidence

The practice of parent and child sharing a sleeping surface, or 'bed-sharing', is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on 98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - anthropology, psychology/psychiatry, and pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children's social, emotional, and physical development.