Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children?

Association between sleep and myopia in children and adolescents: a systematic review and meta-analysis

PURPOSE

There is a scarcity of literature focusing on sleep's impact on myopia in children despite an epidemic rise of myopia among the age group and the importance of early prevention. As such, this systematic review-meta-analysis aims to evaluate the association between various aspects of sleep and myopia in children and adolescents aged 0-19 years.

METHODS

We searched PubMed, EMBASE, and Cochrane Library on 08/12/2022 for studies reporting sleep in relation to myopia among children and adolescents. Myopia was defined as spherical equivalent refraction < -0.5 diopter. The primary outcome was the relationship between sleep duration and myopia prevalence. Secondary outcomes include the effect of sleep quality, bedtime, and waketime on myopia prevalence, incidence, and progression. Odds ratio (OR) was estimated with a 95% confidence interval (95% CI).

RESULTS

Eighteen studies (49,277 participants) were included in the review, and six studies (14,116 participants) were included in the meta-analysis for the primary outcome. There was no significant correlation between sleep and myopia prevalence (OR = 0.905, 95% CI = 0.782 to 1.047). Some studies suggested that better sleep quality (2 of 6 studies), earlier bedtime (3 of 5 studies), and later waketimes (2 of 3 studies) had protective effects on myopia.

CONCLUSION

Sleep duration did not affect myopia prevalence in children, while other aspects of sleep had plausible but inconclusive impacts on myopia development and progression. More research with diverse populations and standardized methods of reporting is needed.

Bedtime Regularity and Sleep Sufficiency in Children With Tourette Syndrome

BACKGROUND

Despite research demonstrating sleep disturbance in children with Tourette syndrome (TS), few studies have examined bedtime regularity and sleep sufficiency, two important sleep health dimensions. Therefore, this study examined bedtime regularity and sleep sufficiency in children with TS relative to matched healthy control subjects, and its associated demographic, clinical, and behavioral factors.

METHODS

Participants were 384 parents or caregivers of children aged three to 17 years, including 192 with current TS and 192 matched healthy control subjects drawn from the 2020-2021 cycle of the National Survey of Children's Health. Parents completed questions assessing demographic (i.e., age, race, sex), clinical (i.e., attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder, anxiety, depression, tic severity, behavioral or conduct problems, ADHD medication, health condition-related impairment), and behavioral (i.e., screen time) characteristics. Mann-Whitney U test and chi-square test of independence were performed to compare groups on bedtime regularity and sleep sufficiency, respectively. Ordinal regression and binary logistic regression without and with backward elimination were performed to evaluate indicators of bedtime regularity and sleep sufficiency, respectively, in children with TS.

RESULTS

Children with current TS had significantly poorer bedtime regularity, but not sleep sufficiency, relative to matched healthy control subjects. In children with TS, anxiety and two or more hours of daily screen time were associated with higher likelihood of poor bedtime regularity. Autism was associated with lower likelihood of insufficient sleep, and depression was associated with increased likelihood of insufficient sleep.

CONCLUSIONS

Findings put forth screen time, anxiety, and depression as intervention targets to optimize sleep health in children with TS.

A survey of mental health literacy in parents and guardians of teenagers

Introduction

Parents and guardians (hereafter caregivers) of teenagers need high levels of mental health literacy (MHL) to manage mental health problems arising in teenagers in their care. Previous studies assessing MHL levels in caregivers of teenagers have reported mixed results, making it difficult to clearly estimate caregiver MHL levels. This study aimed to investigate MHL levels in Japanese caregivers of regular teenagers.

Methods

Responses from caregivers (n = 1,397) of students entering junior and senior high schools to a self-administered online questionnaire were analyzed. The questionnaire assessed (a) knowledge about mental health/illnesses and (b) attitudes towards mental health problems in teens in their care (e.g., recognition of depression as a medical illness and intention to engage in helping behaviors).

Results

The average proportion of correct answers to the knowledge questions (n = 7) was 55.4%; about one tenth (9.2%) of caregivers correctly answered only one or none of the questions. Few caregivers correctly answered about the life-time prevalence of any mental illnesses (46.1%) and appropriate sleep duration for teenagers' health (16.5%). The proportions of caregivers who had the intention to listen to the teen in their care, consult another person, and seek professional medical help if the teen suffered from depression were 99.5%, 91.5% and 72.7%, respectively.

Conclusions

Many teenagers' caregivers appeared to be willing to help the teens in their care if they were suffering from mental health problems. However, there was much room for improvement in knowledge on mental health/illnesses and intention to seek help from medical professionals. Efforts toward better education should be made.

Social Capital and Sleep Outcomes Across Childhood in United States Families

OBJECTIVE

To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income.

METHODS

Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration.

RESULTS

In our sample (N = 35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime.

CONCLUSIONS

Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes.

Sleep and academic performance among students in Hong Kong: Curvilinear relationship suggesting an optimal amount of sleep

OBJECTIVES

This study aimed to elucidate the association between sleep and academic performance using standardized academic assessment in a large and representative sample of school children and adolescents in Hong Kong.

METHODS

This school-based cross-sectional study was conducted in 2016. Students completed territory-wide standardized tests in Chinese, English, and Mathematics and a set of questionnaires covering sleep, academic anxiety and motivation. Parents provided additional information on socioeconomic status and children's study behaviors. Weekday proxy sleep duration was reflected by time-in-bed, the difference between bedtime and wakeup time.

RESULTS

The study included 4262 Grade 3 (G.3) (mean age [SD], 9.2 [0.6] years; girls: 49.7%) and 3297 G.9 students (mean age [SD], 15.3 [0.74]; girls: 57.5%) from 77 schools. Apart from showing a general insufficiency of students' sleep in this metropolitan city, there was a significant quadratic relationship (G.3: β = -0.05, p < .001; G.9: β = -0.03, p < .01), indicating that students with an optimal level of sleep (9.5 h and 8.5 h in G.3 and G.9, respectively) tend to have better academic performance. The significant association remained after controlling for socioeconomic and study-related variables in that sleeping too little or too much was associated with poor academic performance.

CONCLUSIONS

This is the first study to explore the curvilinear association between sleep duration and academic performance by using standardized test and simultaneously examining learning-related controls with a large representative sample in Hong Kong. The findings suggested that there is an inverted U-shaped relationship between sleep duration and academic performance in both school-aged children and adolescents. It is recommended that systematic sleep education and intervention is necessary to encourage the development of optimal sleep pattern, which might have beneficial effect on academic performance for students at both primary and secondary level.

Impact of sleep on attention in primary school-aged autistic children: Exploratory cross-cultural comparison between Singapore and UK children

BACKGROUND

There is a growing body of research studying the impact sleep has on attention among typically developing (TD) children, but research is lacking among autistic children.

AIMS

The present study aimed to explore, for the first time, differences in (1) attention, (2) sleep parameters among primary school-aged Singaporean autistic children (N = 26) and Singaporean TD children (N = 20), and with UK autistic (N = 11) and UK TD children (N = 16), and (3) the impact of sleep on attention.

METHODS AND PROCEDURES

Actigraphy was used to objectively assess sleep, and a Continuous Performance Task was used to measure attentional domains.

OUTCOMES AND RESULTS

There were inconclusive findings indicating that autistic children had poorer sustained attention than TD children. Although autistic children did not display more sleep difficulties than TD children, they showed shorter actual sleep duration (Singapore ASD = 7:00 h, UK ASD = 7:35 h, p < .01) and longer sleep latency (Singapore ASD = 30:15 min, UK ASD = 60:00 min, p < .01) than clinical recommendations. Sleep difficulties were also present among Singaporean and UK TD children. Both TD groups had less actual sleep duration than recommended (Singapore TD = 6:32 h, UK TD = 8:07 h). Singaporean TD children had sleep efficiency below recommended criterion (78.15%). Sleep impacted attention across all groups, but effects were different for autistic and TD groups.

CONCLUSIONS AND IMPLICATIONS

The study highlighted the importance for practitioners and carers to adopt a child-centred approach to assessing sleep and attentional difficulties, especially among autistic children due to the high variability in performance within the group. The impact of cultural and school-setting differences on sleep was also raised.

Application of a composite scoring protocol to identify factors that contribute to the risk of overweight and obesity in Irish children

BACKGROUND

Investigations into the main drivers of childhood obesity are vital to implement effective interventions to halt the global rise in levels. The use of a composite score may help to identify children most at risk of overweight/obesity.

OBJECTIVES

To investigate the cumulative impact of factors associated with overweight/obesity risk in children.

METHODS

Data were analysed from the Irish National Children's Food Survey II which included 600 children, aged 5-12-years. The risk factors examined included social class, parental, early life, lifestyle, and dietary components. A composite score was calculated which ranged from 0 (no risk factors for overweight/obesity) to 4 (4 risk factors for overweight/obesity).

RESULTS

In model 1 (%BF) the four factors associated with overweight/obesity risk were having a parent with overweight/obesity (odds ratio 3.1; 95% confidence interval 1.9-4.8), having a high birth weight of ≥4 kg (2.5; 1.6-3.9), being from a low social class (2.3; 1.4-3.8) and low physical activity (1.9; 1.2-2.8). Children who scored 3-4 points on the composite score had a 10-fold (10.0; 4.2-23.9) increased risk of overweight/obesity compared to those with 0 points, a sevenfold (7.2; 3.9-13.5) increased risk compared to those with 1 point and a threefold (2.6; 1.4-4.8) increased risk compared to those with 2 points, with similar results observed in model 2 (BMI).

CONCLUSION

The use of a composite score is a beneficial means of identifying children at risk of overweight/obesity and may prove useful in the development of effective interventions to tackle childhood obesity.

Characteristic Sleep Patterns and Associated Obesity in Adolescents

Poor sleep adversely affects health and may cause obesity. Poor sleep includes short sleep duration, low quality of sleep, and sleep discrepancy. Although most studies have focused on the association between sleep duration and obesity, poor sleep is a significant risk factor for obesity. Adolescents have characteristic sleep patterns which correspond to poor sleep. Adolescents sleep late due to various biological and psychosocial factors; also, they wake up early to be on time for school. This causes them to sleep less. To make up for this sleep debt, adolescents sleep more on non-school days, which causes sleep discrepancies. Therefore, since adolescents have characteristic sleep patterns, an in-depth investigation is needed to identify whether poor sleep is a risk for obesity. This article presents an overview of the characteristic sleep patterns of adolescents, and reviews studies on the association of each sleep pattern with obesity.

Sleep Duration and Internalizing Symptoms in Children

OBJECTIVE

Emotional problems such as anxiety and low mood have been associated with sleep problems in children. The study's objectives were to 1) assess the association between sleep duration and internalizing symptoms (anxiety and low mood) in children aged 5-12 years (y), and 2) evaluate whether insufficient sleep according to the National Sleep Foundation (NSF) guidelines is associated with internalizing symptoms.

METHODS

A cross-sectional study of N =796 children aged 5-12y, recruited from primary care physicians' offices in Toronto, Canada was conducted through the TARGet Kids! research network. Using linear regression, we investigated 1) the cross-sectional association between parent reported 24-hour sleep duration (hours) and parent reported symptoms using the Strengths and Difficulties Questionnaire (SDQ), controlling for child age, sex, family income, maternal education, family composition, and standardized body-mass index (zBMI). The analysis was repeated using insufficient sleep per NSF guideline as the independent variable.

RESULTS

Sleep duration was inversely associated with internalizing symptoms, B estimate = -0.33 (95%CI -0.57, -0.07), p=0.012. Twenty-eight (14%) children aged 5 y, and 36 (6%) of those aged 6-12y, experienced insufficient sleep. There was a trend toward association between insufficient sleep and internalizing symptoms, B estimate = 0.64 (-0.09, 1.38), p=0.086.

CONCLUSION

The relationship between insufficient sleep and internalizing symptoms among children requires further elucidation. Children who show internalizing symptoms may benefit from interventions supporting sleep.

Cross-sectional and prospective associations of sleep duration and bedtimes with adiposity and obesity risk in 15 810 youth from 11 international cohorts

OBJECTIVES

To investigate associations of bedtimes and sleep durations with adiposity levels in children and adolescents.

METHODS

Individual data were pooled for 12 247 children (5819 with follow-up adiposity at 2.3 ± 1.4 years post-baseline) and 3563 adolescents from 11 international studies. Associations between questionnaire-based sleep durations, bedtimes and four groups of combined bedtimes and sleep lengths (later-shorter [reference]/earlier-shorter/later-longer/earlier-longer) with measured adiposity (body mass index [BMI] and waist circumference z-scores) and weight status, were investigated.

RESULTS

In children, longer sleep durations were consistently associated with lower adiposity markers, and earlier bedtimes were related to lower BMI z-score. Compared to sleeping <10 h, longer baseline sleep duration favourably predicted Δwaist z-score in girls (≥10 and <11 h (β-coefficient (95% confidence interval [CI])): -0.06 (-0.12 to -0.01)) and boys (≥11 h: -0.10 [-0.18 to -0.01]). Combined groups that were defined by longer sleep (later-longer and earlier-longer sleep patterns) were associated with lower adiposity, and later-longer sleep favourably predicted Δwaist z-score in girls (-0.09 [-0.15 to -0.02]). In adolescents, longer sleep durations and earlier bedtimes were associated with lower BMI z-score in the whole sample, and also with lower waist z-score in boys. Combined groups that were characterized by earlier bedtimes were associated with the same outcomes. For example, earlier-shorter (-0.22 (-0.43 to -0.01) and earlier-longer (-0.16 (-0.25 to -0.06) sleep were both associated with lower BMI z-score.

CONCLUSIONS

If the associations are causal, longer sleep duration and earlier bedtimes should be targeted for obesity prevention, emphasizing longer sleep for children and earlier bedtimes for adolescents.

The Sleep-Obesity Nexus: Assessment of Multiple Sleep Dimensions and Weight Status Among Victorian Primary School Children

PURPOSE

To examine the association between sleep and weight status across multiple dimensions of sleep (duration, efficiency, quality and timing) and assess the cumulative influence of these dimensions on the overall sleep-obesity association.

PARTICIPANTS AND METHODS

Cross-sectional data from 2253 students aged 8.8 to 13.5 years participating in two monitoring studies across regional Victoria was analyzed. Students were invited to have measures of height and weight taken and to complete a self-report electronic questionnaire on demographic characteristics and health behaviors. Logistic regression models were used to assess association between sleep dimensions and BMI z-scores.

RESULTS

Beyond sleep duration, poor perceived sleep quality, delayed sleep initiation, later bed times and sleep-wake timing, all significantly increased the odds of overweight/obesity (OR 1.47, 95% CI: 1.07-2.01; OR 1.25, 95% CI: 1.02-1.55; and OR 1.70. 95% CI: 1.28-2.28, respectively). Additionally, a cumulative effect of having multiple poorly scored sleep dimensions was found, where four or more poorly scored sleep dimensions more than doubled the odds of overweight/obesity among children (OR 2.25, 95% CI: 1.41-3.58).

CONCLUSION

This study highlights the importance of measuring and considering multiple dimensions of sleep, along with the individual and additive influence of the sleep dimension on the sleep-obesity nexus.

Sleep in an At Risk Adolescent Group: A Qualitative Exploration of the Perspectives, Experiences and Needs of Youth Who Have Been Excluded From Mainstream Education

The sleep needs, experiences and viewpoints were explored for UK adolescents who have been excluded from mainstream education. Qualitative data was gathered through interviews with 9 participants, aged 11–15 years, who also completed questionnaires. The participants had symptoms of inadequate sleep, poor sleep hygiene behaviours and were not getting the recommended amount of sleep on school nights. Participants described sleep patterns involving often staying up late and having different sleep timing on weekends than weekdays and having difficulties with their sleep. Use of technology and the relevance of family were identified as important and associated with facilitating and hindering factors for sleep. Participants communicated that they lack control over aspects of their sleep and their lives. The experiences and views of the participants can inform professionals’ understanding of how to collaborate with adolescents to improve their sleep and highlight that continued development of sleep education programmes is timely.

A survey of mental health literacy in Japanese high school teachers

BACKGROUND

School teachers are well-positioned to recognize mental health problems in their students and to help them seek appropriate help. Therefore, teachers need to have high levels of mental health literacy (MHL). In East Asia, however, few studies have examined MHL levels in teachers. In this study, MHL levels were investigated in Japanese teachers.

METHODS

Teachers (n = 665) from 27 Japanese high schools answered a self-administered questionnaire which assessed (a) knowledge about mental health/illnesses, (b) correct recognition of specific illnesses (depression, schizophrenia and panic disorder), (c) confidence in helping students with depressive symptoms, and (d) confidence in teaching mental health knowledge to students.

RESULTS

The average proportion of correct answers to the knowledge questions (n = 20) was 58.1%. The proportion of those who correctly answered about the presence of a sharp increase of mental illnesses in adolescence was 51.7%. Few teachers correctly answered about the life-time prevalences of major mental illness in general (21.9%), depression (37.8%) and schizophrenia (19.8%). Depression, schizophrenia and panic disorder in vignette were correctly recognized by 54.1, 35.3 and 78.0% of teachers, respectively. Correct recognition was significantly lower in male than in female teachers. Only a small proportion of teachers had confidence in helping depressed students (19.9%) and in teaching mental health knowledge to students (11.1%).

CONCLUSIONS

MHL in Japanese high school teachers appears to be low. Education programs should be developed and implemented to improve teacher MHL with the aim of helping them to support students suffering from mental health problems.

Feeling better or not: Adjusting affective style moderates the association between sleep duration and positive affect on next day

Affect is intertwined with sleep, yet how to adjust sleep duration to enhance affect remains unknown. Previous studies found that adjusting affective style, reflecting interindividual differences in emotion regulation, functions in processes where sleep modulates our affective state. Hence, this study examined whether and how it moderates the association between daily sleep duration and subsequent affect. An ambulatory assessment design was employed among 64 participants, wherein both within-person sleep duration and affect, and between-person affective styles were measured. Multilevel moderation analysis and simple-slope analysis were applied to test the moderation of adjusting affective style in the sleep-affect association. This study found that adjusting affective style significantly moderated the association between sleep duration and subsequent positive affect. Specifically, the association between sleep duration and subsequent positive affect was positive under higher adjusting affective style and negative under extremely lower adjusting affective style. However, such moderation was not observed in associations between subsequent negative affect and sleep duration. This study uncovers the relationship between sleep duration and subsequent affect, wherein the likelihood for individuals to reach more positive affective state by increasing sleeping duration might count on their ability of emotion regulation. Additionally, negative affect cannot be downregulated simply through long sleep duration.

Mental health and sleep habits/problems in children aged 3-4 years: a population study

Background

Sleep is essential for mental health at all ages, but few studies have investigated the importance of sleep for mental health in early childhood. Therefore, this study examined the association between mental health and sleep habits/problems in children aged 34 years.

Methods

Children aged 3 to 4 years who were living in the community (n=415; 211/204 boys/girls) were recruited for this study. Their mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and their sleep habits/problems were evaluated using the Child and Adolescent Sleep Checklist.

Results

Based on the total difficulties score of the SDQ, the children were divided into two groups: a poor mental health group (n=76) and a control group (n=339). In terms of sleep habits, which included total sleep time, bedtime, wake time, and nap conditions, there were no differences between the two groups. Regarding sleep-related problems, however, anxiety before going to sleep (p=0.026), circadian rhythm abnormalities (p=0.014), and sleepiness during classes outside of naptimes (p=0.031) were significantly higher in the poor mental health group than in the control group. Multiple regression analysis showed that poor mental health status was significantly associated with sleepiness and snoring (p=0.017 and p=0.018, respectively).

Conclusions

The mental health status of 34-year-old children was associated with sleep-related problems, namely sleepiness and snoring. Healthcare providers should pay attention to childrens irregular sleep-wake patterns; moreover, interventions for appropriate sleep hygiene will reduce the psychological burden on both children and their families.

Trajectories of sleep problems in childhood: associations with mental health in adolescence

STUDY OBJECTIVES

We examined initial levels (intercepts) of sleep-wake problems in childhood and changes in sleep-wake problems across late childhood (slopes) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems.

METHODS

Participants were 199 youth (52% boys; 65% White/European American, 35% Black/African American). Sleep-wake problems (e.g. difficulty sleeping and waking up in the morning) were assessed during three time points in late childhood (ages 9, 10, and 11) with self-reports on the well-established School Sleep Habits Survey. At age 18, multiple domains of mental health (externalizing behavior problems, depressive symptoms, and anxiety) and sleep-wake problems were assessed.

RESULTS

Latent growth curve modeling revealed that children with higher levels of sleep-wake problems at age 9 had consistently higher levels of such problems between ages 9 and 11. The initial level of sleep-wake problems at age 9 predicted externalizing behaviors, depressive symptoms, and anxiety at age 18, controlling for mental health in childhood and concurrent sleep-wake problems in adolescence. The slope of sleep-wake problems from ages 9 to 11 did not predict age 18 mental health.

CONCLUSIONS

Youth who had higher sleep-wake problems during late childhood had higher levels of mental health problems in adolescence even after controlling for childhood mental health and concurrent sleep-wake problems. Findings illustrate that childhood sleep problems may persist and predict adolescent mental health even when potentially confounding variables are rigorously controlled.

Predictors of Changes in Sleep Duration in Dutch Primary Schoolchildren: the ChecKid Study

BACKGROUND

Healthy sleep duration is essential to health and well-being in childhood and later life. Unfortunately, recent evidence shows a decline in sleep duration among children. Although effective interventions promoting healthy sleep duration require insight into its predictors, data on these factors are scarce. This study therefore investigated (i) which individual (lifestyle), social and cultural factors, and living conditions and (ii) which changes in these factors might be associated with the changes in sleep duration of Dutch primary schoolchildren observed over time.

METHOD

Data from the ChecKid study was used, a dynamic cohort study among 4-13-year-old children living in the city of Zwolle, the Netherlands. Associations between changes in sleep duration and individual (lifestyle) factors (i.e., age, sex, physical activity behavior, sugar-sweetened beverage consumption, screen behavior), social and cultural factors (i.e., parental rules, ethnicity), and living conditions (i.e., parental education, presence of screens in the bedroom, household size) were analyzed using multivariable linear regression.

RESULTS

A total of 1180 children participated, aged 6.6 ± 1.4 years in 2009. Mean sleep duration decreased from 11.4 ± 0.5 h/night in 2009 to 11.0 ± 0.5 h/night in 2012. Older children, boys, children who used screens after dinner, children with greater computer/game console use, and children whose parents had low levels of education had a greater decrease in sleep duration.

CONCLUSIONS

This article reports on one of the first large, longitudinal cohort studies on predictors of child sleep duration. The results of the study can inform future interventions aimed at promoting healthy sleep in primary schoolchildren.

Radar-based sleep stage classification in children undergoing polysomnography: a pilot-study

STUDY OBJECTIVES

Unobtrusive monitoring of sleep and sleep disorders in children presents challenges. We investigated the possibility of using Ultra-Wide band (UWB) radar to measure sleep in children.

METHODS

Thirty-two children scheduled to undergo a clinical polysomnography participated; their ages ranged from 2 months to 14 years. During the polysomnography, the children's body movements and breathing rate were measured by an UWB-radar. A total of 38 features were calculated from the motion signals and breathing rate obtained from the raw radar signals. Adaptive boosting was used as machine learning classifier to estimate sleep stages, with polysomnography as gold standard method for comparison.

RESULTS

Data of all participants combined, this study achieved a Cohen's Kappa coefficient of 0.67 and an overall accuracy of 89.8% for wake and sleep classification, a Kappa of 0.47 and an accuracy of 72.9% for wake, rapid-eye-movement (REM) sleep, and non-REM sleep classification, and a Kappa of 0.43 and an accuracy of 58.0% for wake, REM sleep, light sleep and deep sleep classification.

CONCLUSION

Although the current performance is not sufficient for clinical use yet, UWB radar is a promising method for non-contact sleep analysis in children.

Non-contact Sleep/Wake Monitoring Using Impulse-Radio Ultrawideband Radar in Neonates

Background: The gold standard for sleep monitoring, polysomnography (PSG), is too obtrusive and limited for practical use with tiny infants or in neonatal intensive care unit (NICU) settings. The ability of impulse-radio ultrawideband (IR-UWB) radar, a non-contact sensing technology, to assess vital signs and fine movement asymmetry in neonates was recently demonstrated. The purpose of this study was to investigate the possibility of quantitatively distinguishing and measuring sleep/wake states in neonates using IR-UWB radar and to compare its accuracy with behavioral observation-based sleep/wake analyses using video recordings. Methods: One preterm and three term neonates in the NICU were enrolled, and voluntary movements and vital signs were measured by radar at ages ranging from 2 to 27 days. Data from a video camcorder, amplitude-integrated electroencephalography (aEEG), and actigraphy were simultaneously recorded for reference. Radar signals were processed using a sleep/wake decision algorithm integrated with breathing signals and movement features. Results: The average recording time for the analysis was 13.0 (7.0-20.5) h across neonates. Compared with video analyses, the sleep/wake decision algorithm for neonates correctly classified 72.2% of sleep epochs and 80.6% of wake epochs and achieved a final Cohen's kappa coefficient of 0.49 (0.41-0.59) and an overall accuracy of 75.2%. Conclusions: IR-UWB radar can provide considerable accuracy regarding sleep/wake decisions in neonates, and although current performance is not yet sufficient, this study demonstrated the feasibility of its possible use in the NICU for the first time. This unobtrusive, non-contact radar technology is a promising method for monitoring sleep/wake states with vital signs in neonates.

The impact of reduced sleep on school related outcomes for typically developing children aged 11–19: A systematic review

This systematic literature review examines the relationship between restricted and reduced sleep and school performance, learning and cognitive functioning in typically developing adolescents. Correlational and experimental data were evaluated from 17 studies which included participants ranging from 11 to 19 years in studies from seven countries around the world. The review found that there is evidence that restricted and reduced sleep is negatively associated with school performance and cognitive outcomes, although the findings were mixed. Implications for psychologists working with schools are discussed. More research and evaluation is needed to establish how these factors relate to each other conclusively.

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

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

Linear and Nonlinear Associations between Sleep and Adjustment in Adolescence

BACKGROUND & OBJECTIVES

A growing body of work supports linear associations between sleep and socioemotional adjustment in adolescence. However, associations between sleep and adjustment are not necessarily linear and investigations of nonlinear effects are scarce. This study examined linear and nonlinear relations between several sleep-wake parameters and externalizing behavior and internalizing symptoms in adolescence, and assessed the role of adolescent sex as a moderator of effects.

PARTICIPANTS

Participants were high school students (N = 180; M age = 17.49, SD = .62; 59% female; 68% White/European American, 32% Black/African American) from a wide range of socio-economic backgrounds living in semirural communities and small towns in Alabama.

METHODS

Sleep-wake parameters were indexed by actigraphy-derived sleep minutes and adolescents' reports on morningness-eveningness (circadian preference), sleep-wake problems (sleep quality), and sleepiness. Adolescents completed questionnaires on externalizing behaviors and internalizing symptoms.

RESULTS

Controlling for sleep duration, a higher preference for eveningness and poor sleep quality were associated in a linear fashion with increased externalizing and internalizing symptoms. Nonlinear relations between sleepiness and internalizing symptoms emerged with pronounced sex-related effects, including somewhat delayed accelerating relations for males and rapidly accelerating associations that tended to plateau for females.

CONCLUSIONS

Results illustrate the importance of examining multiple sleep-wake and adjustment variables as well as linear and nonlinear associations.

Open trial of the Parent Behavior Change Intervention (PBC-I): Study protocol

OBJECTIVE

Parents have profound impacts on adolescents' health behaviors. Yet parents receive minimal training in the elements of conversations that optimally inspire their children toward engaging in healthy behaviors. The current study examines a novel interpersonal target: parent-adolescent conversations about adolescent health behavior change. Derived from advances in the science of behavior change, the Parent Behavior Change Intervention (PBC-I) contains conversational elements (e.g., behavior change techniques, positive communication strategies) hypothesized to reduce parent-adolescent coercion and conflict and facilitate upward spirals of healthy behavior change in adolescents.

METHOD/DESIGN

The first phase of the study involves the development of the PBC-I in a small case series (N = 12 dyads). The second phase involves an open trial of the PBC-I (N = 36 dyads). Adolescents will receive six 50-min sessions of the Transdiagnostic Sleep and Circadian Intervention to improve sleep while their parents receive six50-min sessions of the PBC-I. Parent-adolescent dyads will be assessed before and after the intervention. The primary analysis will examine whether postintervention use of behavior change techniques and positive communication strategies by parents is higher than preintervention use and whether increased use by parents predicts more positive conversational behaviors, less parent-adolescent conflict, higher adolescent motivation for change, and improved adolescent sleep.

DISCUSSION

This research provides an initial test of the hypothesis that improving the parent-adolescent conversation will improve adolescent sleep health behavior. While sleep-related health behaviors are the focus of this study, the research is designed to be relevant to a broad range of health behavior change in young people. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pediatric Sleep Tools: An Updated Literature Review

Since a thorough review in 2011 by Spruyt, into the integral pitfalls of pediatric questionnaires in sleep, sleep researchers worldwide have further evaluated many existing tools. This systematic review aims to comprehensively evaluate and summarize the tools currently in circulation and provide recommendations for potential evolving avenues of pediatric sleep interest. 144 "tool"-studies (70 tools) have been published aiming at investigating sleep in primarily 6-18 years old per parental report. Although 27 new tools were discovered, most of the studies translated or evaluated the psychometric properties of existing tools. Some form of normative values has been established in 18 studies. More than half of the tools queried general sleep problems. Extra efforts in tool development are still needed for tools that assess children outside the 6-to-12-year-old age range, as well as for tools examining sleep-related aspects beyond sleep problems/disorders. Especially assessing the validity of tools has been pursued vis-à-vis fulfillment of psychometric criteria. While the Spruyt et al. review provided a rigorous step-by-step guide into the development and validation of such tools, a pattern of steps continue to be overlooked. As these instruments are potentially valuable in assisting in the development of a clinical diagnosis into pediatric sleep pathologies, it is required that while they are primary subjective measures, they behave as objective measures. More tools for specific populations (e.g., in terms of ages, developmental disabilities, and sleep pathologies) are still needed.

What does a good night's sleep mean? Nonlinear relations between sleep and children's cognitive functioning and mental health

STUDY OBJECTIVES

We attempted to identify the duration and quality of sleep associated with the optimal child outcomes in key developmental domains including cognitive functioning, academic performance, and mental health. In doing so, we examined nonlinear associations between the sleep and developmental variables. Based on racial/ethnic disparities in children's sleep, we assessed this variable as a moderator of examined relations.

METHODS

Two hundred eighty-two children participated (Mage = 9.4 years, SD = .72; 52% boys; 65% white/European American, 35% black/African American). Sleep was examined with actigraphy for seven consecutive nights and with self-reports. Actigraphy-based sleep duration (minutes) and quality (efficiency), as well as self-reported sleep quality were derived. Children reported on their mental health and were administered cognitive performance tests. Mothers and teachers reported on children's mental health; teachers also reported on academic functioning. Schools provided academic achievement data.

RESULTS

Sleep duration had an accelerating nonlinear negative association with externalizing behaviors. Nonlinear associations were also detected between both actigraphy-derived and subjective reports of sleep quality and multiple developmental domains including academic functioning and mental health and the best functioning corresponded with the highest levels of sleep quality. Emphasizing the importance of individual differences, several examined associations were moderated by race/ethnicity.

CONCLUSIONS

Sleep duration and quality emerged as nonlinear predictors of multiple domains of child development. Findings illustrate that the benefits of longer and better-quality sleep did not taper off and that assessments of nonlinear relations may enhance understanding of the nature of associations between sleep and child functioning.

Predictors of Sleep Duration and Sleep Disturbance in Children of a Culturally Diverse Region in North-Eastern Greece

Background Aim: The aim of this study was to examine the sleep characteristics of children and explore associations with various socio-demographic factors in an area of Greece characterized by cultural diversity. Methods: A questionnaire about children's sleep habits had been distributed to parents of children who visited the pediatric outpatient clinic of University General Hospital of Alexandroupolis for a medical examination and to get a health certificate for participation in sports activities. Children with chronic health conditions were excluded. Results: In the study, 449 children (27.1% belonging to minorities) were included, aged 7.6 ± 2.9 years. Most of them (81.7%) slept after 10 p.m., with a mean nocturnal sleep duration of 9.4 ± 1.2 h. The most commonly reported disturbance was snoring (26.2%). Age and high educational level of the mother were both important determinants for sleeping late [OR 1.139 (1.033-1.255); p = 0.009 and OR 1.086 (1.004-1.175); p = 0.040, respectively]. The latter was also associated with an absence of any reported sleep disorder in children [OR 0.934 (0.877-0.994); p = 0.031]. A longer sleep duration was reported among Roma children (p = 0.022), which was more overt in girls (mean sleep duration 10.4 ± 1.6 h). In the Roma group also, the prevalence of sleep disorders was higher. Conclusion: Age progression and maternal educational level, along with cultural background, seem to be correlated with variations in the sleep characteristics of children in a culturally diverse population in Greece.

Differential and interacting effects of age and sleep restriction on daytime sleepiness and vigilance in adolescence: a longitudinal study

Study Objectives

There is contradictory evidence on whether sleep need decreases across adolescence. We investigated this question longitudinally with a dose-response design to test the effects of varied sleep durations on daytime sleepiness and on vigilance and to test whether these relations change with age across early and mid-adolescence.

Methods

Data from 76 participants who completed at least 2 years of the 3-year study are included in this report. Annually, participants ranging in age from 9.8 to 16.2 years completed three different time in bed (TIB) schedules each consisting of four consecutive nights of 7, 8.5, or 10 hours. Daytime sleepiness (multiple sleep latency test [MSLT]) and vigilance (psychomotor vigilance test [PVT]) were measured on the day following the fourth night of each TIB schedule.

Results

Electroencephalogram (EEG)-measured sleep durations changed linearly with TIB. MSLT-measured daytime sleepiness decreased with longer TIB and increased with age. The TIB and age effects interacted such that the TIB effect decreased with age. PVT performance improved with longer TIB and improved with age, but the benefit that increased TIB conferred on PVT performance did not change with age.

Conclusions

These results seem paradoxical because daytime sleepiness increased but vigilance improved with age. The significant age effect on the relation between TIB and sleepiness compared to the lack of an age effect on the relation between TIB and vigilance performance suggests different rates of maturation in underlying brain systems. We interpret these findings in relation to our model of adolescent brain development driven by synaptic elimination.

Effects of a school teacher-led 45-minute educational program for mental health literacy in pre-teens

AIM

A concise teacher-led program for mental health literacy (MHL), suitable for schools with tight schedules was developed, and its effects were examined in pre-teens.

METHODS

Participants comprised 662 grade 5 to 6 students from nine Japanese elementary schools. The program consisted of a 45-minute session, delivered by school teachers using a 10-minute animated film. Program focuses included: mental health problems are common, can be associated with lifestyle and that seeking help from reliable adults is a key to finding solutions. Participants filled out self-report questionnaires before, immediately after and 3 months post-intervention. Changes in MHL were analyzed using multilevel models.

RESULTS

Knowledge about mental health/illnesses, recognition of mental health state and intention to help peers/seek help when suffering from mental health problems, were significantly improved immediately and 3 months post-intervention.

CONCLUSIONS

Concise teacher-led programs administered in schools can have positive and lasting effects on MHL in pre-teens.

Sleep: population epidemiology and concordance in Australian children aged 11-12 years and their parents

OBJECTIVES

To describe objectively measured sleep characteristics in children aged 11-12 years and in parents and to examine intergenerational concordance of sleep characteristics.

DESIGN

Population-based cross-sectional study (the Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.

SETTING

Data were collected between February 2015 and March 2016 across assessment centres in Australian major cities and selected regional towns.

PARTICIPANTS

Of the participating CheckPoint families (n=1874), sleep data were available for 1261 children (mean age 12 years, 50% girls), 1358 parents (mean age 43.8 years; 88% mothers) and 1077 biological parent-child pairs. Survey weights were applied and statistical methods accounted for the complex sample design, stratification and clustering within postcodes.

OUTCOME MEASURES

Parents and children were asked to wear a GENEActive wrist-worn accelerometer for 8 days to collect objective sleep data. Primary outcomes were average sleep duration, onset, offset, day-to-day variability and efficiency. All sleep characteristics were weighted 5:2 to account for weekdays versus weekends. Biological parent-child concordance was quantified using Pearson's correlation coefficients in unadjusted models and regression coefficients in adjusted models.

RESULTS

The mean sleep duration of parents and children was 501 min (SD 56) and 565 min (SD 44), respectively; the mean sleep onset was 22:42 and 22:02, the mean sleep offset was 07:07 and 07:27, efficiency was 85.4% and 84.1%, and day-to-day variability was 9.9% and 7.4%, respectively. Parent-child correlation for sleep duration was 0.22 (95% CI 0.10 to 0.28), sleep onset was 0.42 (0.19 to 0.46), sleep offset was 0.58 (0.49 to 0.64), day-to-day variability was 0.25 (0.09 to 0.34) and sleep efficiency was 0.23 (0.10 to 0.27).

CONCLUSIONS

These normative values for objective sleep characteristics suggest that, while most parents and children show adequate sleep duration, poor-quality (low efficiency) sleep is common. Parent-child concordance was strongest for sleep onset/offset, most likely reflecting shared environments, and modest for duration, variability and efficiency.

A short history of time use research; implications for public health

Background

This section defined time use (TU) research, illustrating its relevance for public health. TUR in the health context is the study of health-enhancing and health-compromising behaviours that are assessed across a 24 h day. The central measurement is the use of Time Use Diaries, which capture 24–48 h, typically asking about behaviour in each 15-min period. TUR is used for understanding correlates of health behaviours, and as a form of population surveillance, assessing behavioural trends over time.

Main body

This paper is a narrative review examining the history of time use research, and the potential uses of TU data for public health research. The history of TUR started in studies of the labour force and patterns of work in the late 19th and early twentieth century, but has more recently been applied to examining health issues. Initial studies had a more economic purpose but over recent decades, TU data have been used to describe the distribution and correlates of health-enhancing patterns of human time use. These studies require large multi-country population data sets, such as the harmonised Multinational Time Use Study hosted at the University of Oxford. TU data are used in physical activity research, as they provide information across the 24-h day, that can be examined as time spent sleeping, sitting/standing/light activity, and time spent in moderate-vigorous activities. TU data are also used for sleep research, examining eating and dietary patterns, exploring geographic distributions in time use behaviours, examining mental health and subjective wellbeing, and examining these data over time. The key methodological challenge has been the development of harmonised methods, so population TU data sets can be compared within and between-countries and over time.

Conclusions

TUR provides new methods for examining public health research questions where a temporal dimension is important. These time use surveys have provided unique data over decades and in many countries that can be compared. They can be used for examining the effects of some large public health interventions or policies within and between countries.

Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children

Background: Behavioral factors such as physical activity, sedentary behavior and diet have previously been found to be key modifiable determinants of childhood overweight and obesity, yet require further investigation to provide an understanding of their potential influence on sleep outcomes along with the sleep-obesity nexus. Methods: The study included 2253 students (ages 8.8-13.5) from two monitoring studies across regional Victoria. Students completed a self-report electronic questionnaire on demographic characteristics, health behaviors (including sleep, physical activity, screen time and diet) and well-being, and were invited to have anthropometric measurements (height and weight) taken. Regression models were used to assess the associations between sleep, behavioral factors and BMI z-scores. Results: Screen time (particularly in bed) and sugar-sweetened beverage (SSB) consumption were shown to increase the likelihood of having more than three sleep problems, while physical activity and other dietary factors were not. After controlling for these behaviors, significance remained for having two or more than three sleep problems and an increased odds of overweight/obesity. Conclusions: This study highlights how the usage of screen devices and SSB consumption behaviors might influence children's weight status via the sleep-obesity nexus.

Individual Differences in Optimum Sleep for Daily Mood During Adolescence

Efforts to establish an empirical basis for recommended sleep durations during adolescence need to take into account individual differences in optimum sleep, defined as the amount of sleep at which peak functioning is observed. A total of 419 adolescents (Mage = 15.03 years) with Mexican American backgrounds reported their nightly sleep duration and daily mood for a 2-week period at 1 or 2 waves of data collection, 1 year apart. Adolescents also completed an established measure of symptomatology. Multilevel modeling revealed a nonlinear association between sleep duration and next-day mood, whereby both too little and too much sleep were associated with elevated levels of daily distress. Significant individual differences in optimum sleep were observed such that younger adolescents and those with elevated levels of internalizing and total symptomatology evidenced greater sleep durations on nights before they reported their lowest levels of daily distress. Younger adolescents and those with higher internalizing and total symptomatology may need more sleep to reach their peak functioning the next day, at least in terms of daily mood.

Sugar consumption and attention-deficit/hyperactivity disorder (ADHD): A birth cohort study

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent symptoms of lack of attention, impulsivity and hyperactivity. The association between nutritional exposures and ADHD has been investigated and some studies have identified adverse effects from higher intake of sugar. The objective of the present study was to evaluate the association between change in sugar consumption between 6 and 11 years of age and incidence of attention-deficit/hyperactivity disorder (ADHD).

METHODS

Pelotas 2004 Birth Cohort Study in Brazil. A food frequency questionnaire (FFQ) was used to estimate sugar consumption and the Development and Well-Being Assessment (DAWBA) was applied to mothers to assess the presence of ADHD.

RESULTS

Only children without ADHD at 6 years and with complete information from FFQ and DAWBA at 6 and 11 years were included in the analyses (n = 2924). Odds ratios with 95% confidence intervals were calculated. Incidence of ADHD between 6 and 11 years was 4.6% (3.6-5.6%) among boys and 1.8% (1.2-2.5%) among girls. Adjusted analyses showed no association between always high sucrose consumption between 6 and 11 years and incidence of ADHD, compared with individuals who always presented low consumption, both among boys (OR = 0.66; 0.21-2.04) and girls (OR = 2.71; 0.24-30.35).

LIMITATIONS

Reflect those that are inherent to use of FFQs, such as memory bias and lack of precision in quantifying the diet.

CONCLUSIONS

The results suggest that there is no association between sucrose consumption between 6 and 11 years of age and incidence of ADHD.

A review of developmental consequences of poor sleep in childhood

Sleep is a fairly diverse and complex construct to operationalize in a scientific and naturalistic context. We report a systematic review and meta-analysis of reviews published in the last 5 years on poor sleep and developmental outcomes. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 42 articles (or 1117 studies) qualified. They reported outcomes related to poor sleep investigated as sleep disorders (38.1%), sleep 'in general' (26.2%), sleep duration (23.8%), in terms of circadian rhythm (4.8%), intra-individual variability (2.4%), and napping (2.4%). Sleep was primarily subjectively reported (30.2%), yet the methodology of sleep assessment was often neither tabulated nor discussed. Overall, most papers had a health-scope, being primarily weight problems expressed as body mass index. Its relationship with performance was measured with the Wechsler intelligence tests, the child behavior checklist and the continuous performance test, whereas meta-analytic papers specifically focused on cognition with sleep disorder (i.e. sleep-disordered breathing; 38.6%), on health (i.e. weight) with sleep duration (25%) and behavior with sleep 'in general' (15.9%), having a high true variance. Nevertheless, an aggregated effect size d of 0.35 (95% confidence interval: 0.27-0.42) suggests that poor sleep is moderately affecting a child's performance and health. In conclusion, poor sleep can no longer be disregarded, yet methodologies that are more rigorous and a scope beyond health may foster a better understanding of the role of (poor) sleep across childhood neurodevelopment.

Sleeping hours: what is the ideal number and how does age impact this?

The objective of this narrative review paper is to discuss about sleep duration needed across the lifespan. Sleep duration varies widely across the lifespan and shows an inverse relationship with age. Sleep duration recommendations issued by public health authorities are important for surveillance and help to inform the population of interventions, policies, and healthy sleep behaviors. However, the ideal amount of sleep required each night can vary between different individuals due to genetic factors and other reasons, and it is important to adapt our recommendations on a case-by-case basis. Sleep duration recommendations (public health approach) are well suited to provide guidance at the population-level standpoint, while advice at the individual level (eg, in clinic) should be individualized to the reality of each person. A generally valid assumption is that individuals obtain the right amount of sleep if they wake up feeling well rested and perform well during the day. Beyond sleep quantity, other important sleep characteristics should be considered such as sleep quality and sleep timing (bedtime and wake-up time). In conclusion, the important inter-individual variability in sleep needs across the life cycle implies that there is no "magic number" for the ideal duration of sleep. However, it is important to continue to promote sleep health for all. Sleep is not a waste of time and should receive the same level of attention as nutrition and exercise in the package for good health.

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

OBJECTIVE

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

METHODS

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

STUDY

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

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

Infant sleep and the influence of a pacifier

BACKGROUND

Divergent opinions are found in the literature regarding the use of a pacifier. During the longitudinal follow-up of children, health professionals must take a position on this issue and offer clear information regarding the pros and cons of pacifier use so that parents/caregivers can feel comfortable enough to make their own decision.

AIM

Evaluate the beneficial effects of pacifier use on the sleep quality of infants.

DESIGN

A cross-sectional study was conducted at public day care centres in the city of Recife, Brazil. Interviews were held with 157 mothers of infants aged five to 13 months. Data were collected on the mother's and child's profiles. Child's sleep quality was determined using the Brief Infant Sleep Questionnaire.

RESULTS

The results demonstrated no statistically significant differences between the group that used a pacifier and the group that did not use a pacifier with regard to sleep variables of the child.

CONCLUSIONS

When deciding whether or not to permit pacifier use, the infant's sleep quality should not be considered a critical factor.

Interventions that stimulate healthy sleep in school-aged children: a systematic literature review

Background

Healthy sleep among children has social, physical and mental health benefits. As most of today’s children do not meet the healthy sleep recommendations, effective interventions are urgently needed. This systematic review summarizes the characteristics and effectiveness of interventions aiming to stimulate healthy sleeping in a general population of school-aged children.

Methods

The search engines PubMed, Embase, Web of Science, PsycInfo and the Cochrane Database Library were systematically searched up to March 2016. We included all studies evaluating interventions targeting healthy sleep duration and/or bedtime routines of children aged 4–12 years. All steps in this systematic review, i.e. search, study selection, quality assessment and data extraction, were performed following CRD Guidelines and reported according to the PRISMA Statement.

Results

Eleven studies were included, of which only two were of strong quality. The interventions varied in terms of targeted determinants and intervention setting. Overall, no evidence was found favoring a particular intervention strategy. One intervention that delayed school start time and two multi-behavioral interventions that targeted both the school and home setting showed promising effects in terms of increasing sleep duration.

Conclusion

Due to few high quality studies, evidence for the effectiveness of any particular intervention strategy to stimulate healthy sleep in children is still inconclusive. However, the more effective interventions in stimulating healthy sleep duration and adherence to regular bedtimes were mostly multi-behavioral interventions that included creating daily healthy routines and combined intervention settings (e.g. home and school). In conclusion, high-quality studies evaluating systematically developed interventions are needed to move this field forward.

Insufficient Sleep Syndrome: Is it time to classify it as a major noncommunicable disease?

Over the last three to four decades, it has been observed that the average total number of hours of sleep obtained per night by normal individuals have decreased. Concomitantly, global figures indicate that insufficient sleep is associated with serious adverse health and social outcomes. Moreover, insufficient sleep has been linked to seven of the fifteen leading causes of death. Additionally, current evidence suggests that sleep plays a significant role in determining cognitive performance and workplace productivity. There is a great need for a systematic analysis of the economic impact of insufficient sleep, particularly given current evidence that this phenomenon, as well as the poor sleep hygiene practices which produce it, is increasing worldwide. This paper takes the view that health authorities around the world need to raise the general awareness of benefits of sleep. There is considerable scope for research into both the public health impact as well as the macroeconomic consequences of insufficient sleep syndrome (ISS). Additionally, various models which estimate the undiagnosed burden of ISS on the GDP (gross domestic product) are needed to prioritize health issues and to highlight the national policies that are necessary to combat this medical problem. Sleep insufficiency has been declared to be a 'public health epidemic'; therefore, we propose ISS as a potential noncommunicable disease. This review elaborates on this topic further, exploring the causes and consequences of insufficient sleep, and thus providing a perspective on the policies that are needed as well as the research that will be required to support and justify these policies.

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

Background

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

Methods

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

Results

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

Conclusions

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

Electronic supplementary material

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

Cross-sectional associations between sleep duration, sedentary time, physical activity, and adiposity indicators among Canadian preschool-aged children using compositional analyses

Background

Sleep duration, sedentary behaviour, and physical activity are three co-dependent behaviours that fall on the movement/non-movement intensity continuum. Compositional data analyses provide an appropriate method for analyzing the association between co-dependent movement behaviour data and health indicators. The objectives of this study were to examine: (1) the combined associations of the composition of time spent in sleep, sedentary behaviour, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) with adiposity indicators; and (2) the association of the time spent in sleep, sedentary behaviour, LPA, or MVPA with adiposity indicators relative to the time spent in the other behaviours in a representative sample of Canadian preschool-aged children.

Methods

Participants were 552 children aged 3 to 4 years from cycles 2 and 3 of the Canadian Health Measures Survey. Sedentary time, LPA, and MVPA were measured with Actical accelerometers (Philips Respironics, Bend, OR USA), and sleep duration was parental reported. Adiposity indicators included waist circumference (WC) and body mass index (BMI) z-scores based on World Health Organization growth standards. Compositional data analyses were used to examine the cross-sectional associations.

Results

The composition of movement behaviours was significantly associated with BMI z-scores (p = 0.006) but not with WC (p = 0.718). Further, the time spent in sleep (BMI z-score: γ_sleep = −0.72; p = 0.138; WC: γ_sleep = −1.95; p = 0.285), sedentary behaviour (BMI z-score: γ_SB = 0.19; p = 0.624; WC: γ_SB = 0.87; p = 0.614), LPA (BMI z-score: γ_LPA = 0.62; p = 0.213, WC: γ_LPA = 0.23; p = 0.902), or MVPA (BMI z-score: γ_MVPA = −0.09; p = 0.733, WC: γ_MVPA = 0.08; p = 0.288) relative to the other behaviours was not significantly associated with the adiposity indicators.

Conclusions

This study is the first to use compositional analyses when examining associations of co-dependent sleep duration, sedentary time, and physical activity behaviours with adiposity indicators in preschool-aged children. The overall composition of movement behaviours appears important for healthy BMI z-scores in preschool-aged children. Future research is needed to determine the optimal movement behaviour composition that should be promoted in this age group.

Impact of Multi-Night Experimentally Induced Short Sleep on Adolescent Performance in a Simulated Classroom

Study Objectives

Investigate whether a realistic "dose" of shortened sleep, relative to a well-rested state, causes a decline in adolescents' learning and an increase in inattentive and sleepy behaviors in a simulated classroom setting.

Methods

Eighty-seven healthy 14.0- to 16.9-year olds underwent a 3-week sleep manipulation protocol, including two 5-night sleep manipulation conditions presented in a randomly counterbalanced within-subjects cross-over design. Wake time was held constant. Bedtimes were set to induce Short Sleep (SS; 6.5 hours in bed) versus Healthy Sleep (HS; 10 hours in bed). During the morning at the end of each condition, participants underwent a simulated classroom procedure in which they viewed lecture-based educational videotapes and completed relevant quizzes. Their behaviors in the simulated classroom were later coded by condition-blind raters for evidence of inattention and sleepiness.

Results

Adolescents had a longer average sleep period during HS (9.1 hours) than SS (6.5 hours). Compared to scores during HS, adolescents scored significantly lower on the quiz, showed more behaviors suggestive of inattention and sleepiness in the simulated classroom, and were reported by adolescents themselves and by their parents to be more inattentive and sleepy during SS. However, the impact of the manipulation on quiz scores was not mediated by changes in attention or sleepiness.

Conclusions

Although effect sizes were modest, these findings suggest that previously-reported correlations between sleep duration and academic performance reflect true cause-effect relationships. Findings add to the growing evidence that the chronically shortened sleep experienced by many adolescents on school nights adversely impacts their functioning and health.