Sociodemographic factors associated with sleep quality and sleep duration in adolescents from Santa Catarina, Brazil: what changed between 2001 and 2011?

Prevalence of Sleep Disturbances in Latin American Populations and Its Association with Their Socioeconomic Status-A Systematic Review and a Meta-Analysis

BACKGROUND

The worldwide increase in the prevalence and incidence of sleep disturbances represents a major public health issue. Among multiple determinants affecting sleep health, an individual's socioeconomic status (SES) is the most ignored and underestimated throughout the literature. No systematic review on the relation between SES and sleep health has been previously conducted in Latin America.

METHODS

PRISMA guidelines were used.

RESULTS

Twenty articles were included in the final sample (all cross-sectional studies), and twelve among them were rated as fair or poor quality. Among these studies, 80.0% (n = 16) were performed in Brazil, 10.0% (n = 2) were performed in Peru, 5.0% (n = 1) were performed in Chile, and 5.0% (n = 1) were multicentric (11 countries). The combined total number of participants was N = 128.455, comprising 3.7% (n = 4693) children, 16.0% (n = 20,586) adolescents, and 80.3% (n = 103,176) adults. The results show the following: (1) The sleep outcomes analyzed were sleep duration, sleep quality/sleep disturbance, insomnia, excessive daytime sleepiness (EDS), obstructive sleep apnea (OSA)/sleep-disordered breathing (SDB) symptoms, and bruxism. (2) The most used determinants were income, education level, employment status/occupation, wealth/assets, and composite indices. (3) Higher SES was associated with shorter sleep duration. (4) Lower SES was associated with a decrease in sleep quality, less frequent snoring, more prevalent EDS, and sleep bruxism. (5) Lower education was associated with insomnia. (6) Higher education was associated with more sleep bruxism. (7) The pooled prevalence using a meta-analysis of the random effects model was 24.73% (95%CI, 19.98-30.19), with high heterogeneity (I2 = 100%). (8) The prevalence of sleep disturbances decreased with high education (OR, 0.83; 95%CI, [0.69-0.99]; I2 = 79%), while it increased with low income (OR, 1.26; 95%CI, [1.12-1.42]; I2 = 59%), unemployment (OR, 2.84; 95%CI, [2.14-3.76]; I2 = 0%), and being a housewife (OR, 1.72; 95%CI, [1.19-2.48]; I2 = 55%).

DISCUSSION

This meta-analysis shows that lower SES (education, income, and work) was associated with sleep disturbances in Latin America. Therefore, sleep disturbance management should be addressed with a multidimensional approach, and a significant investment in targeted public health programs to reduce sleep disparities and support research should be made by the government before the situation becomes uncontrollable.

Sleep patterns and awareness of the consequences of sleep deprivation in Saudi Arabia

PURPOSE

Sleep deprivation is a growing challenge in modern society and places a burden on people's physical and mental well-being. However, only a few studies have investigated sleep patterns and awareness of the associated risks of sleep deprivation in Middle Eastern countries. This study aimed to explore these issues in adults in Saudi Arabia.

METHODS

This was a quantitative cross-sectional study. We collected information on the participants' demographic characteristics, sleep hours, and sense of feeling sleep-deprived over the previous 3 months regardless of sleep duration. Current knowledge of the health consequences associated with chronic sleep deprivation and attitudes toward seeking in-person health care for sleep deprivation symptoms were additionally assessed.

RESULTS

Among 1449 adults, only 41% of the participants slept for the recommended duration for adults of 7 h or more. However, 70% reported feeling sleep-deprived at least some of the time regardless of their sleep duration. Smokers, students, and those on sleep medications were more likely to report feeling sleep-deprived. Most participants (strongly) agreed that chronic sleep deprivation had a negative effect on their health (92%) and social (88%) and professional lives (91%), yet only 10% of our sample had visited a doctor for their sleep deprivation symptoms.

CONCLUSIONS

We found a high level of sleep deprivation among residents of Saudi Arabia and a strong awareness of the association between chronic sleep deprivation and negative consequences, yet a lower awareness of the association with specific medical comorbidities. Our findings also suggested a lack of health care engagement among sleep-deprived participants.

Factors associated with sleep quality in university students

To investigate factors associated with poor sleep quality. A cross-sectional study was conducted in 2019 with random sampling. Information on sleep was obtained using the Mini Sleep Questionnaire (MSQ). Independent variables included sociodemographic, behavioural, academic and psychological health characteristics. Adjusted analyzes were performed using Poisson regression. A total of 996 undergraduate students participated in the study. The poor sleep quality affected 23.1% of the sample (95%CI 20.5-25.9), ranging from 13.4% for those with little concern about violence in the neighbourhood to 36.5% for those with less social support. In the adjusted analysis, female sex [PR] 1.81; (95%CI 1.33-2.45), concern about violence in the neighbourhood [PR] 2.21; (95%CI 1.48-3.28), discrimination at university [PR] 1.42; (95%CI 1.08-1.86) and food insecurity [PR] 1.45; (95%CI 1.11-1.89) were associated with the presence of poor sleep quality, as well as having less social support and income and suffering psychological distress. The results highlight socioeconomic and mental health factors that affect sleep quality and demonstrate the need for reflection and interventions capable of minimizing this problem.

Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research

STUDY OBJECTIVES

This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship.

METHODS

Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions.

RESULTS

Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship.

CONCLUSIONS

Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes.

CITATION

Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.

Physical activity, sleep quality and life satisfaction in adolescents: A cross-sectional survey study

Background

Physical activity, sleep is an important component of adolescents' 24-h movement behavior, and life satisfaction predicts adolescent physical and mental health. However, few studies have explored the relationship between the two variables among Chinese high school students. Consequently, this study aimed to explore the relationship between sleep quality and life satisfaction among Chinese high school students.

Methods

This cross-sectional study was conducted in October 2020 in five high schools in Xuchang City, China. High school students from senior 1 to senior 3 were asked to fill up a questionnaire of demographic characteristics and validated screen instructions for sleep quality (Pittsburgh Sleep Quality Index) and life satisfaction (Satisfaction with Life Scale). The multivariate regression model was applied to explore the association between sleep quality and life satisfaction.

Results

A total of 1127 individuals (51.1% males) participated in this survey, and the prevalence of poor sleep quality was 42.3%. The mean score on the Satisfaction with Life Scale was 16.72 ± 5.67, according to the corresponding scoring criteria, with 15-19 being generally dissatisfied. After controlling for demographic variables, the contribution of subjective sleep quality (β = - 0.181, p < 0.01), sleep duration (β = - 0.080, p < 0.01) and daytime dysfunction (β = - 0.311, p < 0.01) to life satisfaction of high school students increased to 23.2%, indicating that subjective sleep quality, sleep duration, and daytime dysfunction were 22.9% predictive of life satisfaction among high school students. And also, physical activity on schooldays and weekend days were associated with better sleep quality and higher life satisfaction (p < 0.05).

Conclusions

Among Chinese high school students, the prevalence of sleep problems was high, and the majority of students held moderate life satisfaction. Sleep quality was positively correlated with life satisfaction among Chinese high school students, with better sleep quality resulting in higher life satisfaction among students.

The Impact of Sleep and Mental Health on Working Memory and Academic Performance: A Longitudinal Study

Sleep and mental health can affect cognition and academic performance. The present study aimed to investigate the relationships between sleep, mental health, working memory, and academic performance. We collected demographic data from university students during the non-academic summer period and the academic term. We also measured academic performance (GPA), sleep (PSQI), depression (PHQ-9), anxiety (GAD-7), and disordered social media use (SMDS). Working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). We assessed 83 students (42.2% male) with a mean age of 21 years. Compared to the non-academic summer period, students had significantly worse sleep and distress scores in the academic term. Anxiety, depression, and distress scores were significantly correlated with worse sleep quality. Despite worse mental health and sleep in the academic term, working memory improved compared to the non-academic summer period and was also correlated with a higher GPA. However, a higher GPA was significantly associated with longer sleep latency, increased sleep disturbances, and increased use of sleep medication. Students experiencing poor sleep suffered from poor mental health, although they maintained high GPA and working memory scores. Cognitive resilience, including higher working memory, may mask poor sleep quality and mental health among university students.

Modeling the change trajectory of sleep duration and its associated factors: based on an 11-year longitudinal survey in China

BACKGROUND

Sleep duration is a vital public health topic, yet most existing studies have been limited to cross-sectional surveys or inconsistent classifications of sleep duration categories, and few characterized its continuous development process. The current study aimed to depict its change trajectory in the general population and identify associated factors from a dynamic perspective.

METHODS

A total of 3788 subjects (45.4% male, mean age 46.72 ± 14.89 years) from the China Health and Nutrition Survey were recruited, and their daily sleep duration for five consecutive measurements from 2004 to 2015 was recorded. We adopted latent growth modelling to establish systematic relations between sleep duration and time. Participants' sociodemographic characteristics, lifestyle, and health factors were taken as covariates.

RESULTS

The change in sleep duration could be depicted by a linear decreasing trajectory with the mean yearly decrease at 2.5 min/day. The trajectory did not differ by residence, BMI category, chronic disease situation, smoking status, or drinking status. Moreover, there were sex and age differences in the trajectory, and females and those under 30 were prone to larger decrease rates.

CONCLUSION

The quantified yearly change in sleep duration provided insights for the prediction and early warning of insufficient sleep. Public health interventions focusing on slowing down the decrease rates among females and young individuals are warranted.

COVID-19 and sleep patterns in adolescents and young adults

OBJECTIVE

In March 2020, the world experienced a global pandemic, which involved the shutdown of schools or a transposition to remote teaching in most countries. The objective of the present study was to investigate the impact of the COVID-19 pandemic related lockdown on sleep patterns and sleep quality in adolescents and young adults.

METHODS

An online survey was conducted in June 2020 with adolescents and young adults (n = 498) aged 12-25 years. Participants had to answer questions on sleep, first retrospectively, referring to the time prior to the pandemic, and then referring to the time during the pandemic.

RESULTS

A pronounced shift towards later sleep combined with an increase in sleep duration was found during the pandemic. However, these changes in sleep habits were more pronounced in adolescents than in young adults and seem to occur mostly during weekdays compared to weekends. During the pandemic, teens also reported an improvement in daytime sleepiness and subjective sleep quality, while young adults reported an increase in sleep difficulties associated with sleep onset difficulties, nocturnal and early morning awakenings, and nightmares.

CONCLUSIONS

The COVID-19 related lockdown seems to have had a beneficial effect on sleep in adolescents. In young adults, benefits are not as obvious. These results support that later school start times would be beneficial for adolescents. However, in young adults it could be important to investigate the effects of other situational or interindividual factors (stress, lifestyle habits, employment, etc.).

Socioeconomic status and sleep disturbances among pediatric population: a continental systematic review of empirical research

To this day, no consensus has been established on the definition and the conceptualization of the socioeconomic status (SES), since all the available studies on the relation between SES and health did not use the same conceptual framework and operationalization to assess SES. While literature reported that SES markers (such as income, social support networks, education, employment or occupation) influence the health of populations by shaping living conditions; empirical research does not tell us which SES markers affect more strongly the sleep components of the individuals, as well as which sleep disorders (SD) are affected and how. Even though several original studies have tried to assess how changes in socioeconomic status of parents may affect the psychosocial environment and mental health of an individual directly or through his community, no systematic reviews on the influence of SES on children's sleep are available. This systematic review make an update on the different measures of SES and sleep disturbances used for pediatric population across the different regions of the world. Recommendations for a future standardization of SES measures is proposed, for a better understanding of its influence on sleep disturbances.

Adequate sleep duration among children and adolescents: a review of the Brazil's Report Card

abstract – This study aimed to summarize existing research examining the prevalence of adequate sleep duration or meeting sleep recommendations among Brazilian children and adolescents. A systematic review was conducted on eight databases. The criteria for inclusion were original research, samples including Brazilian children and adolescents (age 0–18), studies that reported variables regarding sleep duration using both objective or subjective measures, school- or population-based surveys with random sampling, and cross-sectional or cohort studies. Of the 54 articles included, only 27 used data from different studies. Most of the studies were conducted in the southern region (n = 17) with only two studies having a nationally representative sample. Two studies included children below age five, and the age group most investigated was adolescents (>10 years old). A majority of the studies used a self-reported questionnaire and showed variability in the cutoff point applied for adequate sleep duration with the most reported being ≥8 hours. The proportion of adolescents who met recommendations or had adequate sleep duration ranged from 15% to 89%. Among children, the prevalence ranged from 17% to 95%. The least variability was observed among toddlers, ranging from 93% to 95%. No consistent gender differences were observed among the gender-stratified groups of children and adolescents across the studies. It can be observed that, because of the wide range of results and the lack of data with national representativeness, the prevalence of sufficient sleep among young people aged below 18 remains undefined in Brazil.

Assessing the relationship between weight stigma, stress, depression, and sleep in Chinese adolescents

INTRODUCTION

Weight stigma is defined as the social devaluation of people with overweight or obesity, and its negative effects on the health of adolescents from western countries are well documented, but little is known about the relationships with health behaviors and outcomes in Asian youth. The prevalence of obesity among Chinese adolescents continues to increase, potentially causing negative evaluations of youth with obesity, and potentially reduced quality of life. The health effects of these negative evaluations of Chinese youth with obesity have received little attention.

PURPOSE

The purpose of this study was to examine relationships between weight stigma, stress, depression, and sleep in Chinese adolescents.

METHODS

We utilized a cross-sectional study conducted in Wuhan, China. Sociodemographic, weight stigma, stress, depression, and sleep data were collected through a self-reported questionnaire. Descriptive statistics, t test, correlations, and mediation analyses were performed. A total of 1626 adolescents between 14 and 19 years of age were included in the analysis.

RESULTS

The data showed that adolescents with weight stigma presented significantly higher level of stress and depression, lower global sleep quality, longer sleep latency, and shorter sleep duration than those without weight stigma (p < 0.05). Stress and depression mediated the relationship between weight stigma and global sleep quality (SE = 0.007, 95% CI = 0.053 to 0.081).

CONCLUSION

These findings suggest that adolescents who experience weight stigma may have increased stress and depressive symptoms, which are associated with poorer global sleep quality and more daytime dysfunction.

PHYSICAL ACTIVITY, SCREEN TIME, NUTRITIONAL STATUS AND SLEEP IN ADOLESCENTS IN NORTHEAST BRAZIL

Objective:

To verify the prevalence of sleep quality and duration and its association with the level of physical activity, screen time and nutritional status in adolescents.

Methods:

This is a cross-sectional study with 1,432 adolescents (53.1%, female), ten to 14 years old (12.0±1.0 year) from public schools in Joao Pessoa, Northeast Brazil. Physical activity (≥300 vs. <300 minutes/week), screen time (≤2 vs. >2 h/day) and duration (<8 vs. ≥8 h/day) and perception of sleep quality (negative vs. positive perception) were measured by questionnaire. Nutritional status was assessed by body mass index (low weight / normal weight vs. overweight / obesity). Binary logistic regression was used to analyze association between variables, considering different aggregation of negative factors.

Results:

The prevalence of insufficient duration and negative perception of sleep quality was 12.6% (95%CI 10.9-14.4) and 21.0% (95%CI 18.9-23.1), respectively. There was a linear trend in the chance of the adolescents to present insufficient duration of sleep as a result of simultaneous negative factors (physical inactivity, excessive screen time, being overweight) (OR=4.31; 95%CI 1.50-12.48).

Conclusions:

Adolescents exposed simultaneously to low levels of physical activity, excessive screen time and overweight had a lower sleep duration.

[Factors associated with sleep disorders in university students]

The objective was to investigate sleep disorders and associated sociodemographic and behavioral factors. A census of university students was carried out. Questions extracted from the Munich Chronotype Questionnaire investigated: insufficient sleep duration (< 6 hours/day for < 65 years and < 5 hours/day for other ages), long latency (> 30 minutes), low self-rated sleep quality, nocturnal awakenings (involuntary, in the middle of the night), and daytime sleepiness (difficulty concentrating). Independent variables included sociodemographic and behavioral characteristics. Adjusted analyses were performed with Poisson regression. Of the 1,865 students, 32% exhibited insufficient sleep on class days, 8.2% insufficient sleep on weekends, 18.6% long latency on class days, 17.2% long latency on weekends, 30% low self-rated sleep quality, 12.7% nocturnal awakenings, and 32.2% daytime sleepiness. Higher alcohol consumption was associated with insufficient sleep duration and long latency on class days, low quality sleep, awakenings, and daytime sleepiness. Smoking was associated with insufficient sleep duration on weekends, awakenings, and low-quality sleep. Black and brown skin color were associated with insufficient sleep duration on class days, low-quality sleep, and awakenings. Morning classes were associated with insufficient sleep and daytime sleepiness. Female gender was associated with low-quality sleep and awakenings. The most frequent sleep disorders were insufficient sleep on class days, low self-rated quality of sleep, and daytime sleepiness. Alcohol consumption and smoking and black and brown skin color were the principal factors associated with sleep disorders.

Greenspace exposure and sleep: A systematic review

Green space is considered a critical environmental factor for sleep quality and quantity. However, no systematic review exploring this relationship exists. The purpose of this systematic review was to 1) explore research related to green space and sleep, and 2) examine the impact of green space exposure on sleep quality and quantity. Papers from eight electronic databases were eligible for inclusion if they met the following criteria: well-designed, any analysis exploring green space and sleep, provided sleep and green space measurement, published in peer-reviewed journals, and written in English. Thirteen eligible studies related to green space and sleep were selected after peer-review procedures. Cross-sectional studies (n = 7) used either a questionnaire or the combination of Geographic Information Systems and remote sensing images for green space measurement, while questionnaires were primarily used to measure both sleep quality and quantity. Intervention studies (n = 5) were categorized into three types: walking program, gardening, and working in a forest. Eleven out of thirteen studies concluded that green space exposure was associated with improvement in both sleep quality and quantity. The findings support the evidence of a positive association between green space exposures and sleep quality and quantity, and also suggest green exercise and therapeutic gardening as possible intervention methods to improve sleep outcomes.

Determinants of Subjective Poor Sleep Quality in Social Media Users Among Freshman College Students

INTRODUCTION

Social media (SM) usage has increased markedly among young adults. It is linked to poor sleep quality (PSQ), a risk factor for mental and physical health concerns. This study identified the determinants of PSQ in SM users among freshman college students.

MATERIAL AND METHODS

A cross-sectional design was used and 842 students completed a self-administered questionnaire. Analyses were performed using the χ ² test to examine differences in the characteristics of poor and good sleepers and logistic regression to estimate the risk of PSQ with reference to SM usage patterns.

RESULTS

Around 75.40% (n = 635) of the participants had PSQ. There was a significant difference in the PSQ rate between males (66.3%) and females (79.3%, p < 0.001), those who were physically active (67.2%) and those who were not (82.4%, p < 0.001), those who were mentally depressed (86.5%) and those who were not (61.5%, p < 0.001), and those with anxiety (87.8%) and those without (64.3%, p < 0.001). The risk of PSQ was lower among students who used SM for education (OR = 0.65, CI = 0.42 to 0.99, p = 0.048), had higher laptop usage (OR = 0.67, CI = 0.47 to 0.96, p = 0.03), and had higher SM usage during daytime (OR = 0.46, CI = 0.32 to 0.67, p < 0.001). The risk of PSQ was higher among those who reported SM usage at bedtime (OR = 1.69, CI = 1.01 to 2.81, p = 0.046).

DISCUSSION

Among SM users, PSQ was related to sociodemographic features, lifestyle characteristics, and health-risk factors. Further research is required to confirm these findings.

The effects of family dysfunction trajectories during childhood and early adolescence on sleep quality during late adolescence: Resilience as a mediator

RATIONALE

Sleep quality has been linked to several behavioral and psychological problems. No longitudinal study has examined the associations and underlying mechanisms between the trajectories of family characteristics and sleep quality in adolescents.

OBJECTIVE

This study investigates the effects of heterogeneous trajectories of family dysfunction on sleep quality in adolescents and examines whether resilience mediates these associations.

METHOD

Data came from 2280 adolescents participating in a longitudinal study across grades 2 through 11 in northern Taiwan. Group-based trajectory modeling was used to identify discrete developmental patterns of family dysfunction. Multiple linear regression was applied to examine the associations between family dysfunction trajectories and sleep quality. Mediation analysis was conducted to test whether resilience mediates the associations examined.

RESULTS

Four distinct trajectories of family dysfunction were identified: low persistent (26%), escalating dysfunction (21%), moderate stable (25%), and high persistent (28%). Compared to adolescents in the low-persistent trajectory, those in the escalating-dysfunction, moderate-stable, and high-persistent trajectories had significant lower levels of sleep quality (B = -0.19, p < .001, B = -0.14, p < .01, and B = -0.13, p < .05, respectively). Resilience significantly mediated the effects of all family dysfunction trajectories (relative to the low-persistent trajectory) on sleep quality (95% bootstrap confidence intervals are -0.06 to -0.02, -0.05 to -0.02, and -0.08 to -0.03 for escalating-dysfunction, moderate-stable, and high-persistent trajectories, respectively).

CONCLUSIONS

Family dysfunction conferred risks for poor sleep quality in adolescents and the negative effects, in part, were through decreasing resilience. Interventions to improve sleep quality in adolescents by targeting family function may be more effective when incorporating resilience.

EXERCISE OR PHYSICAL ACTIVITY: WHICH IS MORE STRONGLY ASSOCIATED WITH THE PERCEPTION OF SLEEP QUALITY BY ADOLESCENTS?

OBJECTIVE

To analyze the association of exercises and physical activity with the perception of sleep quality by adolescents.

METHODS

This is a cross-sectional epidemiological survey with statewide coverage, whose sample was composed of 6,261 adolescents (14-19 years old) who were selected by random sampling of conglomerates. The Global School-Based Student Health Survey questionnaire was used for data collection. The chi-square test and the binary logistic regression were applied for data analyses.

RESULTS

In the sample, 29% of adolescents did not exercise and were not classified as physically active. Adolescents who did not exercise were more likely to present a negative perception of sleep quality (OR 1.13, 95%CI 1.04-1.28, p=0.043). No association between the level of physical activity and the perception of sleep quality was found (OR 1.01, 95%CI 0.89-1.14, p=0.868). Those who practiced exercises only had less chance of perceiving sleep quality as poor (OR 0.82, 95%CI 0.71-0.95). However, those who practiced exercise and had a physically active life had less chances of having a negative perception of their sleep (OR 0.79, 95%CI 0.68-0.93).

CONCLUSIONS

Practicing physical activity alone was not enough to increase the chances of positive sleep quality perception. Only physical exercise had a positive association with sleep quality perception.

Sleep and subjective cognitive decline in cognitively healthy elderly: Results from two cohorts

Subjective cognitive decline may reflect a dementia prodrome or modifiable risk factor such as sleep disturbance. What is the association between sleep and subjective cognitive decline? Cross-sectional design, from two studies of older adults: the WHICAP in the USA and the HELIAD in Greece. A total of 1,576 WHICAP and 1,456 HELIAD participants, without mild cognitive impairment, dementia or severe depression/anxiety, were included. Participants were mostly women, with 12 (WHICAP) and 8 (HELIAD) mean years of education. Sleep problems were estimated using the Sleep Scale from the Medical Outcomes Study. Subjective cognitive decline was assessed using a structured complaint questionnaire that queries for subjective memory and other cognitive symptoms. Multinomial or logistic regression models were used to examine whether sleep problems were associated with complaints about general cognition, memory, naming, orientation and calculations. Age, sex, education, sleep medication, use of medications affecting cognition, co-morbidities, depression and anxiety were used as co-variates. Objective cognition was also estimated by summarizing neuropsychological performance into composite z-scores. Sleep problems were associated with two or more complaints: WHICAP: β = 1.93 (95% confidence interval: 1.59-2.34), p ≤ .0001; HELIAD: β = 1.48 (95% confidence interval: 1.20-1.83), p ≤ .0001. Sleep problems were associated with complaints in all the cognitive subcategories, except orientation for the WHICAP. The associations were noted regardless of objective cognition. At any given level of objective cognition, sleep disturbance is accompanied by subjective cognitive impairment. The replicability in two ethnically, genetically and culturally different cohorts adds validity to our results. The results have implications for the correlates, and potential aetiology of subjective cognitive decline, which should be considered in the assessment and treatment of older adults with cognitive complaints.

Association of sleep quality with sociodemographic factors and lifestyle in adolescents from southern Brazil

BACKGROUND

Good sleep quality is an essential component for growth, development, and physical and mental health of the individual, in addition to being a positive indicator of health and well-being. The objective of this study was to estimate the prevalence of poor sleep quality and to identify the association of poor sleep quality with sociodemographic factors, lifestyle, weight status, and associated aerobic fitness in adolescents.

METHODS

This study included 1110 students aged 14-19 years from city of São José/SC, Brazil. Sleep quality of the subjects was assessed using a questionnaire and classified as adequate and low. Independent variables were gender, age, monthly household income, maternal education, school shift, global physical activity, proper diet, screen time, sleeping hours of full week, sleeping hours of weekdays, sleeping hours of weekends, weight status, and aerobic fitness. Binary logistic regression was used to estimate odds ratios and confidence intervals of 95%.

RESULTS

Prevalence of poor sleep quality was 60.4%. More likely to have poor sleep quality were identified in female students (OR 1.68, 95% CI 1.11-2.55), whose mothers had higher levels of education (OR 1.44, 95% CI 1.20-1.73) and low aerobic fitness (OR 1.80, 95% CI 1.02-3.19).

CONCLUSION

Adolescents who were most likely to report poor sleep quality were female, those whose mothers had a higher educational level and had low aerobic fitness. Students with sedentary risk behavior were less likely of reporting poor sleep quality.

Sociodemographic and behavioral characteristics of obese students with sleep problems in Southern Brazil

ABSTRACT Objective This study estimated the combined prevalence of insufficient number of hours of sleep per day and excess body adiposity among young students. The sociodemographic and behavioral characteristics associated with this concurrent health conditions were investigated. Methods This is a cross-sectional school-based study of 975 participants aged 11-14 years in Florianópolis, Santa Catarina state, Brazil. Body adiposity was assessed based on tricipital and subscapular skinfold measurements and classified according to Lohman. The total number of hours of sleep per day was reported by the students’ parents/guardians, and it was classified as follows: as <8 hours per day and ≥8 hours per day. Data on sociodemographic characteristics, food consumption, and physical activity were collected using a self-administered questionnaire. The chi-square test and multinomial logistic regression with a 5% significance level were used to evaluate the association between the variables. Results The combined prevalence of insufficient number of hours of sleep per day and excess body adiposity was 25.1% (CI95%:20.7-29.9). The sociodemographic and behavioral factors predictive of these conditions were as follows: 13-14 year age group and household monthly income in the intermediate tertile. Conclusion The concurrent presence of insufficient sleep and excess body adiposity was found in a little more than a quarter of the students investigated. The population subgroups belonging to the 13-14 year age group and intermediate tertile of income were more likely to have concurrent insufficient number of hours of sleep per day and excess body adiposity.

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.

Proposal of cutoff points for pediatric daytime sleepiness scale to identify excessive daytime sleepiness

The objective of the present study was to propose cutoff points for the Pediatric Daytime Sleepiness Scale (PDSS) through sensitivity and specificity analyses in order to identify excessive daytime sleepiness, considering parameters such as duration and quality of sleep, health perception, stress control and depressive moods (feelings of sadness) in adolescents. A total of 1,132 adolescents, aged 14-19 years old, of both sexes, from the public high school of São José - SC, answered the questionnaire with information on age, daytime sleepiness, sleep duration, health perception, stress management, depressive moods (feelings of sadness) and quality of sleep. The Receiver Operating Characteristic (ROC) curve was used to estimate cutoff points considering the sensitivity and specificity values ​​that best identify adolescents with excessive daytime sleepiness, using independent variables as a reference. The majority of the sample was female (54.2%), aged 14-16 years. The girls presented worse quality of sleep (66.4%), and the boys had a more positive perception of health (74.8%), better stress control (64.8%) and lower depressive moods (feelings of sadness) (63.3%). The largest area in the ROC curve was the one that considered sleep quality as a parameter in both sexes (area of the curve = 0.709 and 0.659, respectively, for boys and girls, p < 0.001). Considering sleep quality as a reference, the cutoff point for excessive daytime sleepiness was 15 points. The other parameters used were also significant (p < 0.005). Poor sleep quality was the parameter most strongly related to daytime sleepiness, and a cutoff of 15 points for the PDSS for both sexes should be used in the definition of excessive daytime sleepiness. For the other parameters, stress management, depressive mood (feelings of sadness) and health perception, different cutoff points are suggested for boys and girls.

Prevalence of sleep duration among Saudi adults

Objectives:

To examine the associations between sleep duration and a variety of demographic and clinical variables in a sample of Saudi adults.

Methods:

A cross-sectional study among 2,095 participants was conducted at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, between May and October 2014. A questionnaire was administered to collect data related to clinical health outcomes and demographic characteristics. Participants were asked to report their average sleep duration per night in hours.

Results:

One-third (33.8%) reported short sleep duration of less than 7 hours/night. Short sleep duration was more prevalent in females (37.3% versus 31.4%, p=0.004). The most common medical problems reported were obesity with body mass index of >30 Kg/m² (39.1%), hypertension (33.9%), diabetes mellitus (20.8%), depression (4.3%), asthma (17.3%), COPD (6.6%), and hyperlipidemia (2.7%). Diabetes mellitus was associated with long sleep of more than 9 hours/night (25.4%, p=0.011) and hypertension (54.2%, p=0.001). The linear regression model tend to reduce their sleep duration by roughly 22 minutes in female gender, 66 minutes in participants with hyperlipidemia, and 70 minutes in participants with poor sleep quality.

Conclusions:

Short sleep duration per night was prevalent, it affects one in every 3 Saudi adults. Long sleep duration of more than 9 hours was associated with increased comorbid conditions.

TEMPO DE TELA, PERCEPÇÃO DA QUALIDADE DE SONO E EPISÓDIOS DE PARASSONIA EM ADOLESCENTES

RESUMO Introdução: O sono é um importante componente no processo de desenvolvimento biológico e mental das crianças e dos adolescentes, considerado fonte de revitalização das funções orgânicas. Objetivo: Analisar a associação entre o tipo e tempo de exposição à tela, a percepção da qualidade de sono e os episódios de parassonia em adolescentes. Métodos: Estudo transversal que incorpora um levantamento epidemiológico de base escolar com amostra representativa (n = 481) de estudantes (14 a 19 anos) do ensino médio da rede pública estadual do município de Caruaru, PE. Para a análise do sono e do estilo de vida, foi utilizada a versão traduzida e adaptada do Global School-Based Student Health Survey (GSHS). Recorreu-se à regressão logística binária para análise da associação entre as variáveis, considerando-se como desfecho a percepção negativa da qualidade de sono. Resultados: A prevalência de percepção negativa da qualidade de sono foi de 58% (IC 95% 53,5-62,3). Entre os comportamentos analisados, verificou-se que dormir oito horas ou menos por dia e assistir mais de duas horas de TV por dia aumentam, respectivamente, 2,69 (IC 95% 1,61-4,71) e 1,71 (IC 95% 1,08-2,73) as chances de relatar percepção negativa de sono. O tempo excessivo de tela, sobretudo diante da TV, esteve associado à maior quantidade de episódios de parassonia. Conclusão: A qualidade do sono está relacionada tanto com a quantidade de horas de sono, quanto com o tempo de exposição à TV. Além disso, uma quantidade maior de episódios de parassonia ocorreu entre os adolescentes que assistem mais de três horas de TV por dia.

Social determinants of inadequate sleep in US children and adolescents

BACKGROUND AND OBJECTIVES

Despite recognised disparities in child health outcomes associated with sleep, the majority of research has been based on small, homogeneous samples. Using a nationally-representative sample of US children and adolescents, we examined trends and social determinants of inadequate sleep across age groups.

STUDY DESIGN

Comparison of cross-sectional studies.

METHODS

Our study used the 2003 (n = 68,418), 2007 (n = 63,442), and 2011/2012 (n = 65,130) waves of the National Survey of Children's Health, a nationally-representative survey of 6-17-year-olds. Parents reported whether the child had inadequate sleep (0-6 days of not getting enough sleep vs 7 days).

RESULTS

From 2003 through 2011/12, inadequate sleep increased from 23 to 36% among 6-9-year-olds, 30 to 41% among 10-13-year-olds, and 41 to 49% among 14-17-year-olds. Among 10-17-year-olds, those from households with more than a high school degree were more likely to have inadequate sleep (adjusted ORs 1.2). Although for 10-13-year-olds there was a gradient in inadequate sleep across income (aORs 1.2-1.3), for 14-17-year-olds, only those from the two highest income levels were more likely to have inadequate sleep (aORs 1.3-1.4). Parents' reports that neighbours did not watch out for other's children was associated with an increased risk for inadequate sleep across all ages (aORs 1.1-1.3).

CONCLUSIONS

Inadequate sleep occurred as young as age six years and increased with age, became more prevalent, and was socially patterned. In order to prevent inadequate sleep across the life course, surveillance and monitoring are needed across all age groups to identify critical periods for intervention.

Characteristics of sleep habits among adolescents living in the city of Ribeirão Preto (SP)

INTRODUCTION

Sleep is an important physiological condition that plays a role in the physical and emotional development of adolescents. The aim of the study is to determine some sleep characteristics of adolescents living in the city of Ribeirão Preto (SP).

METHODS

This is a cross-sectional descriptive study conducted at 14 schools in the city of Ribeirão Preto (SP) including adolescents aged 10-19 years using a questionnaire about sleep habits. The χ2 test was used to determine differences between genders with the aid of the EPI-INFO 7 software, with the level of significance set at p<0.05.

RESULTS

A total of 535 adolescents (65% girls) were included in the study. Of these, 47.7% studied during the morning period and 10.3% had a job and studied in the evening period. Regarding sleep duration, 242 (45%) slept <9 h per night during week days and 256 (48%) during the weekends (Saturday and Sunday). Of the total number of adolescents studied, 75.5% reported that they went to bed when they felt sleepy, 90% reported delay in falling asleep, 84.3% used some type of electronic equipment before going to sleep, and 44% reported that they woke up during the night. In the morning, 70.3% needed to be awakened, and 44.7% reported a delay in waking up. During daytime, 70% felt somnolent and 34% reported that they slept during the day. Girls reported that they felt more daytime sleepiness (71.3%) and slept more during the day (62.1%) than boys (28.7% and 37.9%, respectively).

CONCLUSION

The study showed that almost half the adolescents investigated sleep less than the minimum time considered ideal. Furthermore, most of the adolescents went to the bed when they felt sleepy, used electronic devices before falling sleep, had difficulties falling asleep, need to be awaken in the morning and felt sleepy during the day.

School Start Time and Adolescent Sleep Patterns: Results From the U.S. National Comorbidity Survey--Adolescent Supplement

OBJECTIVES

We estimated associations between school start time and adolescent weeknight bedtime, weeknight sleep duration, and weekend compensatory sleep and assessed whether associations differ by age, sex, or urbanicity.

METHODS

We used a subsample of a nationally representative, cross-sectional survey of 7308 students aged 13 to 18 years attending 245 schools to estimate associations of school start time, reported by school principals, with weeknight bedtime and sleep duration and weekend compensatory sleep, reported during adolescent face-to-face interviews.

RESULTS

Start time was positively associated with weeknight bedtime. Associations between start time and weeknight sleep duration were nonlinear and were strongest for start times of 8:00 am and earlier. Associations differed by sex and urbanicity, with the strongest association among boys in major metropolitan counties. Start time was negatively associated with sleep duration among boys in nonurban counties. Start time was not associated with weekend compensatory sleep.

CONCLUSIONS

Positive overall associations between school start time and adolescent sleep duration at the national level support recent policy recommendations for delaying school start times. However, the impact of start time delays may differ by sex and urbanicity.

Efeito de uma sessão de treinamento de força sobre a qualidade do sono de adolescentes

INTRODUÇÃO: o sono é uma função biológica fundamental para a conservação da energia e a restauração do metabolismo energético.OBJETIVO: analisar o efeito de uma sessão do treinamento de força realizada em diferentes horários sobre a qualidade do sono de adolescentes e examinar se a relação entre a melhoria da qualidade do sono e o horário da sessão de treino se altera após o ajuste para idade.MÉTODOS: participaram do estudo seis estudantes do sexo masculino moradores internos do IFPE - Campus Vitória de Santo Antão, PE, Brasil. Foram realizadas três sessões de treinamento de força em diferentes horários manhã, tarde e noite, durante 12 semanas. A escala OMINI-RES foi utilizada para percepção do esforço. A qualidade do sono foi avaliada pelo Índice de Qualidade do Sono de Pittsburgh PSQI. Ainda foram avaliadas variáveis antropométricas massa corporal, estatura, IMC e a composição corporal % gordura, massa gorda e massa magra.RESULTADOS: foram observadas diferenças entre as sessões de treino realizadas em diferentes horários e a diagnose de qualidade do sono manhã: P < 0,001; tarde: P = 0,001; noite: P = 0,047. Houve correlação entre a sessão de treino realizada pela manhã r = 0,95 e à tarde r = 0,92 e a diagnose de qualidade do sono. Utilizando o modelo de regressão linear, as sessões de treinamento de força realizadas pela manhã R2= 0,91 e tarde R2= 0,75 explicaram de forma significativa a melhora da qualidade do sono em adolescentes, mesmo após o controle pela idade.CONCLUSÃO: as sessões de treinamento de força realizadas pela manhã e tarde apresentaram melhor resposta de qualidade do sono de adolescentes.