The association of mothers' and fathers' insomnia symptoms with school-aged children's sleep assessed by parent report and in-home sleep-electroencephalography

Objectively measured sleep continuity in children and adolescents with ADHD: A systematic review and meta-analysis

Sleep disturbances are often linked to attention-deficit/hyperactivity disorder (ADHD). Consistent findings document that children and adolescents with ADHD report more sleep problems than their typically developing (TD) peers across subjective sleep domains. However, few differences between these groups were observed in objectively measured sleep parameters, such as polysomnography (PSG) and actigraphy. This study synthesized empirical studies to identify objectively measured sleep continuity differences between children and adolescents with ADHD and TD. We included observational research and baseline data from intervention studies between 5- to 18-year-old individuals with ADHD and their TD peers at five databases from inception and September 2022. This systematic review and meta-analysis of 45 articles, including 1622 children and adolescents with ADHD and 2013 TD, found that compared with TD, children and adolescents with ADHD have higher sleep latency and moderately decreased sleep efficiency measured by actigraphy. Polysomnography-measured differences between ADHD and TD were not significant. Medication status and comorbid psychiatric status significantly moderated the group differences in sleep efficiency between ADHD and TD. Also, the group differences in sleep latency between ADHD and TD were moderated by actigraphy recorded nights. These findings highlight the importance of reducing disparities in sleep parameters among children and adolescents with and without ADHD.

Early Sleep Differences in Young Infants with Autism Spectrum Disorder

OBJECTIVE

Children with autism spectrum disorder (ASD) experience greater sleep challenges than their neurotypical peers, but sleep patterns for infants later diagnosed with ASD are unknown. This study examined differences in total sleep duration and proportion of sleep experienced at night within the first 6 months of life among infants later diagnosed with ASD, infants who demonstrated subclinical characteristics of ASD and were classified as exhibiting the broad autism phenotype (BAP), and their typically developing (TD) peers. In addition, associations between infant sleep variables and developmental outcomes at 24 months were explored.

METHODS

Participants included 79 infants enrolled in a prospective, longitudinal study of the early development of ASD. Between ages 1 week and 6 months, participants completed a monthly retrospective 24-hour sleep log. At 24 months, participants received a comprehensive diagnostic evaluation, including the Autism Diagnostic Observation Schedule-2 and Mullen Scales of Early Learning and Vineland-II and were clinically characterized as ASD, BAP, or TD.

RESULTS

When accounting for the influence of age, infants later diagnosed with ASD slept less within the 24-hour period than infants in TD or BAP groups from 0 to 6 months ( p = 0.04). Percentage of sleep experienced during nighttime hours did not significantly differ between groups from 0 to 6 months ( p = 0.25). Greater nighttime sleep percentage at 6 months predicted higher receptive language ( p < 0.001) and fine motor scores ( p < 0.0001) at 24 months. Total sleep duration at 6 months did not predict any developmental outcomes at 24 months.

CONCLUSION

Findings suggest that differences in sleep may occur among autistic individuals earlier in life than previously documented and have cascading effects on development.

Relating parental stress with sleep disorders in parents and children

OBJECTIVE

To assess whether child sleep disorders positively correlate with parental insomnia, hypersomnia, and sleep apnea, and whether parental and child sleep disorders simultaneously positively associate with parental stress. Potential modifying influences of these associations by age, sex, and marital status will be considered.

METHODS

Analyses are based on 14,009 employees aged 18-64 with dependent children (n = 44,157) insured by Deseret Mutual Benefit Administrator (DMBA) in 2020. Rate ratios are adjusted for age, sex, and marital status.

RESULTS

The rate of parental stress is 3.00 (95% CI 2.33-4.85) times greater for those with insomnia and 1.88 (95% CI 1.59-2.22) times greater for those with sleep apnea. There is no increased risk of stress for those with hypersomnia. The number of dependent children filing one or more medical claims for a sleep disorder is 2.0%. Mean age is significantly older among those with a sleep disorder (17.1 vs. 14.4, t p < .0001). Child sex is not associated with the risk of having a sleep disorder. The rate of employee insomnia is 111% greater if their child has a sleep disorder, and employee sleep apnea is 115% greater if their child has a sleep disorder. The association between child sleep disorders and sleep apnea decreases with employee age (Wald chi-square p = 0.0410). The rate of employee stress is 90% greater if their child has a sleep disorder, 189% greater if they have insomnia, and 81% greater if they have sleep apnea. The strength of the association between insomnia and stress is greater for women (Wald Chi-square p = 0.0114), between sleep apnea and stress is greater for women (Wald chi-square p = 0.0010), and between sleep apnea and stress is greater for singles (Wald chi-square p = 0.0010).

CONCLUSIONS

Better understanding the connection between parent and child sleep problems and parent stress, and modifying influences, may improve treatment of these disorders.

Actigraphy‐measured sleep concordance, night‐wakings, intraindividual sleep variability in parents and their children—Associations with childhood sleep disturbances

The relationship between the sleep of parents and their children has primarily been studied using self-reported measures, but data using objective sleep assessments are limited. In particular, objective assessments of sleep disturbance and night-wakings in parents in relation to their children's night-wakings is underexamined. This pilot study employed actigraphy to determine concordance in sleep-wake patterns between parents and their children, and examine temporal links between their wakings lasting five min or longer. The study also explored individual variability in parents' sleep based on parent-reported sleep disturbances in children. A total of 20 parents and children (aged 2-12 years, no co-sleepers) contributed actigraphy data for the 14-night study, totalling 280 nights of data. Parents reported their sleep quality using the Pittsburgh Sleep Quality Index, and children's sleep using the Children Sleep Habits Questionnaire. Concordance analysis of actigraphy data revealed an average of 70.6% match in sleep/wake state between parents and children. Parents were three times more likely to have an awakening within 10 min of their child waking than vice versa. Parent-reported sleep disturbances in children were associated with poorer actigraphic sleep outcomes for both the parent and child. Parents of poorly sleeping children demonstrated greater variability in their bedtime, and wake after sleep onset. Further examination of temporal links between parent-child sleep can improve our understanding of factors that predispose or precipitate sleep disturbances across families. Given the high concordance in parent-child sleep and poorer actigraphy sleep outcomes in parents of children with sleep disturbances, there is a need to deliver efficacious sleep interventions at the family level.

Digital solutions for sleep problems in children: A pilot study

Children with sleep difficulties have limited options for treatment. Advancements in technology allow for the digital delivery of evidence-based sleep strategies developed with a focus on cognitive behavioral therapy (CBT) approaches for insomnia. An initial survey study was conducted to assess the need and current management of sleep problems in pediatric populations. A secondary pilot study evaluated the effect of a digitally-delivered sleep strategy for the treatment of pediatric sleep problems. In the pilot study, participants had access to a mobile application which provided individualized CBT-focused sleep solutions delivered over 6-10 weeks. A total of 218 participants were surveyed to determine their need and approach for pediatric sleep problems. Approximately 74% reported sleep problems in children aged 0-1 (46%), 2-4 (67%), 5-12 (85%), and 13-17 (73%). In the pilot study, 11 families with pediatric sleep problems (children categorized as baby, toddler and school-aged) were enrolled and received the DrLullaby digital intervention. An improvement in key sleep behavior was observed including "time to fall asleep" (n = 8; 72.7%), "total time asleep" (n = 6; 54.5%) and "time awake" (n = 7; 63.6%). Within group analysis for time awake and time to fall asleep showed a mean change from baseline of 75.6% and 31.3%, respectively. Within group analysis for total time asleep showed a mean improvement of 1 h and 3 min compared to baseline. The collective distress scale score was decreased by 35%. These results suggest viability of the digital delivery of evidence-based sleep strategies for treatment of pediatric sleep problems.

Predictors of Sleep-Problem Trajectories Across Adolescence

Stress and sleep problems are significantly correlated in adolescents. Few longitudinal studies, however, have evaluated possible correlates and predictors of sleep problems at multiple points across adolescence. The current study examined the relation between stress and sleep problems across four years in a sample of adolescents who varied in risk for psychopathology. Participants included 223 adolescents (55% female) and 223 mothers (77% with a history of a mood disorder during their child's life). Youth were evaluated in grade 7 (M = 12.69 years, SD = 0.61) and again in grades 8, 9, and 11. Sleep problems were assessed as part of a clinical interview, and weekly stressful events were measured with the Life Events Interview for Adolescents. Multi-group latent growth curve analyses were conducted. Among youth whose mothers had a history of depression (high-risk), sleep problems significantly increased over time (p < .001). Second, among high-risk youth, at each time point, higher stress levels during the prior three months significantly predicted higher levels of sleep problems (p < .001). Finally, across the entire sample, at each time point a greater level of sleep problems predicted higher stress ratings a year later (p ≤ .001). Thus, stress was a significant predictor of sleep problems across multiple years of adolescence, particularly among offspring of mothers with a history of depression. Results highlight targets for preventive interventions for sleep problems in youth.

Psychological distress and its influencing factors among psychiatric nurses in China: A cross-sectional study

BACKGROUND

Psychiatric nurses often face abuse, attacks, escape, suicides, and other situations related to the care of patients with mental disorders, which are more likely to induce psychological distress.

AIMS

This study aimed to examine the relationship between coping styles and psychological distress among Chinese psychiatric nurses in Shandong and the significance of sleep quality as a mediating factor.

METHODS

A total of 812 psychiatric nurses in Shandong, China, were investigated using the Psychological Distress Scale (K10), Simplified Coping Style Questionnaire (SCSQ), Pittsburgh Sleep Quality Index (PSQI) and self-compiled general information questionnaire.

RESULTS

Psychological distress was detected in 571 psychiatric nurses (70.3%). The psychological distress of psychiatric nurses was significantly different with respect to professional title (χ² = 10.627, P < 0.05) and shift work (χ² = 9.120, P < 0.01). Psychological distress positively correlated with negative coping style (r = 0.266, P < 0.01) and sleep quality (PSQIT) (r = 0.532, P < 0.01). A significant positive correlation was found between psychological distress and all dimensions of sleep quality (r = 0.158-0.456, P < 0.05). Professional title, positive coping style, negative coping style, sleep quality (PSQIT), subjective sleep quality, sleep disorder and daytime dysfunction predicted psychological distress in psychiatric nurses (R ² = 0.363, F = 65.343, P < 0.01). The relationship between negative coping style and psychological distress was partially mediated by sleep quality, with the mediating effect accounting for 37.97% of the total effect.

CONCLUSIONS

Psychiatric nurses have a high rate of psychological distress, which is closely related to coping styles, and sleep quality has a certain regulatory effect.

Children's sleep and fathers' health and wellbeing: A systematic review

Night-waking is typical across infancy and early childhood, inevitably disrupting family sleep. For some children, sleep problems develop and endure throughout childhood. This systematic review focused on fathers, and synthesised the evidence pertaining to the effects of children's sleep (from birth to 12 years) on fathers' health and wellbeing. A total of 29 studies were included. Key outcomes reported for fathers were: sleep and fatigue; mental and general health; and family functioning. An association between child sleep and father's sleep was observed when child's sleep was measured via actigraphy or paternal report, but not when measured via maternal report, suggesting that mothers may not always be aware of disruptions that awaken fathers. Findings showed poorer child sleep was associated with poorer general health and wellbeing among fathers, however, associations of poor child sleep with depression were fewer, and less frequent than those reported for mothers in the same households. Poor child sleep was negatively associated with the quality of family relationships, both within the couple and between parent and child. Future studies seeking to understand the interplay of child sleep and family wellbeing should apply objective measurement of sleep and integrate formal measures of family dynamics into the study design.

Sleep, Classroom Behavior, and Achievement Among Children of Color in Historically Disinvested Neighborhoods

Children of color are more likely to have poor sleep health than White children, placing them at risk for behavioral problems in the classroom and lower academic performance. Few studies, however, have utilized standardized measures of both classroom behavior and achievement. This study examined whether children's sleep (parent and teacher report) in first grade concurrently related to independent observations of classroom behavior and longitudinally predicted achievement test scores in second grade in a sample of primarily Black (86%) children (n = 572; age = 6.8) living in historically disinvested neighborhoods. Higher teacher-reported child sleepiness was associated with lower adaptive behaviors and higher problem behaviors in the classroom, and predicted lower achievement. Parent-reported bedtime resistance and disordered breathing also predicted lower achievement.

The Effects of the COVID19-Related Lockdown Are Modulated by Age: An Italian Study in Toddlers and Pre-Schoolers

Although the issue has been repeatedly explored, data on the impact of the COVID-19 pandemic on children’s sleep quality are inconsistent. To clarify these discrepancies, here we investigate possible age-related differences. During the lockdown, 112 parents of toddlers (0–3 years, N = 61) and pre-schoolers (4–5 years, n = 51) completed an online survey including the Children’s Sleep Habits Questionnaire (CSHQ). Sleep-related items required an additional retrospective judgment, referring to the pre-pandemic period. During the lockdown, sleep schedules were delayed in both age groups whereas sleep quality (CSHQ total scores) improved in pre-schoolers but not in toddlers. Between-groups comparisons revealed that, prior to the lockdown, pre-schoolers showed worse sleep quality than toddlers, whereas this difference disappeared during home confinement. Also, pre-schoolers’ sleep timing was advanced before the lockdown and delayed during the lockdown relative to toddlers’. Our data highlight a significant modulation of age on the impact of the pandemic crisis on sleep, with pre-schoolers experiencing greater effects than toddlers. This profile suggests that factors affecting sleep features have different weights at different ages: sleep patterns would be mainly determined by developmental factors (i.e., biological drive) in younger children, whereas environmental factors (e.g., major lifestyle changes) would have a stronger effect on older ones.

Factors Affecting the Quality of Sleep in Children

Sleep quality is one of the domains of sleep. Having adequate quality sleep is defined as one’s “feeling fresh” after waking-up. Inadequate sleep quality results in sleep insufficiency producing a variety of symptoms and signs. The central nervous system is affected the most in children, although other system too may be involved. Several factors affect sleep quality in children including genetics, sleep habits, medical problems, parents/caregiver factors, screen time and the child’s environment. These factors are inter-related and dynamic. The outcome of sleep insufficiency is many involving neurocognitive and neurobehavior, mood and emotional issues and specific conditions, like pulmonary hypertension, cor pulmonale and obesity. Management should start with proper history taking to identify the multifaceted nature of the condition. Treatment is planned cognizant of the age of the patient and the associated etiological factors, and should involve both the children and their parents.

Do Mothers Have Worse Sleep Than Fathers? Sleep Imbalance, Parental Stress, and Relationship Satisfaction in Working Parents

PURPOSE

Previous research indicates that mothers take a larger responsibility for child care during the night and that they have more disturbed sleep than fathers. The purpose of this study was to determine whether such a sleep imbalance exists in working parents of young children, and the extent to which it depends on the way sleep is measured. The study also examined whether imbalanced sleep between parents predicts parental stress and relationship satisfaction.

METHODS

Sleep was measured for seven consecutive days in 60 parenting couples (average age of the youngest child: 3.3 years ± SD 2.5 years). Actigraphs were worn across the week, and ratings of sleep, parental stress, and relationship satisfaction were made daily.

RESULTS

Mothers perceived their sleep quality as worse (b= -0.38 scale units, p<0.001), with more wake periods (b= +0.96 awakenings, p<0.001) but with longer sleep duration (b= +32.4 min, p<0.01) than fathers. Actigraphy data confirmed that mothers slept longer than fathers (b= +28.03 min, p<0.001), but no significant differences were found for wake time, number of awakenings or who woke up first during shared awakenings. Furthermore, there was no difference in whether mothers and fathers slept sufficiently. The level of sleep imbalance between parents did not predict parental stress. A larger imbalance in subjective sleep sufficiency predicted decreased relationship satisfaction for fathers (b= -0.13 scale units, p<0.01) but increased relationship satisfaction for mothers (b= 0.14 scale units, p<0.05). No other sleep imbalance measures predicted relationship satisfaction.

CONCLUSION

Our findings are in line with previous research on sleep in men and women in general, with longer sleep and subjective reports of sleep disturbances in women, rather than previous research on sleep in parents of young children. Thus, we found no evidence of a sleep imbalance when both parents have similar working responsibilities.

Associations Between Child Sleep Problems and Maternal Mental Health in Children with ADHD

Objective/Background: Children with attention-deficit/hyperactivity disorder (ADHD) experience more sleep problems than typically developing children. In addition, higher rates of depression are experienced by mothers of children with ADHD compared to mothers of children without ADHD. This study aimed to determine whether particular sleep problems in children with ADHD are associated with specific maternal mental health difficulties. Participants: Female caregivers of 379 children with ADHD (5-13 years) participated. The child's ADHD diagnosis was reconfirmed during recruitment by caregivers completing the ADHD Rating Scale-IV. Method: Caregivers reported on their mental health using the Depression Anxiety Stress Scale and their child's sleep using the Children's Sleep Habits Questionnaire. Unadjusted and adjusted regression analyzes were undertaken. Results: In the adjusted analyzes, there were small significant associations between most aspects of child sleep (i.e. Bedtime Resistance, Night Waking, Parasomnias, Sleep Duration, Daytime Sleepiness and Total Sleep Problems) and maternal Anxiety and Stress, with the exception of Sleep-Onset Delay. Bedtime Resistance, Sleep Duration, Daytime Sleepiness and Total Sleep Problems also had small significant associations with maternal Depression. Sleep Anxiety had a small significant association with maternal Anxiety only. Conclusions: This study demonstrates important connections between many child sleep problems and particular aspects of maternal mental health, suggesting adaptations to behavioral sleep interventions for children and mental health interventions for parents to take a family approach may be beneficial. Future research should consider the longitudinal associations between child sleep and parent mental health in an effort to inform future intervention approaches.

Examining Sleep and Mood in Parents of Children with Sleep Disturbances

OBJECTIVE

The current study examined sleep and mood associations in parents of children with sleep disturbances across a sample of typically developing children and children with neurodevelopmental disorders. The mediating effect of children's sleep on the relationship between parents' sleep and mood was also assessed. The study explored differences in parents' sleep based on whether 1) the child had a sleep disturbance, and 2) the child was typically developing or had a neurodevelopmental disorder.

METHODS

A total of 293 parents of children aged 2-12 years completed an online questionnaire. Parental sleep was examined using the Pittsburgh Sleep Quality Index, the Glasgow Sleep Effort Scale and the Pre-sleep Arousal Scale, and mood was assessed using the Profile of Mood States-short form. Measures for children included the Child's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire.

RESULTS

Across the overall sample, children's sleep disturbances were associated with parents' sleep disturbances, accounting for 22% of the change in parental sleep quality. Children's sleep partially mediated parents' sleep and mood. Significant differences were observed for sleep and mood outcomes in parents of children with sleep disturbances (CSHQ scores ≥41). However, no significant differences were reported for children's sleep disturbances and parents' sleep quality based on whether the child was typically developing or had a neurodevelopmental disorder.

CONCLUSION

Parents of children with sleep disturbances experience poor sleep and high pre-sleep arousal, indicative of insomnia. Given that these parents experience cognitive arousal and insomnia, it is recommended that parents' sleep problems are addressed and treated in clinical settings.

Comparison of Blood Pressure and Kidney Markers between Adolescent Former Preterm Infants and Term Controls

BACKGROUND

Preterm infants are at an increased risk of developing hypertension and chronic kidney disease later in life. No recommendations exist for blood pressure (BP) and renal follow up for these patients.

AIM

To compare BP and serum and urinary kidney markers between preterm-born adolescents and term-born controls.

METHODS

BP measurements in 51 preterm-born (≤32 weeks gestational age) and 82 term-born adolescents at the age of 10-15 years were conducted. Stepwise regression analysis explored the association between BP and participant characteristics. Kidney markers measured in the serum and urine were creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and uromodulin. Kidney markers measured in the serum were cystatin C, beta-2 microglobulin, and beta trace protein.

RESULTS

Systolic BP was significantly higher in preterm boys compared with term boys, but not in girls, and low birth weight was associated with higher BP in boys. In the preterm group, maternal hypertension/preeclampsia and adolescent height were associated with higher systolic BP. Serum creatinine and NGAL were significantly higher in the preterm group.

CONCLUSIONS

Our study confirms an inverse sex-dependant relationship between birth weight and BP at adolescent age. The higher serum creatinine and NGAL in the preterm group may indicate that premature birth affects kidney function in the long term.

Low energy intake and dietary quality are associated with low objective sleep quality in young Japanese women

Literature reports suggest that subjective sleep quality is associated with nutrient intake in elderly people and workers. However, few studies have suggested an association between objective sleep quality and dietary intake in adolescents and young women. We hypothesized that objective sleep quality is associated with dietary intake in adolescents and young women. We evaluated the association between energy and nutrient intake and objective sleep quality in adolescents and young Japanese women. In a cross-sectional study of 80 women aged 18-27 years, dietary intake was assessed using the self-administered diet history questionnaire. Objective sleep quality was assessed by actigraphy. Lifestyle characteristics, dietary habits, and mental health were assessed using specific questionnaires. Subjects were classified into 3 groups according to sleep efficiency (SE <80%, 80%-85%, and ≥85%), and the relationships between dietary intake and objective sleep quality were statistically evaluated. No significant differences occurred in lifestyle characteristics, physical activity levels, eating behavior, and mental health status among the 3 SE groups. Energy intake was significantly lower in the low-SE group than in the middle- (P = .004) and high- (P = .015) SE groups. Protein intake was significantly lower in the low-SE group than in the high-SE group (P = .034). The mean energy-adjusted intakes of vitamin K, vitamin B₂, potassium, magnesium, iron, zinc, copper, and tryptophan were significantly lower in the low-SE group than in the high-SE group. Adequate energy intake and a high-quality diet including vitamins, minerals, and tryptophan may result in high sleep quality and help prevent sleep problems.

Relationships of coping styles and sleep quality with anxiety symptoms among Chinese adolescents: A cross-sectional study

BACKGROUND

Limited published research has examined the relationships of coping styles and sleep quality with anxiety symptoms in Chinese school adolescents. We aimed to explore the effect of coping styles and sleep quality on anxiety symptoms. Furthermore, we investigated the interactions of coping styles and sleep quality with anxiety symptoms.

METHODS

The survey was conducted in Jiangxi Province, China. The Simplified Coping Style Questionnaire, Pittsburgh Sleep Quality Index and Chinese Secondary School Students Anxiety Scale were utilized to assess sleep quality, coping styles and anxiety symptoms, respectively. Multiple logistic regression analysis was applied to explore the relationships of coping styles and sleep quality with anxiety symptoms.

RESULTS

A total of 3081 students participated in this study, 50.8% of whom were boys; the number of participants in grades 1, 2 and 3 were 979, 1085 and 1017, respectively. The prevalence of anxiety symptoms was 27.3%. Individuals with poor sleep quality were 3.558 (95% CI = 2.716-4.660) times as likely to have anxiety symptoms than those with good sleep quality. Higher negative coping style scores increased the prevalence of anxiety symptoms (OR = 2.101, 95% CI = 1.894-2.332), whereas higher positive coping style scores were related to reduced odds of anxiety symptoms (OR = 0.892, 95% CI = 0.800-0.995). Interactions of coping styles and sleep quality with anxiety symptoms were not found (all p > 0.05). The association between negative coping style and anxiety symptoms was mediated by sleep quality.

LIMITATIONS

This study was cross-sectional and limited to Ganzhou City.

CONCLUSIONS

The results of our study showed a higher prevalence of anxiety symptoms compared with the result of a previous study in Chinese school adolescents. Negative coping style and poor sleep quality were associated with an increased prevalence of anxiety symptoms, whereas positive coping style was related to a decreased prevalence of anxiety symptoms. Sleep quality was a mediating factor between negative coping style and anxiety symptoms.

The association between sleep and dual-task performance in preterm and full-term children: an exploratory study

OBJECTIVES

The present study explored associations between sleep and children's dual-task performance using cognitive-motor dual tasks (eg, walking and talking). Previous research with older adults indicated correlations between higher gait variability and unfavorable sleep continuity variables. Based on this research, as a first objective, we investigated similar correlations in a sample of children. Second, we explored correlations between dual-task performance and dimensions of sleep architecture. Third, we tested moderating effects of prematurity on these associations.

METHODS

In this study, 7-to 12-year-old children were tested in dual-task situations; of those, 39 were formerly preterm, and 59 were full-term born children. They were asked to walk and simultaneously perform different cognitive tasks. Gait was measured using an electronic walkway system. Sleep was measured using in-home sleep-electroencephalography.

RESULTS

After accounting for age and cognition, regression analyses revealed correlations between a higher number of awakenings after sleep onset and lower dual-task performance; concerning sleep architecture, analyses revealed correlations between a higher amount of rapid-eye-movement (REM) sleep and lower gait variability. Furthermore, associations between a higher amount of slow wave sleep (SWS) and children's higher cognitive performance were found. Moderation analyses indicated no effects of prematurity.

CONCLUSIONS

Our exploratory study suggests that a more disrupted sleep was related to children's poorer dual-task performance. Our findings support claims that REM sleep seems more related to performance in procedural tasks whereas SWS seems more related to performance in declarative tasks, suggesting that different sleep stages may support the processing of different performance types.

Sleep findings in Brazilian children with congenital Zika syndrome

Study Objectives

Zika virus infection during pregnancy may result in congenital Zika syndrome (CZS), whose characteristics are being described.

Methods

The present study aimed to investigate the sleep characteristics of 136 infants/toddlers (88 with CZS and 48 with typical development (TD), age and gender matched, 60% girls and 40% boys in both groups) using the Brief Infant Sleep Questionnaire. The ages of children in both groups ranged from 5 to 24 months (CZS 15.9 ± 0.4 vs. TD 15.8 ± 1.0 months, P= 0.90).

Results

The results show that 34.1% of CZS and 2% of TD children were defined as poor sleepers, 15% of CZS and 2% of TD children remained awake at night for a period longer than 1 hour, and 24% of CZS and 2% of TD children slept less than 9 hours. The CZS group showed shorter total sleep time (CZS 11.24 ± 2.6 vs. TD 12.02 ± 1.9 hours, P= 0.03) and shorter nocturnal sleep duration than the TD group (CZS 8.2 ± 0.2 vs. TD 9.4 ± 0.2 hours, P= 0.0002). In contrast to the control group (P= 0.02, r= -0.34), in the CZS group, no correlation was found between age and nocturnal wakefulness. Future studies should explore these data in relation to the development and maturation of the central nervous system of these children.

Conclusions

Considering the well-known consequences of poor sleep quality on health in several populations, the presence of sleep disorders should be considered in CZS using multidisciplinary treatments.

Prevalence of self-reported trauma in a sample of Iranian children is low and unrelated to parents' education or current employment status

Objective:

In Western countries, the prevalence of childhood trauma (CT) ranges from 15 to 25%. CT might be indirectly associated with lower parental socioeconomic status and educational attainments. The aims of this cross-sectional study were fourfold: to assess prevalence of CT in a large sample of Iranian children; to compare the Iranian prevalence rates with those of Western countries; to explore gender-specific patterns; and to explore possible socioeconomic predictors.

Method:

The sample comprised 608 children (mean age 11.49 years, 51.5% females). All completed the Farsi version of the Trauma Symptoms Checklist for Children. Additionally, parents reported on their current employment status and highest educational level.

Results:

Trauma symptoms were reported by 20 of 295 boys and 23 of 313 girls. The overall prevalence was 7.1%. Child-reported trauma symptoms were not associated with parents’ socioeconomic status or highest educational level. Compared to prevalence findings from U.S. national surveys (ranging from 15-25% of children and adolescents), the prevalence among 11- and 12-year-olds in the present study was considerably lower.

Conclusions:

The overall prevalence of reported trauma symptoms among a large sample of Iranian children was unrelated to parents’ socioeconomic status, and was lower than that reported in U.S. surveys.

Study Protocol of Sleep Education Tool for Children: Serious Game "Perfect Bedroom: Learn to Sleep Well"

Promoting a healthy sleep is a big challenge and becomes a strategic priority in public health, due to the severe consequences on children's development and risk to psychiatric diseases. Interventions that promote healthy sleep, such as those that focus on the dissemination of behavioral and environmental recommendations of sleep hygiene with children, are presented as an alternative. Serious game design offers wide-reaching domains in health applications and is increasing in popularity, particularly with children and teens because of it's potential to engage and motivate players differently from other interventions. This study aims to evaluate effects of serious game on sleep hygiene recommendations "Perfect Bedroom: learn to sleep well," on sleep habits and sleep parameters of healthy children. This is an experimental, prospective and quantitative study. We will randomize children in experimental (n = 88) and no intervention groups (n = 88). The experiment has four stages (pre-intervention, intervention, post-intervention, and follow-up), which will count with participation of children and their parents/guardians. In the evaluation stages, the guardians will answer questionnaires and scales to assess sociodemographic and health data, sleep habits and sleep pattern of their child. The children themselves will answer the following: a scale to assess sleepiness levels, a questionnaire to evaluate the serious game and the game itself, will characterize their bedroom and the activities they perform before sleep, with strategies developed by researches. Intervention with experimental group conducted with the serious game "Perfect Bedroom" will happen twice a week, for 3 weeks in a row, resulting in six sessions of 50 min each. Inferential analysis will be conducted for comparisons between groups and intragroups to measure effect of intervention in primary outcomes (sleep habits) and secondary outcomes (sleep parameters). We expect that the intervention with this game can provide valuable evidence to a new approach in promoting healthy sleep habits, with applications in clinical, educational, and familiar settings, which could diminish future health issues and risk at psychiatric diseases, decreasing the social burden of treatments for these conditions in children.

Correspondence of maternal and paternal perception of school-aged children's sleep with in-home sleep-electroencephalography and diary-reports of children's sleep

OBJECTIVE

Parents are often the first to report children's sleep difficulties. The aim of the present study was to evaluate the accuracy of parent reports by examining the correspondence of maternal and paternal reports of children's sleep with in-home electroencephalography (EEG) sleep assessment and sleep diary reports.

METHODS

A total of 143 children (57 formerly very preterm born children) aged 7-12 years underwent one night of in-home sleep-EEG; mothers and fathers reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire, and children and parents together completed a sleep diary of children's sleep.

RESULTS

Less EEG-derived total sleep time (TST) was associated with increased mother questionnaire reports of sleep duration problems, while less sleep efficiency (SE) and longer sleep onset latency (SOL) were associated with increased mother questionnaire reports of sleep onset delay. For fathers, only longer SOL was related to increased father questionnaire reports of sleep onset delay. The abovementioned associations did not change with children's increasing age and did not differ for boys and girls. More parent questionnaire reports of sleep duration problems, sleep onset delay, and night wakings were related to shorter diary reports of sleep duration, increased sleep latency, and more nocturnal awakenings, respectively.

CONCLUSIONS

Mother questionnaire reports of children's sleep corresponded moderately with objective measures of TST, SE, and SOL assessed with in-home sleep-EEG. Both mother and father questionnaire reports of children's sleep duration problems, sleep onset delay, and night wakings were related to diary reports of children's sleep.

Heart rate variability and salivary cortisol in very preterm children during school age

The autonomic nervous system (ANS) plays a major role in the human stress response and reflects physical and psychological adaptability to a changing environment. Long-term exposure to early life stressors may alter the function of the ANS. The present study examines differences in the ANS between children born very preterm and full-term as well as the association between the ANS and the hypothalamic-pituitary-adrenal (HPA) axis, the other main branch of the human stress system. Fifty-four healthy children born very preterm (<32nd gestational week) and 67 full-term children aged 7-12 years provided data for the present study. Polysomnography (PSG) assessments were obtained during a night at the children's home in lying position at rest (wake) and during different sleep stages (stage 2 sleep, slow wave sleep, rapid-eye-movement sleep). Autonomic function was assessed by use of heart rate variability, specifically low frequency power (LF), high frequency power (HF), total spectral power (Tot Pow), and the LF/HF ratio. HPA axis activity was measured using salivary cortisol the next morning at awakening, 10, 20, and 30min later. Children born very preterm had lower LF/HF ratio during wake and stage 2 sleep compared to full-term children. Moreover, higher LF, Tot Pow, and LF/HF ratio during wake, stage 2 sleep, and REM sleep were related to more post-awakening cortisol secretion. The present study provides evidence on long-term ANS alterations after very preterm birth. Moreover, findings suggest a relation between the ANS and the HPA axis and therefore support the notion of mutual feedback between the two human stress systems.