Sleep patterns and sleep deprivation recorded by actigraphy in 4th-grade and 5th-grade students

The Connection between Sleep Patterns and Mental Health: Insights from Rural Chinese Students

BACKGROUND

The association between sleep patterns and young students' mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined.

METHOD

A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns.

RESULTS

Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a "U-shaped" relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10-11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6-8% decrease in mental health risks.

CONCLUSIONS

These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students.

Interactive effect between sleep and exercise on depressive symptoms in Chinese adolescents

Objectives

The study aimed to investigate the effects of sleep and exercise, individually and jointly, on depressive symptoms in Chinese adolescents.

Methods

Cluster sampling was used to conduct a cross-sectional, electronic survey among 11,563 students from five primary and high schools in Sichuan Province in Western China. The questionnaire contained custom-designed items concerning sleep and exercise, while it used the Center for Epidemiologic Studies Depression Scale to assess depressive symptoms and the Core Self-Evaluations Scale to assess core self-evaluation. Data were analyzed using descriptive statistics and multivariate linear regression.

Results

A total of 10,185 valid questionnaires were collected, corresponding to an effective response rate of 88.1%. Among the respondents in the final analysis, 5,555 (54.5%) were boys and 4,630 (45.5%) were girls, and the average age was 15.20 ± 1.72 years (range, 11-18 years). Only less than half of the respondents (4,914, 48.2%) reported insufficient sleep, while the remainder (5,271, 51.8%) had adequate sleep. Nearly one-quarter (2,250, 22.1%) reported insufficient exercise, while the remainder (7,935, 77.9%) reported adequate exercise. More than half of the respondents (5,681, 55.7%) were from vocational high school, 3,368 (33.1%) were from junior high school, 945 (9.3%) were from senior high school, and 191 (1.9%) were from primary school. The prevalence of depressive symptoms among all respondents was 29.5% (95% CI 28.7%-30.4%). When other variables were controlled, the depression score did not vary significantly with gender (B = -0.244, SE = 0.127, P = 0.054), but it decreased by 0.194 points per 1-year increase in age (B = -0.194, SE = 0.037, P < 0.001). Students getting adequate sleep had depression scores 2.614 points lower than those getting insufficient sleep (B = -2.614, SE = 0.577, P < 0.001), while students who engaged in adequate exercise had depression scores 1.779 points lower than those not exercising enough (B = -1.779, SE = 0.461, P < 0.001). The depression score decreased by 0.919 points per 1-point increase in the core self-evaluation score (B = -0.919, SE = 0.008, P < 0.001). In regression controlling for gender, age, and core self-evaluation, sleep and exercise were found to be related significantly to influence depressive symptoms (B = 0.821, SE = 0.315, P = 0.009).

Conclusion

Adequate sleep and adequate exercise are individually associated with milder depressive symptoms in Chinese adolescents. Our results further highlight the need for researchers and clinicians to take into account not only the individual but also the joint effects of sleep and exercise on depression in adolescents when conducting research and designing interventions. If sleep or physical exercise has substantially reduced the risk of depressive symptoms, further reductions by improving sleep and exercise become difficult and may even have opposite effects.

Distance to Natural Environments, Physical Activity, Sleep, and Body Composition in Women: An Exploratory Analysis

A growing body of evidence indicates that living close to nature is associated with better health and well-being. However, the literature still lacks studies analyzing the benefits of this proximity for sleep and obesity, particularly in women. The purpose of this study was to explore how distance to natural spaces is reflected in women's physical activity, sleep, and adiposity levels. The sample consisted of 111 adult women (37.78 ± 14.70). Accessibility to green and blue spaces was assessed using a geographic-information-system-based method. Physical activity and sleep parameters were measured using ActiGraph accelerometers (wGT3X-BT), and body composition was assessed using octopolar bioimpedance (InBody 720). Nonlinear canonical correlation analysis was used to analyze the data. Our findings reveal that women living in green spaces close to their homes had lower levels of obesity and intra-abdominal adiposity. We also demonstrated that a shorter distance to green spaces seemed to correlate with better sleep onset latency. However, no relationship was found between physical activity and sleep duration. In relation to blue spaces, the distance to these environments was not related to any health indicator analyzed in this study.

Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol

Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.

Effects of multiple exposures to general anesthesia on the sleep quality of children after plastic surgery in Beijing, China: a cohort study

To assess the effects of the number and duration of general anesthesia exposure on the sleep quality of 6-15-year-old school children who underwent plastic surgery. The study was conducted on 688 children who underwent plastic surgery between the ages of 6 and 15 years using the Sleep Disorder Scale for Children (SDSC). The children were divided into two groups according to their exposure to general anesthesia: No General Anesthesia (NGA) and General Anesthesia (GA) groups. The GA group was further divided into three subgroups according to the number of exposures: Single-exposure, Double-exposure, and Multiple-exposure groups. The GA group was also subdivided into two groups according to the cumulative total time of anesthesia exposure: < 3 h and ≥ 3 h groups. Multivariate logistic regression analysis was used to confirm the potential factors that affect children with sleep disturbance (SDSC scores > 39) after general anesthesia exposure. Linear regression was used to analyze the correlation of the factors with the SDSC scores. The SDSC scores were higher in the GA group [35.4 ± 4.3 vs. 34.0 ± 3.6, P < 0.0001] as compared to the NGA group. The number of children with SDSC scores > 39 was also higher in the GA group [80 (17.5%) vs. 17 (7.4%), P < 0.0001]. More anesthesia exposure was correlated with higher total SDSC scores [34.5 ± 4.3 for single exposure vs 35.1 ± 3.9 for double exposure vs 37.5 ± 4.5 for multiple exposures, P < 0.0001] and a higher proportion of SDSC scores > 39 [24 (12.0%) for single exposure vs 24 (15.5%) for double exposure vs 32 (31.1%) for multiple exposures, P < 0.0001]. Longer anesthesia exposure was also correlated with higher total SDSC scores [34.4 ± 4.5 for < 3 h vs. 35.8 ± 4.2 for ≥ 3 h, P = 0.002]. The number of exposures to general anesthesia was a potential factor in sleep disturbance among children, determined based on logistic regression. Children who underwent plastic surgery between the ages of 6 and 15 years with general anesthesia exposure might have worse sleep quality and a higher incidence of sleep disorders. More frequent anesthesia exposure leads to worsened sleep quality and a higher incidence of sleep disorders. This study also confirmed that a longer duration of cumulative anesthesia exposure also leads to worse sleep quality.

The Role of Sleep and Eating Patterns in Adiposity Gain among Preschool-Aged Children

BACKGROUND

Short sleep duration is related to risk for obesity in preschool children. However, the underlying mechanism(s) are not clear.

OBJECTIVE

We evaluated the relationship between sleep characteristics with body composition, energetics and weight-regulating behaviors in preschool-aged children; and the longitudinal associations between children's sleep and eating patterns with body composition at 1-year follow-up.

METHODS

Data were drawn from a longitudinal study of 118 children aged 3-5 years. Sleep (duration, midpoint, regularity) and physical activity (PA) were measured by accelerometry over 6 consecutive days; total energy expenditure (TEE) using the doubly-labeled water method; body composition (fat mass, fat-free mass, and %body fat) by dual energy x-ray absorptiometry; and dietary intake (energy intake, timing) using two 24-h recalls. Multivariable regression was used to estimate interindividual associations of sleep parameters with body composition, PA, TEE and dietary outcomes; and to examine the relationship between sleep and dietary behaviors with body composition one year later.

RESULTS

Cross-sectionally, later sleep midpoint was associated with greater fat mass (0.33; 95% CI: 0.05, 0.60) and %body fat (0.92; 95% CI: 0.15, 1.70). Later sleep midpoint was associated with delayed morning (0.51; 95% CI: 0.28, 0.74) and evening meal times (0.41; 95% CI: 0.29, 0.53), higher nighttime (45.6; 95% CI: 19.7, 71.4), and lower morning (-44.8; 95% CI: -72.0, -17.6) energy intake. Longitudinally, shorter sleep duration (-0.02; 95% CI: -0.03, -0.00) and later meal timing (0.83; 95% CI: 0.24, 1.42) were associated with higher %body fat 1 year later.

CONCLUSIONS

Shorter sleep duration and later meal timing are associated with adiposity gain in preschoolers.

Sleep problems, sleep duration, and use of digital devices among primary school students in Japan

BACKGROUND

There is growing concern that screen time and media use in school-age children can negatively affect children's sleep. These negative effects are explained by three main underlying mechanisms: reduced sleep, time allocated for more media consumption; increased mental, emotional, or psychological stimulation by media content; and the effects of light emitted by digital devices on circadian rhythms and sleep physiology and arousal. In this study, we focused not only on sleep duration, but also on sleep problems. We conducted a large-scale survey to examine the relationship between excessive use of digital devices, Internet addictive behaviour, sleep duration, and sleep problems.

METHODS

We conducted a cross-sectional study of children enrolled in 20 public primary schools in Nagoya City, Japan. Children's parents/guardians completed a questionnaire including the brief sleep questionnaire for Japanese children which is a shortened version of the 'Children's Sleep Habits Questionnaire'. Logistic regression analyses were used to identify associations between sleep problems and grade, sex, weekday sleep time, weekend sleep time, ownership of digital devices, frequent checking of digital devices, use of digital devices for more than 4 hours per day, and Internet addiction.

RESULTS

In total, 8172 responses were received (91.6% response rate). After excluding incomplete responses, we analysed complete datasets for 6893 children with a mean age of 9.0 years. When adjusted for sex, grade, sleep duration on weekdays, and sleep duration on weekends, failure to control (odds ratio [OR] = 1.48; 95% confidence interval [CI]: 1.29-1.70; p < .001), more use than intended (OR = 1.27; 95% CI: 1.12-1.44; p < .001), and use to escape a dysphoric mood (OR = 1.30; 95% CI: 1.03-1.64; p = .027) were associated with children's sleep problems. A shorter weekday and a longer weekend sleep duration indicated a higher likelihood of sleep problems.

CONCLUSIONS

After adjusting for sleep duration, a relationship was found between the three Internet addictive behaviours and sleep problems, but not ownership of digital devices. Parents and teachers may need to address screen media-related sleep problems in children, as these problems may be influenced by psychological factors.

Regularity and Timing of Sleep Patterns and Behavioral Health Among Adolescents

OBJECTIVE

Sleep is vital to supporting adolescent behavioral health and functioning; however, sleep disturbances remain under-recognized and undertreated in many health care settings. One barrier is the complexity of sleep, which makes it difficult for providers to determine which aspects-beyond sleep duration-may be most important to assess and treat to support adolescent health. This study examined associations between 2 sleep indices (regularity and timing) and adolescent behavioral health and functioning over and above the impact of shortened/fragmented sleep.

METHOD

Eighty-nine adolescents recruited from the community (mean age = 14.04, 45% female participants) completed 7 days/nights of actigraphy and, along with a parent/guardian, reported on behavioral health (internalizing and externalizing symptoms) and psychosocial functioning. Stepwise linear regressions examined associations between sleep timing and regularity and behavioral/functional outcomes after accounting for shortened/fragmented sleep.

RESULTS

Delayed sleep timing was associated with greater self-reported internalizing (F[6,82] = 11.57, p = 0.001) and externalizing (F[6,82] = 11.12, p = 0.001) symptoms after accounting for shortened/fragmented sleep. Irregular sleep was associated with greater self-reported and parent-reported externalizing symptoms (self: F[7,81] = 6.55, p = 0.01; parent: F[7,80] = 6.20, p = 0.01) and lower psychosocial functioning (self: F[7,81] = 6.03, p = 0.02; parent: F[7,78] = 3.99, p < 0.05) after accounting for both shortened/fragmented sleep and delayed sleep timing.

CONCLUSION

Sleep regularity and timing may be critical for understanding the risk of poor behavioral health and functional deficits among adolescents and as prevention and intervention targets. Future work should focus on developing and evaluating convenient, low-cost, and effective methods for addressing delayed and/or irregular adolescent sleep patterns in real-world health care settings.

Sleeping patterns and childhood obesity: an epidemiological study in 1,728 children in Greece

STUDY OBJECTIVES

Sleep is an essential normal function for children's growth and development, but over the years, lifestyle changes have resulted in insufficient sleep, a factor that may be associated with increased childhood obesity. The aim of this study was to evaluate the association between sleep duration and sleep patterns separately on weekdays and weekends regarding children's weight status.

METHODS

This study was conducted among Greek students (55.1% girls) in 2014-2016. Children's weight status was classified according to the International Obesity Task Force tables and guidelines. Sleep duration was determined based on the sleep and wake time that children reported, separately for weekdays and weekends. Classification and regression tree analysis was used to derive sleep patterns and evaluate their relation to children's weight status.

RESULTS

Multiadjusted analysis revealed an inverse association between average duration of sleep on weekdays and weekends with the likelihood of being overweight/obese (odds ratio per 1 hour 0.82; 95% confidence interval, 0.73-0.92). This was more prominent on weekends than on weekdays. Children who had lower duration on weekdays, but catch-up sleep duration on weekends, were 2% (95% confidence interval, 0.97-0.99) less likely to be overweight/obese compared to those children having both less or increased sleep duration on weekdays and weekends.

CONCLUSIONS

Sleep duration and sleep patterns seem to be associated with childhood weight status. Interventions should be developed to educate parents on the importance of an adequate sleep duration and healthy sleep patterns for their children's healthy development.

Sleep Quality of Students from Elementary School to University: A Cross-Sectional Study

BACKGROUND

Sleep affects a wide array of health outcomes and is associated with the quality of life. Among students, sleep quality is affected by school stage and grade; however, data regarding the different sleep-related problems students experience at different school stages are limited. In this study, we aimed to explore sleep quality among a student sample ranging from elementary school to university level.

METHODS

Overall, data were examined for 9392 subjects aged 9-22 years. Information on sociodemographic characteristics and other variables were collected through self-administered questionnaires. Sleep quality on school nights was evaluated using the standard Pittsburgh Sleep Quality Index; global score >5 was classified as poor sleep quality. For the high school sample, logistic regression analysis was used to estimate associations between sleep quality and certain factors.

RESULTS

Of the elementary school, middle school, vocational high school, senior high school, and university students, 7.5%, 19.2%, 28.6%, 41.9%, and 28.5%, respectively, showed poor sleep quality. The high school students reported the highest prevalence of shorter sleep duration (70.8%), day dysfunction (84.7%), and subjective poor sleep quality (17.2%). The elementary school students showed the highest prevalence of poor sleep efficiency (17.9%). The university students showed the highest prevalence of sleep medication use (6.4%). The vocational high school students reported the highest prevalence of sleep latency (6.3%) and sleep disturbance (7.4%). Logistic regression modeling indicated that sleep quality is positively associated with school stage, grade, family atmosphere, academic pressure, and number of friends.

CONCLUSION

Sleep quality and sleep features change greatly from elementary school to university. Interventions to improve sleep quality should consider targeting the specific issues students experience at each school stage. Alarmed by the high prevalence of poor sleep quality among high school students, it is recommended that high school students should be informed of their sleep matter and the consequences.