Estimating child sleep from parent report of time in bed: development and evaluation of adjustment approaches

ABC Grow Healthy Practices and Obesity-Related Health Behaviours in Family Child Care Homes in South Carolina

BACKGROUND

Many states throughout the United States have introduced Quality Rating and Improvement Systems (QRIS) to address childhood obesity in preschool-age children, but few have examined the impact of these standards in Family Child Care Homes (FCCHs). In South Carolina, the ABC Grow Healthy Practices are specific QRIS items that include diet, physical activity and sleep practices.

METHODS

The purposes of this cross-sectional study are to (1) describe physical activity levels, sleep duration and diet quality of children attending FCCHs in South Carolina and (2) compare physical activity levels, sleep duration and diet quality between children attending FCCHs that were enrolled versus not enrolled in the ABC programme. Means and percentages were used to summarize child- and parent-level descriptive characteristics, physical activity levels, diet quality and sleep behaviours overall and by sex, race/ethnicity and ABC participation. t tests and chi-square analyses were used to compare child- and parent-level demographic characteristics as well as child-level behaviours by ABC status.

RESULTS

Results revealed low physical activity levels (11.2 ± 4.1 min/h of total physical activity and 5.5 ± 2.6 min/h of moderate and vigorous physical activity) and poor diet quality (Healthy Eating Index 56.0 ± 10.3) in all children. There were statistically significant differences in fat and protein consumption between ABC and non-ABC FCCHs, as well as differences in demographic characteristics.

CONCLUSION

Future research is recommended to assess whether strengthening guidelines and improving implementation of obesity prevention standards will improve physical activity levels and diets of children attending FCCHs.

Sleep Behaviour in Sickle Cell Disease: A Systematic Review and Meta-Analysis

Background/Objectives: There is a high prevalence of sleep behaviour disorders, as well as sleep disordered breathing (SDB), in individuals living with sickle cell disease (SCD). SDB has been systematically reviewed; therefore, this systematic review and meta-analysis focused on sleep behaviour. Methods: The comprehensive literature search, following PRISMA reporting guidelines, included all languages, conference proceedings and published theses from inception through February 2022. We identified 31 studies, with most of the research being conducted in North America, using polysomnography, actigraphy and questionnaires/diaries in paediatric SCD cohorts. Results: Total sleep time (TST) decreased, while sleep onset latency (SOL) increased with age. TST was higher on self-reported sleep diary measures and lower on polysomnography (PSG) and actigraphy assessments. SOL was lowest during PSG and highest in actigraphy. The discrepancy between sleep measures might be due to the overestimation of sleep behaviour by parents. In six studies, TST and SOL were compared between people living with SCD and healthy controls; in four, TST was longer in those living with SCD while it was shorter in two. Meta-analyses on the effect of TST and SOL were limited due to publication bias, with heterogeneity between the studies, in part related to measurement differences. No significant differences were found. Conclusions: The scarcity of case-control studies and significant heterogeneity in findings likely attributable to variations in sleep assessment methodologies. Gaps in the literature should be addressed.

Characteristics and Transition of Sleep-Wake Rhythm in Nursery School Children: The Importance of Nocturnal Sleep

In this study, we investigated the sleep-wake rhythm of nursery school children with the aim of supporting their health and mental/physical development. We analyzed 4881 children from infancy to 6 years of age, using 2 week sleep tables recorded by their guardians. The tables contained night bedtimes, wake times, nighttime/daytime sleep duration, and the differences in these between weekdays and weekends. The total sleep decrement of children with increasing age is attributed to a decrease in daytime sleep, while nighttime sleep duration remains almost unchanged at about 10 h, which is, therefore, referred to as the nighttime basic sleep duration (NBSD). Although bedtime stabilizes at around 9:30 p.m. by the age of 2, wake-up times tend to be before 7 a.m., which results in sleep insufficiency during weekdays. This lack of sleep is compensated for by long naps on weekdays and by catching up on sleep on weekend mornings, which may contribute to future social jet lag. Guardians are encouraged to know their children's exact NBSD and set an appropriate bedtime to be maintained on weekdays. This helps to prevent sleep debt and fosters a consistent daily rhythm of waking up at the same time both on weekdays and weekends. These conditions are believed to support mental/physical development and school and social adaptation.

Sleep Duration Is Associated with Household Food Insecurity and Sugar-Sweetened Beverage Intake Among Women, Infants and Children Participating Children Ages 0-5

PURPOSE

To determine associations between child and household characteristics and sleep duration among low-income children in Los Angeles County.

DESIGN

Cross-sectional study.

SETTING

Survey data collected in 2017 and 2020 in Los Angeles County, California.

SAMPLE

Special Supplemental Nutrition Program for Women, Infants and Children (WIC) households with children ages 4-60 months.

MEASURES

Sleep duration for children 4-60 months old (less than recommended (LTR), recommended range, more than recommended (MTR)), household food insecurity (HFI), sociodemographics, and daily servings of sugar-sweetened beverages (SSB).

ANALYSIS

Multinomial logistic regression, stratified by child age, was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between household/child characteristics and LTR or MTR sleep compared to recommended duration among WIC participating children 4-60 months old.

RESULTS

The final sample included 3512 children ages 4-23 months and 6035 children ages 24-60 months. In the study population, 32% (3-5 years old) to 44% (4-11months) of children under 5 did not meet the recommended hours of sleep per night. HFI was associated with higher odds of LTR (OR 1.27, CI 1.12-1.45) and MTR (OR 1.46, CI 1.15-1.87) sleep among 24-60 month-old children. Each additional daily SSB serving was associated with higher odds of LTR sleep (4-23 months: OR 1.10, CI 1.02-1.19; 24-59 months: OR 1.12, CI 1.08-1.17).

CONCLUSIONS

HFI and SSB intake are associated with not getting the recommended amount of sleep among low-income WIC participating children. Nutrition assistance program participants may benefit from receiving information about recommended sleep duration for young children and how to establish sleep routines to optimize sleep duration.

Longitudinal sleep multi-trajectories from age 1 to 5.5 years and their early correlates: results from the Étude Longitudinale Française depuis l'Enfance birth cohort study

STUDY OBJECTIVES

To identify sleep multi-trajectories in children from age 1 to 5.5 years and their early correlates.

METHODS

We collected early family, maternal, and child characteristics, including children's nighttime sleep duration (NSD) and daytime sleep duration (DSD), night waking (NW), and sleep-onset difficulties (SOD), by parental phone interviews at age 2 months and 1-, 2-, 3.5-, and 5.5 years. Group-based multi-trajectory modeling identified sleep multi-trajectory groups. Multinomial logistic regression assessed associations with early factors.

RESULTS

We identified five distinct sleep multi-trajectory groups for NSD, DSD, NW, and SOD in 9273 included children. The "Good sleepers" (31.6%) and "Long sleepers" (31.0%) groups had low NW and SOD prevalence and shorter NSD but longer DSD in "Good sleepers" than in "Long sleepers." The "Good sleepers but few SOD" group (10.3%) had long NSD and DSD but a SOD peak at age 3.5 years; the "Improving NW and SOD" group (9.6%) showed short but rapidly increasing NSD to a plateau and high but decreasing NW and SOD; the "Persistent NW and SOD" group (17.5%) had persistent high NW and SOD. Maternal depression during pregnancy and sleep habits at age 1 (e.g. parental presence or feeding to fall asleep, sleeping at least part of the night away from own bed) were common risk factors associated with the most disordered sleep multi-trajectory groups.

CONCLUSIONS

We identified distinct sleep multi-trajectory groups and early life-associated factors in preschoolers. Most of the factors associated with the most sleep-disordered multi-trajectory groups are likely modifiable and provide clues for early prevention interventions.

Sleep ecology, objective sleep characteristics and behavior problems in preschoolers referred to child protection services: An exploratory study

BACKGROUND

Exposure to environmental risk factors increases the negative impact maltreatment has on children's development. Sleep ecology (i.e., sleep hygiene and home sleeping conditions) can be one of these factors. Poor sleep hygiene and suboptimal home sleeping conditions can alter sleep characteristics, which in turn, may lead to behavior problems (BPs), highly prevalent in maltreated preschoolers.

OBJECTIVES

Describe sleep ecology in maltreated preschoolers and explore associations between their sleep ecology, objective sleep characteristics and BPs.

METHOD

Parents (n = 22) completed the Children's Sleep Hygiene Scale (CSHS), and a sleep environment questionnaire to document sleep ecology. Children wore an actigraph to record objective sleep characteristics. Parents completed the Behavioral Assessment Scale for Children (BASC-2) to assess children's BPs. Descriptive and correlational analyses were performed.

RESULTS

Most of the parents (90.5 %) reported adequate sleep hygiene. However, 20 parents (95.2 %) reported suboptimal home sleeping conditions. Better physiological and overall sleep hygiene were related to earlier sleep onset. Better emotional sleep hygiene was associated with shorter nighttime awakenings and better sleep efficiency. Later sleep onset was associated with lower anxiety, and longer 24-hour sleep duration with higher somatization. Better physiological sleep hygiene was associated with less depression, and better emotional sleep hygiene with less hyperactivity.

CONCLUSION

This study showed that sleep hygiene could be associated with maltreated preschoolers' sleep characteristics and BPs, and that their home sleeping conditions may be of concern. Associations between sleep ecology, objective sleep characteristics and BPs deserve to be better understood, and further explored.

Effect of sleep on development of early childhood caries: a systematic review

PURPOSE

To investigate the impact of sleep on the development of early childhood caries (ECC).

METHODS

Seven electronic databases and grey literature were searched with various keyword combinations. Two reviewers independently selected studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale. The studies were included if they evaluated the impact of sleep parameters on the caries experience or severity of ECC in children under 6 years of age.

RESULTS

Four cross-sectional studies and two longitudinal studies were included. Children who had irregular bedtimes had a 66-71% higher chance of developing ECC. Children who slept after 11 pm might have a 74-85% higher chance of developing ECC. Children who slept less than 8 h during the night had a 30% increased risk of caries than children who slept more than 11 h.

CONCLUSION

Irregular or late bedtime and fewer sleeping hours could be an independent risk factor for ECC. The risk of ECC might be related inversely in a dose-response manner to the number of sleep hours.

Association between Sleep and Suicidal Ideation in Chinese Undergraduate Students

Suicide is an important global public health issue, which deserves more attention. This study aims to examine the relative independent relationship between suicide ideation and subjective sleep quality, sleep hygiene, and insomnia symptoms in undergraduate students in China. This population-based study included 2379 undergraduate students aged 18-26, randomly recruited from three public universities in Shanghai. The participants completed four questionnaires: the Pittsburgh Sleep Quality Index; Sleep Hygiene Practice Scale; Insomnia Severity Index; and the Symptom Checklist 90 (specifically the depression and anxiety dimensions and Q15-suicide ideation). The results of Spearman's correlation analysis indicate that poor sleep quality, short sleep duration, poor sleep hygiene, and insomnia symptoms were all associated with suicidal ideation in undergraduate students. However, according to the results of the hierarchical linear regression, no experience of sharing a bedroom at home, poor relationship with roommates, short sleep duration, sleep medicine use, and good daytime function were related to suicidal ideation, after controlling for the symptoms of depression and anxiety, which may be important in the identification of suicidal ideation. Sleep problems are highly discoverable and modifiable, and have a low sense of shame, therefore, sleep interventions for individuals with suicidal ideation and poor sleep quality may be an efficient and effective approach to suicide prevention.

Association between poor sleep for infants to two years and subsequent mental health symptoms: A systematic review and meta-analysis

Sleep plays a complex bidirectional role in the life span of most mental health illness. How soon poor sleep becomes an indicator of future mental illness is unknown. Infant sleep is a complex concept which can impact greatly on both baby and family well-being. Thus, a systematic review and meta-analysis were conducted to investigate whether poor infant sleep to age two is associated with future mental health symptoms. A systematic search of Medline, Embase, CINAHL, PsycINFO, Web of Science and Cochrane was conducted, using PRISMA guidelines. The search resulted in 17 articles to include in this review. A combined adjusted odds ratios of 1.65 (95% CI = 1.34, 2.05) for infant sleep problems leading to subsequent mental health symptoms resulted. A variety of outcome measures for both poor infant sleep and mental health symptoms/diagnosis were used, limiting the generalisability of results. Poor sleep in infancy should be considered one of many risk factors for future mental health disorder signifying the importance of early intervention.

Sleep Duration and Internalizing Symptoms in Children

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Relationship between parents' health literacy and children's sleep problems in Japan

Background

Sleep problems in preschool children can stunt their health and growth. However, the factors that cause sleep problems in children are not well understood. The aim of this study was to determine the relationship between parents’ health literacy (HL) and children’s sleep problems. The study was conducted at two kindergartens, two nursery schools, and a center for early childhood education in Chitose-city, Hokkaido, Japan.

Method

This study used a multicenter cross-sectional design. The sample comprised 354 preschoolers (aged 3–6 years) and their parents. In families with two or more children attending the same facility, only the oldest child was asked to participate in the study. Exclusion criteria included participants whose completed questionnaires had missing values. Children’s sleep problems were assessed using the Japanese version of the Children’s Sleep Habits Questionnaire (CSHQ-J). Parents’ HL was assessed using the 14-item Health Literacy Scale (HLS-14). The parents were classified into two groups (high HL group and low HL group). Multiple regression modelling was used to determine the association between HLS-14 and CSHQ-J scores.

Results

Of the 354 parents, 255 (72%) were in the high HL group and 99 (28%) in the low HL group. The mean CSHQ-J score was significantly lower in the high HL group than in the low HL group (45.3 ± 6.0 points vs. 46.8 ± 5.9 points, p = 0.043). In multiple regression analyses, parents’ HL was independently associated with their CSHQ-J score after adjusting for all confounding factors (adjusted R² = 0.22, β = − 0.11; p = 0.043).

Conclusions

Parents’ HL appears to affect their children’s sleep problems. This finding suggests that parents’ HL may be a target for intervention to improve children’s sleep problems.

Developmental Profile of Sleep and Its Potential Impact on Daytime Functioning from Childhood to Adulthood in Sickle Cell Anaemia

Young individuals with sickle cell anaemia (SCA) experience sleep disturbances and often experience daytime tiredness, which in turn may impact on their daytime functioning and academic attainment, but there are few longitudinal data.

METHODS

Data on sleep habits and behaviour were taken on the same day as an in-hospital polysomnography. This study assesses the developmental sleep profiles of children and young adults aged 4-23 years old with SCA. We examined retrospective polysomnography (PSG) and questionnaire data.

RESULTS

A total of 256 children with a median age of 10.67 years (130 male) were recruited and 179 returned for PSG 1.80-6.72 years later. Later bedtimes and a decrease in total sleep time (TST) were observed. Sleep disturbances, e.g., parasomnias and night waking, were highest in preschool children and young adults at their first visit. Participants with lower sleep quality, more movement during the night and increased night waking experienced daytime sleepiness, potentially an indicator of lower daytime functioning. Factors influencing sleep quantity included age, hydroxyurea prescription, mean overnight oxygen saturation, sleep onset latency, periodic limb movement, socioeconomic status and night waking.

CONCLUSION

Sleep serves an important role for daytime functioning in SCA; hence, quantitative (i.e., PSG for clinical symptoms, e.g., sleep-disordered breathing, nocturnal limb movement) and qualitative (i.e., questionnaires for habitual sleep behaviour) assessments of sleep should be mutually considered to guide interventions.

Objective and Subjective Assessments of Sleep in Children: Comparison of Actigraphy, Sleep Diary Completed by Children and Parents' Estimation

In research and clinical contexts, parents' report and sleep diary filled in by parents are often used to characterize sleep-wake rhythms in children. The current study aimed to investigate children self-perception of their sleep, by comparing sleep diaries filled in by themselves, actigraphic sleep recordings, and parental subjective estimation. Eighty children aged 8-9 years wore actigraph wristwatches and completed sleep diaries for 7 days, while their parents completed a sleep-schedule questionnaire about their child' sleep. The level of agreement and correlation between sleep parameters derived from these three methods were measured. Sleep parameters were considered for the whole week and school days and weekends separately and a comparison between children with high and low sleep efficiency was carried out. Compared to actigraphy, children overestimated their sleep duration by 92 min and demonstrated significant difficulty to assess the amount of time they spent awake during the night. The estimations were better in children with high sleep efficiency compared to those with low sleep efficiency. Parents estimated that their children went to bed 36 min earlier and obtained 36.5 min more sleep than objective estimations with actigraphy. Children and parents' accuracy to estimate sleep parameters was different during school days and weekends, supporting the importance of analyzing separately school days and weekends when measuring sleep in children. Actigraphy and sleep diaries showed good agreement for bedtime and wake-up time, but not for SOL and WASO. A satisfactory agreement for TST was observed during school days only, but not during weekends. Even if parents provided more accurate sleep estimation than children, parents' report, and actigraphic data were weakly correlated and levels of agreement were insufficient. These results suggested that sleep diary completed by children provides interesting measures of self-perception, while actigraphy may provide additional information about nocturnal wake times. Sleep diary associated with actigraphy could be an interesting tool to evaluate parameters that could contribute to adjust subjective perception to objective sleep values.

Night-to-Night Variability in the Bedtime Routine Predicts Sleep in Toddlers

The present study examined relations between nightly bedtime routines and sleep outcome measures in a sample of 185 toddlers aged 30 months. Parents reported on their toddler's sleep duration and the length and activities included in the bedtime routine each night for approximately 2 weeks. Toddlers wore actigraphs to track their sleep during the same time period. Correlation, mean difference, and regression analyses indicated that toddlers experienced different bedtime routines and exhibited differences in parent reported sleep duration between weeknights and weekends. Multi-level models revealed that variability in the bedtime routine on an individual night most consistently affected parent reported sleep duration on that night. Differences in the bedtime routines between weeknights and weekends also affected actigraph recorded sleep duration and sleep efficiency. Results suggest that keeping consistent bedtime routines between weeknights and weekends is important for optimal sleep outcomes.

Sleep Patterns in Chinese Preschool Children: A Population-Based Study

STUDY OBJECTIVES

This study aimed to (1) provide data on normal sleep patterns in Chinese preschool children, (2) identify cross-cultural differences of sleep patterns among children from China and other countries, (3) estimate the prevalence of sleep duration not meeting the optimal amount, and (4) characterize delayed weekend sleep pattern.

METHODS

A population-based sample of 1,610 children aged 3-6 years was recruited from 10 cities across China. Parents completed questions about their child's sleep patterns adapted from the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

The mean bedtime was 9:31 PM, wake time was 7:27 AM, nighttime sleep duration was 9 hours 30 minutes, daytime sleep duration was 1 hour 31 minutes, and total sleep duration was 11 hours 2 minutes. The children had a shorter nighttime sleep duration but longer daytime naps, resulting in no differences in total sleep duration compared with counterparts predominantly in the west. Of the children, 85.3% met the recommended amount of sleep of 10 to 13 hours, and 10.8% slept fewer than 10 hours. The prevalence of sleep less than 10 hours was higher in older children and children from eastern China. Children went to bed and woke up more than 30 minutes later on weekends than weekdays, accounting for 40.1% and 50%, respectively. Children in western China showed longer delay than children in eastern China (P < .05).

CONCLUSIONS

Age- and region-specific variability of sleep patterns are reported as well as insufficient sleep and delayed weekend sleep pattern in Chinese preschool children. The cross-cultural difference of sleep patterns was in temporal placement rather than sleep duration.

Sleep Duration and Telomere Length in Children

OBJECTIVE

To test the association between sleep duration and telomere length in a pediatric population.

STUDY DESIGN

We analyzed cross-sectional data for 1567 children from the age 9 study wave of the Fragile Families and Child Wellbeing Study, a population-based birth cohort of children born between 1998 and 2000 in large American cities (population >200 000). We measured telomere length using quantitative polymerase chain reaction, and children's typical nightly sleep duration was reported by their primary caregivers. Using linear regression, we estimated the association between sleep duration and telomere length both in unadjusted models and adjusting for a number of covariates.

RESULTS

We found that children with shorter sleep durations have shorter telomeres than children with longer sleep durations. Each hour less of nightly sleep duration is associated with having telomeres that are 0.015 log-kilobases per chromosome shorter (P < .05). We found no difference in this association by race, sex, or socioeconomic status.

CONCLUSIONS

We provide preliminary evidence that children with shorter sleep durations have shorter telomeres. This finding is consistent with a broader literature indicating that suboptimal sleep duration is a risk for increased physiological stress and impaired health. Future research should address the limitations of our study design by using longitudinal study designs and telomere measurements, measuring sleep duration via polysomnography or actigraphy, and assessing the intermediate biological mechanisms of the link between sleep and telomere dynamics.

Sibling sleep-What can it tell us about parental sleep reports in the context of autism?

Sleep problems are common in families raising children with Autism Spectrum Disorder (ASD). Clinicians often depend on parent reports of child sleep but minimal research exists to address the accuracy or biases in these reports. To isolate parent-report accuracy (from differences in sleep behaviors), the sleep of younger siblings were assessed within a two-group design. The present study compared parent diary reports of infant sibling sleep to videosomnography and actigraphy. In the high-risk group, families had at least one child with ASD and a younger sibling (n = 33). The low-risk comparison group had no family history of ASD (n = 42). We confirmed comparable sleep behaviors between the groups and used paired t tests, two-one-sided-tests (TOST), and Bland-Altman plots to assess parent report accuracy. The parameters of sleep onset, nighttime sleep duration, awakenings, morning rise time, and daytime sleep duration were evaluated. Diary and videosomnography estimates were comparable for nighttime sleep duration, morning rise time, and awakenings for both groups. Diary and actigraph estimates were less comparable for both groups. Daytime sleep duration estimates had the largest discrepancy with both groups reporting (on average) 40 additional minutes of sleep when compared to actigraphy estimates. In the present study, families raising children with ASD were just as accurate as other families when reporting infant sleep behaviors. Our findings have direct clinical implications and support the use of parent nighttime sleep reports.

Relations Between Toddler Sleep Characteristics, Sleep Problems, and Temperament

Two sources of information (parent-reported sleep diaries and actigraph records) were used to investigate how toddler sleep characteristics (bed time/sleep onset, wake time/sleep offset, total nighttime sleep, and total sleep time) are related to sleep problems and temperament. There were 64 toddler participants in the study. Consistent with studies of older children, parent reports differed from actigraph-based records. The findings that parent-reported and actigraph-recorded sleep characteristics varied as a function of parent report of toddler sleep problems and temperament add needed information on toddler sleep. Such information may contribute to improving parents' awareness of their child's sleep characteristics and correlates of problem sleep.

Temperament moderates the association between sleep duration and cognitive performance in children

The importance of sufficient sleep for cognitive performance has been increasingly recognized. Individual differences in susceptibility to effects of sleep restriction have hardly been investigated in children. We investigated whether individual differences in temperament moderate the association of sleep duration with sustained attention, inhibition, and working memory in 123 children (42% boys) aged 9 to 11 years. Sleep duration was assessed using parental diaries, and temperament traits of extraversion and negative affectivity were assessed by child self-report (Early Adolescent Temperament Questionnaire-Revised). Computerized assessment of sustained attention (short-form Psychomotor Vigilance Task, PVT), inhibition (PVT Go/No-Go adaptation), and working memory (visual Digit Span) were performed at school. Our findings demonstrate that long-sleeping introverted and negatively affective children show worse sustained attention and working memory than short-sleeping children with these temperaments.

Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis

CONTEXT

Mixed findings exist on whether stimulant medications alter youth sleep.

OBJECTIVE

To determine the effect of stimulant medications on sleep.

DATA STUDIES

Studies published through March 2015 were collected via CINAHL, PsycINFO, and PubMed. References of retrieved articles were reviewed.

STUDY SELECTION

Eligibility criteria included studies with children/adolescents who had attention-deficit/hyperactivity disorder (ADHD), random assignment to stimulants, and objective sleep measurement. Studies that did not include information about key variables were excluded.

DATA EXTRACTION

Study-level, child-level, and sleep data were extracted by 2 independent coders. Effect sizes were calculated by using random effects models. Potential moderators were examined by using mixed effect models.

RESULTS

A total of 9 articles (N = 246) were included. For sleep latency, the adjusted effect size (0.54) was significant, indicating that stimulants produce longer sleep latencies. Frequency of dose per day was a significant moderator. For sleep efficiency, the adjusted effect size (-0.32) was significant. Significant moderators included length of time on medication, number of nights of sleep assessed, polysomnography/actigraphy, and gender. Specifically, the effect of medication was less evident when youth were taking medication longer. For total sleep time, the effect size (-0.59) was significant, such that stimulants led to shorter sleep duration.

LIMITATIONS

Limitations include few studies, limited methodologic variability, and lack of unpublished studies.

CONCLUSIONS

Stimulant medication led to longer sleep latency, worse sleep efficiency, and shorter sleep duration. Overall, youth had worse sleep on stimulant medications. It is recommended that pediatricians carefully monitor sleep problems and adjust treatment to promote optimal sleep.