World Sleep Society recommendations for the use of wearable consumer health trackers that monitor sleep

Wearable consumer health trackers (CHTs) are increasingly used for sleep monitoring, yet their utility remains debated within the sleep community. To navigate these perspectives, we propose pragmatic, actionable recommendations for users, clinicians, researchers, and manufacturers to support CHT usage and development. We provide an overview of the evolution of multi-sensor CHTs, detailing common sensors and sleep-relevant metrics. We advocate for standardized 'fundamental sleep measures' across manufacturers, distinguishing these from proprietary exploratory metrics with future potential. We outline best practices for using CHT-derived sleep data in healthy individuals while addressing current device limitations. Additionally, we explore their role in evaluating and managing individuals at risk for or diagnosed with insomnia, sleep apnea, or circadian rhythm sleep-wake disorders. Guidance is provided on device selection to align with their intended use and on conducting and interpreting performance evaluation studies. Collaboration with manufacturers is needed to balance feature comprehensiveness with clinical utility and usability. Finally, we examine challenges in integrating heterogeneous sleep data into clinical health records and discuss medical device certification for specific wearable CHT features. By addressing these issues, our recommendations aim to inform the usage of CHTs in the global community and to begin bridging the gap between consumer technology and clinical application, maximizing the potential of CHTs to enhance both personal and community sleep health.

Wrist accelerometry and machine learning sensitively capture disease progression in prodromal Parkinson's disease

Sensitive motor measures are needed to support trials in Parkinson's disease (PD). Wrist sensor data was collected continuously at home from 269 individuals with PD (106 with prodromal PD). Submovements were smaller, slower, and less variable in PD and prodromal PD. A machine-learned composite measure captured disease progression in prodromal PD more sensitively than the MDS-UPDRS Part III motor score. Wearable sensor-based measures may be useful in upcoming clinical trials.

Adolescents' next-day perceptions of their sleep quality, quantity, sleepiness and sleepiness-related symptoms relative to actigraphy metrics

BACKGROUND

Next-day perceptions of sleep and related symptoms are frequently collected in research and clinical practice, but how they correlate with objective sleep measures in adolescents has received little attention.

METHODS

Participants were aged 16-17 years and without a sleep disorder, anxiety or depression diagnosis. Seven-day wrist actigraphy was collected alongside daily survey ratings of sleep quality, sufficiency, morning and daytime sleepiness, and sleepiness-related mood and concentration. Within-person associations between daily actigraphic sleep metrics (6 variables representing quantity, quality and timing) and subjective ratings were estimated using mixed effects regression models with participant included as a random effect.

RESULTS

The sample comprised 71 adolescents (49 % female, 51 % male). No actigraphy metrics linked to sleep sufficiency ratings. Sleep onset was the strongest correlate of sleep quality and morning sleepiness in the expected direction e.g. every 10 min later onset led to a -1.4 point (95 % CI: -2.1, -0.7) drop in the sleep quality score (5-point scale, higher worse), but significant relationships were only in females. While actigraphic sleep quantity metrics were linked to several ratings, all effect sizes were marginal. Sleep quality metrics in the overall sample were not correlated to any ratings. Unexpectedly, timing and quantity metrics linked to sleepiness-related mood ratings, but in the opposite direction hypothesized.

CONCLUSIONS

The lack of correlation between objective and subjective sleep quality add to the complexity of defining sleep quality accurately. Sleep onset timing, rarely explored in these types of studies emerged as an important correlate of sleep quality perception and other subjective ratings.

What goes on when the lights go off? Using machine learning techniques to characterize a child's settling down period

Objectives

Current approaches to objective measurement of sleep disturbances in children overlook the period prior to sleep, or the settling down time. Using machine learning techniques, we identified key features that characterize differences in activity during the settling down period that differentiate children with sensory sensitivities to tactile input (SS) and children without sensitivities (NSS).

Methods

Actigraphy data were collected from children with SS (n = 17) and children with NSS (n = 18) over 2 weeks (a total of 430 evenings). The settling down period, indicated using caregiver report and actigraphy indices, was isolated each evening and seven features (mean magnitude, maximum magnitude, kurtosis, skewness, Shannon entropy, standard deviation, and interquartile range) were extracted. 10-fold cross-validation with random forests were used to determine accuracy, sensitivity, and specificity of differentiating groups.

Results

We could accurately differentiate groups (accuracy = 83%, specificity = 83%, sensitivity = 84%). Feature importance maps identify that children with SS have higher maximum bouts of activity (U = -2.23, p = 0.026) during the settling down time and a higher variance in activity for the children with SS (e.g., interquartile range, Shannon entropy) that sets them apart from their peers.

Conclusion

We present a novel use of machine learning techniques that successfully uncovered differentiating features within the settling down period for our groups. These differences have been difficult to capture using standard sleep and rest-activity metrics. Our data suggests that activity during the settling down period may be a unique target for future research for children with SS.

Exposure to high temperature and sleep in preadolescents from two European birth cohorts

INTRODUCTION

Hot temperatures disrupt sleep in adults, but the impact on younger populations, despite the essential role of sleep in their health and development, remain underexplored.

AIM

We assessed the relationship between ambient nocturnal temperature and physiological sleep characteristics and self-reported daytime sleepiness in preadolescents from two European birth cohorts.

METHODS

We evaluated preadolescents from the Dutch Generation R Study (3,340 (mean age 13.5 years) and the Spanish INMA Project (587 (mean age 14.3 years)). Ambient nocturnal temperature at participants' residences was estimated with the UrbClim model at a 100x100m resolution. Physiological sleep characteristics (total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency) were measured with a wrist-accelerometer up to nine nights. Self-reported daytime sleepiness was assessed using the Paediatric Daytime Sleepiness Scale or the Sleep Disturbances Scale for Children. We ran linear mixed models for each physiological sleep characteristic and distributed lag models for daytime sleepiness.

RESULTS

Nocturnal temperatures ranged from -7.0-31.0 °C (Generation R) and 1.3-30.3 °C (INMA). In Generation R, higher nocturnal temperatures were associated with a shorter total sleep time (-3.7 min per 5 °C [95 % CI -5.4; -1.9]) and poorer sleep efficiency (-0.3 % per 5 °C [95 % CI -0.5; -0.1]), especially in warmer months and low socioeconomic status level neighbourhoods. No associations were found for physiological sleep characteristics in INMA or for daytime sleepiness scores in either cohort.

CONCLUSION

Warmer temperatures were associated with shortened sleep duration and poorer sleep efficiency in adolescents in the Netherlands, but not in Spain. These results suggest potential cross-country differences in the relationship between ambient temperature and adolescent sleep, though comparisons should be made cautiously due to differences in climate, acclimatization, population characteristics, and sample size. Climate change may worsen preadolescents sleep, underscoring the need for strategies to protect sleep and promote long-term health.

Napping, sleep and affect in late- and short- sleeping adolescents: An actigraphy and daily diary study

OBJECTIVES

Adolescents in the United States do not typically attain enough sleep at night due to a combination of factors, including biological maturation and academic and social commitments. This lack of sleep leads to poor cognitive, mental, and physical health outcomes. Naps may compensate for inadequate sleep, however, little is known about how napping affects nocturnal sleep and mood over time among adolescents who are poor sleepers.

METHODS

The present study used daily diary and actigraphy data collected over 15days in a sample of late- and short-sleeping adolescents (n=99; Mage=15.9years; 55% Female; 46% White, 30% Black, and 24% Multiracial/Other). Multilevel modeling was utilized to examine daily associations between daytime napping and subsequent nocturnal sleep outcomes, controlling for previous night sleep. Sex was explored as a moderator.

RESULTS

The majority of participants (76%) napped at least once during the study period, and almost one-fifth of the sample demonstrated "habitual" or frequent napping. Nap occurrence was associated with a decrease in total sleep time by 27 minutes as well as later sleep onset time that night. Later nap offset time was associated with later nocturnal sleep onset time, and longer nap duration was associated with later nocturnal sleep onset time and lower sleep efficiency. Napping was unrelated to affect. Sex did not moderate any relations between napping and nocturnal sleep or affect.

CONCLUSIONS

The findings indicate that napping is common and generally associated with worse nocturnal sleep outcomes among a sample of late- and short-sleeping adolescents.

Are you Lonesome Tonight? Ecological Momentary Assessment of Evening Loneliness, Worry, and Actigraphic Sleep in Adolescents

OBJECTIVES

This study aims to evaluate the association between ecological assessment experience of loneliness and nocturnal sleep in a sample of healthy adolescents and to investigate the potential mediating role of pre-sleep worry in this relationship.

METHODS

Each evening, participants completed an electronic diary including items assessing loneliness and worry. The time of diary administration was set on an individual basis to capture the actual pre-bed experience. Sleep parameters were assessed using actigraphy.

RESULTS

Analyses were conducted on 72 participants (53.9% boys; Mage = 15.65; SD = 1.32) and 535 nights. Multilevel structural equation modeling indicated that within person loneliness fluctuations over the assessment period predicted shorter sleep duration through the mediation of high pre-sleep worry (B = -1.634, p = .027); More specifically, at the within level, loneliness was significantly and positively related to worry (B = .131, p = .001), which in turn was negatively related to sleep duration (B = -12.502, p = .028).One step increase in loneliness-associated pre-sleep worry predicted a decrease of 12 minutes in sleep duration. The mediation path was not influenced by anxiety and gender differences in the adjusted analysis. Results on other sleep parameters were not significant.

CONCLUSIONS

Findings suggest that adolescents' loneliness experienced at bedtime may influence sleep duration through worry. Sleep-promoting interventions in adolescents may benefit from targeting loneliness and pre-sleep cognitions.

What constitutes restless sleep in children?

Parents commonly report in sleep questionnaires and in person to clinicians that their child is restless in sleep. There is little agreement on what constitutes restless sleep and so the significance of this observation is uncertain and its relationship to parental concerns about daytime tiredness, learning difficulties or problematic behaviours is unclear. Restless sleep may be secondary to other sleep problems such as obstructive sleep apnoea or periodic limb movement disorder. However, there may be some evidence to support the concept of restless sleep as a primary sleep problem. Certainly, more evaluation of restless sleep with validated tools and agreed definitions should be the starting point in clarifying the significance of restless sleep in childhood.

Associations between real-life light exposure patterns and sleep behaviour in adolescents

One of the most striking changes in the regulation of sleep-wake behaviour during adolescence is circadian phase delay. Light exposure synchronises circadian rhythms, impacting sleep regulation, however, the influence of real-life light exposure on sleep variations remains less clear. We aimed to describe the sleep and light exposure patterns of high school students with comparable schedules and socio-economic backgrounds, and to evaluate whether there was any association between them, considering chronotype. We analysed five school days and two free days of actigraphy records, from 35 adolescents (24 female, mean age: 16.23 ± 0.60). The sample was described using the Sleep Regularity Index (SRI), chronotype (actigraphy MSFsc), and self-reported diurnal preference (Morning/Evening Scale). Regression models were constructed to assess the impact of light exposure (daytime and nighttime) on subsequent sleep episodes; and to confirm whether the associations could be an indirect consequence of chronotype. Despite following similar routines, the SRI varied considerably (48.25 to 88.28). There was compatibility between the actigraphy proxy for chronotype and the self-reported diurnal preference, extracted using the circadian rhythm scale for adolescents. Less light exposure during the day was associated with later sleep onset and shorter sleep duration. An increase of 100 lux in average daytime light exposure advance of 8.08 minutes in sleep onset and 7.16 min in sleep offset. When the regressions were controlled for chronotype, these associations persisted. These findings facilitate discussions regarding the behavioural aspect of the impact of real-life light exposure on sleep and its potential as a target for interventions aiming to enhance adolescents' sleep quality.

Actigraphy-assessed sleep duration and quality and executive function in a sample of typically developing preschoolers

Sleep is essential for cognitive development and brain maturation during early childhood. Studies focused on preschool populations using objective measures of sleep are still scarce. The objective of this study was to examine the associations between objective measures of sleep duration and quality with executive functioning in a 133 non-clinical sample of Spanish participants (Mage = 60.33 months, SD = 9.04; ages 41-77 months; 51.1% girls). Sleep was assessed for five weeknights using actigraphy; Shape School task was applied to assess inhibition and cognitive flexibility; and Word Span task was used to assess working memory. The results revealed that relation between sleep and executive functioning was significant for inhibition and working memory. Preschoolers with higher sleep efficiency showed better results in executive functioning tasks after controlling for the effect of age. Additionally, age and sleep duration and quality variables were predictive of inhibition, working memory, and cognitive flexibility. These results suggest that the different dimensions of sleep could play an important role in the development of executive functions during preschool age. Therefore, improving sleep could lead to an improvement in children's executive functioning in both clinical and educational contexts.

Home noninvasive ventilation in pediatric patients: Does one size fit all?

BACKGROUND

A French national survey showed that 1447 children were treated with long-term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in 2019. Data about the ventilatory settings for children are scarce. The aim of the study was to report the CPAP/NIV settings from the survey according to the patients' age and disorders.

METHODS

CPAP and NIV settings were compared between 5 age groups (<1, 1-5, 6-11, 12-17 and ≥ 18 years), and 6 disease categories (upper airway disorders; neuromuscular disease, NMD; disorder of the central nervous system; cardiorespiratory disorder; congenital bone disease, CBD; and other).

RESULTS

Age correlated positively with constant CPAP pressure (r = 0.364, p < 0.0001), and negatively with CPAP adherence (r = -0.173, p < 0.0001). Mean age at CPAP initiation, CPAP pressures and adherence did not differ between disorders. Regarding NIV, mean inspiratory positive airway pressure (IPAP) increased with age (r = 0.152, p = 0.0001), whereas respiratory rate (RR; r = -0.593, p < 0.0001) and adherence to NIV decreased with age (r = -0.154, p = 0.0002). NIV settings were quite similar between disease categories, with the CBD group having the highest IPAP, and NMD group having the lowest expiratory positive airway pressure and RR. Adherence tended to be higher with NIV than CPAP.

CONCLUSIONS

CPAP pressure and IPAP increase with age, while settings seem quite similar between diseases. Even if our study provides some information about CPAP/NIV settings, they should always be individually adapted according to the severity of the disease.

Anhedonia Links Sleep Problems and Suicidal Thoughts: An Intensive Longitudinal Study in High-Risk Adolescents

Growing research indicates that sleep problems are a robust independent risk factor for suicidal thoughts and behaviors among youth. However, relatively little is known about how this risk is conferred. This study used an intensive longitudinal design to investigate anhedonia as a mechanism linking sleep problems and next-day suicidal thoughts in a clinically high-risk sample of adolescents. Adolescents (N = 48; Mage=14.96; 77.1% white, 64.6% female) completed an ecological momentary assessment (EMA) study design for 28 days following discharge from acute psychiatric care for suicide risk. Daily sleep diaries were used to assess prior night total sleep time and sleep onset latency. Ecological momentary assessment was used to assess anhedonia and suicidal thoughts up to six times per day. A series of multi-level structural equation models were used to examine facets of anhedonia as parallel mediators of the association between sleep problems and next-day suicidal thoughts. Significant direct effects were found between sleep problems and consummatory anhedonia, consummatory anhedonia and suicidal thoughts, and anticipatory anhedonia and suicidal thoughts. There were significant indirect (mediated) effects between sleep problems and next-day suicidal thoughts through consummatory anhedonia, but not anticipatory anhedonia. Findings provide initial evidence as to how sleep problems may confer risk for next-day suicidal thoughts- by increasing consummatory anhedonia. Future research is needed to replicate these findings in larger samples and investigate how modifying anhedonia may mitigate suicide risk in youth.

No match, more sleep: Greater weekend catch-up sleep in youth soccer players on free weekends

This study aimed to compare young soccer players' week and weekend sleep behaviors in two different microcycle types: with and without an official match (no sporting commitments). Twenty-three youth male players (mean ± SD; age: 17.2 ± 0.6 years) from the same U19 soccer team had their sleep objectively monitored for eight weeks. Questionnaires for subjective sleep quality, sleepiness, and to identify individual chronotype were completed at the beginning of the study. External training and match loads were monitored using global positioning systems. Overall, all players slept less than 8 h throughout the study and 16 slept less than 7 h. On weekdays, total sleep time (TST) was reduced (390 ± 60 min). A significant (p < 0.05) main effect of the microcycle type, night of the week, and an interaction between the two were observed for TST, bedtime, and wake-up time, indicating that weekend sleep adjustments were dependent on whether a match was played or not. Specifically, weekends without a match showed higher TST (+34 min, p < 0.001), and later bed and wake-up times (+48 min, p < 0.001; and +1.06 h, p < 0.001; respectively) compared with weekends that included a match. While players seem to try to compensate their week sleep debt when possible, sleep adjustments were more predominant on weekends without a match, despite still relatively short sleep durations observed.

Associations between sleep duration, insomnia, depression, anxiety and registry-based school grades: A longitudinal study among high-school students

This study explored the prospective associations between sleep patterns, mental health and registry-based school grades among older adolescents. In the spring of 2019, 1st year high-school students in Western Norway were invited to a survey assessing habitual sleep duration, insomnia, depression and anxiety. Sleep patterns, depression and anxiety were assessed using the Munich ChronoType Questionnaire, the Bergen Insomnia Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7. Students consenting to data linkage with the county school authorities were re-invited 2 years later. Registry-based grade point averages for each of the included school years were accessed through the school authorities. The final longitudinal sample included 1092 students (65.1% girls; initial mean age 16.4 years). Data were analysed using linear mixed models. Longer school night sleep duration and less severe symptoms of insomnia, depression and anxiety were all associated with higher grade point averages at baseline in crude analyses. Shorter school night sleep duration, as well as more severe symptoms of insomnia and depression at baseline, all predicted better grade point averages at 2-year follow-up when controlled for baseline grade point averages. By contrast, anxiety symptomatology at baseline was unrelated to changes in grade point averages over time. The longitudinal associations between school night sleep duration and insomnia symptoms on grade point averages were significant also when adjusted for sex and baseline symptoms of depression and anxiety. These findings indicate that shorter school night sleep duration and more severe insomnia symptoms predict lower grade point averages development over time, irrespective of co-existing symptoms of depression and anxiety.

The sleep problems in individuals with Rett syndrome and their caregivers

LAY ABSTRACT

Sleep problems are common and impactful among individuals with Rett syndrome (RTT) and their caregivers. We examined the sleep patterns of 29 RTT patients and their primary caregivers using various assessment tools. The study found that a majority of the patients experienced sleep disturbances, with younger patients showing more sleep difficulties. Caregivers also reported poor sleep quality. The findings emphasize the need to address sleep problems in RTT management, as improving sleep quality can positively impact the well-being of individuals with RTT and their caregivers.

Are nocturnal awakenings at age 1 predictive of sleep duration and efficiency at age 6: Results from two birth cohorts

Objective

To investigate the association of nighttime awakenings at 12 months with the duration and efficiency of nighttime sleep at 6 years of age.

Methods

Data from two population-based prospective studies (The Pelotas 2004 and The Pelotas 2015 Birth Cohorts) were used. Information on nighttime awakenings was provided by mothers during the 12-month follow-up interview. Infants who awakened >3 times after sleep onset at 12 months were considered frequent wakeners. Sleep duration and sleep efficiency were obtained by actigraphy at the 6-year follow-up. Children wore the device at the wrist of the non-dominant arm continuously for 3-7 days, including at least one weekend day. Unadjusted and adjusted beta coefficients were obtained by linear regression for each cohort separately.

Results

2500 children from the 2004 and 2793 from the 2015 cohort had full information on nighttime awakenings at 12 months and actigraphy at 6 years and were analyzed. Prevalence of frequent wakeners was 6.3 % and 5.9 % in the 2004 and 2015 cohort, respectively. Mean bedtime and wake-up time at 6 years were, respectively, 23:23 and 08:41 h in the 2004 cohort, and 00:10 and 09:00 h int the 2015 cohort. Nighttime sleep lasted on average 7.54 and 7.24 h respectively in the 2004 and the 2015 cohort, and the sleep efficiency was 81.1 and 82.5 % respectively. In adjusted analyses, no associations were found between awakening at 12 months and sleep duration or sleep efficiency at 6 years of age.

Conclusion

In both cohorts sleep duration and efficiency were below the recommendation for school-age children (respectively 9-11 h and 85 %). There was no relationship between the number of nighttime awakenings at 12 months and sleep duration or efficiency at 6 years.

Evaluation of the association between excessive screen use, sleep patterns and behavioral and cognitive aspects in preschool population. A systematic review

In this review, we analyzed the possible relationship between the excessive use of screens and sleep patterns, and how this may affect certain behavioral and cognitive factors in preschool children. The selection, extraction and synthesis of the data were conducted according to PRISMA guidelines. The search was carried out in the electronic databases Medline (PubMed), PsycINFO (American Psychological Association), Scopus and Web of Science (WOS). Of the 597 articles initially identified, 13 met the inclusion criteria. The risk of bias of the articles selected was evaluated using a specific scale created for this purpose. The results found indicate that excessive use of screens is associated with a negative impact on the duration and quality of sleep-in preschoolers, and this worsening of sleep in infancy is related with a greater probability of the appearance of internalizing and externalizing behavioral problems and certain cognitive problems. The results also suggest that sleep could play a mediating or moderating role as a bioregulatory system that attenuates or increases the onset of behavioral and cognitive difficulties in those children most exposed to digital devices.

Epidemiology of sleep patterns and circadian typology in uruguayan children: The contribution of school shifts

Healthy sleep is defined by the combination of adequate duration, good quality, and regular timing. In children, sleep thus depends on the interplay of individual, parental, organizational, community, and social variables, but only a few studies have addressed this issue in a comprehensive way nationwide. Using the Uruguayan nationally representative survey (Nutrition, Child Development, and Health Survey, Encuesta de Nutrición, Desarrollo Infantil y Salud, ENDIS), we present the first epidemiological characterization of chronobiological and sleep parameters in Latin American children. On average, Uruguayan urban children (n = 2437; 5-10-years old) showed quite late chronotypes (MSFsc = 03:53 ± 1:07), moderate misalignment (SJL = 1.0 ± 0.9 h), and adequate sleep duration (SDweek = 9.9 ± 1.0 h). Further, we show the substantial influence of school shift schedules on children's circadian typology and sleep patterns. Our results show that children attending the morning school shift have a higher risk of sleep problems than afternoon-school shift ones. The chronotype and sleep were earlier in morning-school shift children than in children attending the afternoon school shift. However, morning-school shift children had stronger misalignment, shorter sleep on school days, and a higher risk of chronic sleep deficit and non-healthy circadian misalignment (even worse in late chronotypes) than afternoon-shift children. This evidence points to the need of evaluating policies to reorganize school start times to prevent the negative effects that early schooling seems to have on children's sleep health, which has been neglected so far.

Insomnia symptoms in children and adolescents: screening for sleep problems with the two-item Sleep Condition Indicator (SCI-02)

BACKGROUND

Sleep problems are common in young people. Yet brief screening measures to identify those most in need of an intervention are lacking. This study investigated the potential of the two-item Sleep Condition Indicator (SCI-02) for screening insomnia symptoms in children and adolescents. We sought to establish whether there are distinct subgroups with different sleep profiles and whether subgroup membership varied with gender and school year group.

METHODS

Students (school years 5-13; typical age 9-18 years) in England completed the OxWell Student Survey in 2021. Sleep measures included: SCI-02, sleep onset latency (SOL), sleep duration, daytime sleepiness, and worry disrupting sleep. Latent profile analysis and multinomial logistic regression explored sleep profiles and predicted class membership.

RESULTS

In total, 29,304 participants answered sleep items. Of these, 95% provided binary gender (n = 27,802, 55% female) for analyses. Five sleep profiles emerged. The profiles, labelled "good", "moderate", or "poor" sleepers, vary by sleep quality - which includes time taken to fall asleep (SOL), amount of sleep (sleep duration), and the disruption of sleep due to worry. The profiles are then further differentiated by high levels of daytime sleepiness - labelled "sleepy". "Good Sleepers" (18,355, 66%), "Moderate Sleepers" (4825, 17.4%), "Moderate Sleepy Sleepers" (1250, 4.5%), "Poor Sleepers" (1037, 3.7%) and "Poor Sleepy Sleepers" (2335, 8.4%). Probable insomnia rates (SCI-02 ≤ 2) were high in both poor sleeper profiles (70-80%) compared with other profiles (0%) and the sample overall (9%). Compared with "Good Sleepers", all other profiles were mostly female. Daytime sleepiness - the defining characteristic of the sleepy sleeper profiles - was more common in secondary school participants than primary school.

CONCLUSIONS

The SCI-02 is an efficient, two-question measure to screen for potential sleep problems in young people. Sleep disruption was high: one in ten were experiencing poor sleep. Females and adolescents appeared more vulnerable to poor sleep and daytime sleepiness. The SCI-02 has the potential for use in school and community contexts to identify children and adolescents who may benefit from support managing their sleep.

Bidirectional associations between the duration and timing of nocturnal sleep and daytime naps in adolescents differ from weekdays to weekends

STUDY OBJECTIVES

Previous studies examining bidirectional relationships between nocturnal sleep and napping have focused on sleep duration, leaving a gap in our understanding of how sleep timing contributes. Here, we assessed the duration and timing for night sleep and daytime naps, to evaluate how the previous night's sleep influences the next day's napping, and how napping influences same-night nocturnal sleep.

METHODS

We analyzed sleep diary and actigraphy data from 153 teens (males = 43.8%, mean age = 16.6 years). Participants who never napped were excluded. Nocturnal sleep-nap relationships were investigated using logistic and linear regression models separately for weekdays and weekends.

RESULTS

Participants napped an average of 2.3 times a week. 167 school day naps and 107 weekends were recorded. Naps were on average 82.12 ± 53.34 minutes and the average nap onset was 14:58 ± 3.78 hours. Their duration, start and end times did not significantly differ between weekdays and weekends. Nocturnal sleep duration did not predict next-day nap occurrence or duration. However, on school days, earlier wake times significantly increased the likelihood of napping that day, and advanced nap timing. On weekends, later bedtimes and wake times delayed nap timing. On school days, napping longer than one's average shortened nocturnal sleep whereas on weekends, waking from a nap later than one's average delayed bedtimes.

CONCLUSIONS

Early wake times increase the likelihood of napping and advance the time of a nap that day. Naps may be detrimental to the same night's sleep only if they are long and occur late, as these can delay bedtimes and shorten nocturnal sleep duration, especially on school days.

CLINICAL TRIALS

The Cognitive and Metabolic Effects of Sleep Restriction in Adolescents (NFS4), https://clinicaltrials.gov/study/NCT03333512, ID: NCT03333512. Investigating Preferred Nap Schedules for Adolescents (NFS5), https://clinicaltrials.gov/study/NCT04044885, ID: NCT04044885.

Nourishing the Infant Gut Microbiome to Support Immune Health: Protocol of SUN (Seeding Through Feeding) Randomized Controlled Trial

BACKGROUND

The introduction of complementary foods during the first year of life influences the diversity of the gut microbiome. How this diversity affects immune development and health is unclear.

OBJECTIVE

This study evaluates the effect of consuming kūmara or kūmara with added banana powder (resistant starch) compared to a reference control at 4 months post randomization on the prevalence of respiratory tract infections and the development of the gut microbiome.

METHODS

This study is a double-blind, randomized controlled trial of mothers and their 6-month-old infants (up to n=300) who have not yet started solids. Infants are randomized into one of 3 groups: control arm (C), standard kūmara intervention (K), and a kūmara intervention with added banana powder product (K+) to be consumed daily for 4 months until the infant is approximately 10 months old. Infants are matched for sex using stratified randomization. Data are collected at baseline (prior to commencing solid food) and at 2 and 4 months after commencing solid food (at around 8 and 10 months of age). Data and samples collected at each timepoint include weight and length, intervention adherence (months 2 and 4), illness and medication history, dietary intake (months 2 and 4), sleep (diary and actigraphy), maternal dietary intake, breast milk, feces (baseline and 4 months), and blood samples (baseline and 4 months).

RESULTS

The trial was approved by the Health and Disability Ethics Committee of the Ministry of Health, New Zealand (reference 20/NTA/9). Recruitment and data collection did not commence until January 2022 due to the COVID-19 pandemic. Data collection and analyses are expected to conclude in January 2024 and early 2025, respectively. Results are to be published in 2024 and 2025.

CONCLUSIONS

The results of this study will help us understand how the introduction of a specific prebiotic complementary food affects the microbiota and relative abundances of the microbial species, the modulation of immune development, and infant health. It will contribute to the expanding body of research that aims to deepen our understanding of the connections between nutrition, gut microbiota, and early-life postnatal health.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000026921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378654.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56772.

Extending weeknight sleep duration in late-sleeping adolescents using morning bright light on weekends: a 3-week maintenance study

Study Objectives

Our sleep extension intervention in adolescents showed that gradually shifting weekday bedtime earlier plus one weekend of morning bright light advanced circadian phase and increased weeknight sleep duration. Here, we examine at-home maintenance of these changes.

Methods

Fourteen adolescents (15.3-17.9 years; 7 female) completed a 7-week study. After usual sleep at home (2-week baseline), intervention participants (n = 8) gradually advanced weekday bedtime (1 hour earlier than baseline during week 3; 2 hours earlier in week 4) and received bright light (~6000 lux; 2.5 hours) on both mornings of the intervening weekend. During three maintenance weeks, intervention participants were instructed to maintain their school-day wake-up time on all days, keep their early week four bedtimes, except on weekends when they could go to bed up to 1 hour later, and get a 2.5-hour light box exposure within 5 minutes of waking on one morning (Saturday or Sunday) of both weekends at home. Control participants (n = 6) slept as usual at home and did not receive weekend bright light. Dim light melatonin onset (DLMO) was measured after the 2-week baseline, 2-week intervention, and 3-week maintenance in all participants. Actigraphic sleep-wake was collected throughout.

Results

After the 2-week intervention, DLMOs advanced more compared to control (37.0 ± 40.0 minutes vs. -14.7 ± 16.6 minutes), weekday sleep duration increased by 69.7 ± 27.8 minutes and sleep onset was 103.7 ± 14.2 minutes earlier compared to baseline. After three maintenance weeks, intervention participants showed negligible DLMO delays (-4.9 ± 22.9 minutes); weekday fall-asleep times and sleep durations also remained stable.

Conclusions

Early circadian phase and extended sleep can be maintained with at-home weekend bright light.

Differences in elementary-age children's accelerometer - measured physical activity between school and summer: three-year findings from the What's UP (Undermining Prevention) with summer observational cohort study

BACKGROUND

Among elementary-aged children (5-12yrs), summer vacation is associated with accelerated gains in Body Mass Index (BMI). A key behavioral driver of BMI gain is a lack of physical activity (PA). Previous studies indicate PA decreases during summer, compared to the school year but whether this difference is consistent among boys and girls, across age, and by income status remains unclear. This study examined differences in school and summer movement behaviors in a diverse cohort of children across three years.

METHODS

Children (N = 1,203, age range 5-14 years, 48% girls) wore wrist-placed accelerometers for a 14-day wear-period during school (April/May) and summer (July) in 2021 to 2023, for a total of 6 timepoints. Mixed-effects models examined changes in school vs. summer movement behaviors (moderate-to-vigorous physical activity [MVPA], sedentary) for boys and girls, separately, and by age and household income groups (low, middle, and upper based on income-to-poverty ratio).

RESULTS

Children provided a total of 35,435 valid days of accelerometry. Overall, boys (+ 9.1 min/day, 95CI 8.1 to 10.2) and girls (+ 6.2 min/day, 95CI 5.4 to 7.0) accumulated more MVPA during school compared to summer. Boys accumulated less time sedentary (-9.9 min/day, 95CI -13.0 to -6.9) during school, while there was no difference in sedentary time (-2.7 min/day, 95CI -5.7 to 0.4) for girls. Different patterns emerged across ages and income groups. Accumulation of MVPA was consistently greater during school compared to summer across ages and income groups. Generally, the difference between school and summer widened with increasing age, except for girls from middle-income households. Accumulation of sedentary time was higher during school for younger children (5-9yrs), whereas for older children (10-14yrs), sedentary time was greater during summer for the middle- and upper-income groups. For boys from low-income households and girls from middle-income households, sedentary time was consistently greater during summer compared to school across ages.

CONCLUSIONS

Children are less active and more sedentary during summer compared to school, which may contribute to accelerated BMI gain. However, this differs by biological sex, age, and income. These findings highlight the complex factors influencing movement behaviors between school and summer.

Sleep duration and social jetlag in healthy adolescents. Association with anxiety, depression, and chronotype: a pilot study

PURPOSE

Misalignment between sleep opportunity and chronotype preference during adolescence may affect sleep and mental health. The aim of this study was to objectively evaluate sleep duration and social jetlag (SJL) to observe if there is a relationship with anxiety, depression, or chronotype.

METHODS

Community based cohort study (n = 65) was conducted in Northern Europe. Participants recorded their sleep during the regular school schedule for 3 school nights and 2 free nights with FDA-cleared/EU Medical Device Directive (CE-02862) compliant home sleep test. They also completed validated questionnaires to assess (Morningness Eveningness Questionnaire; MEQ), sleepiness (Epworth Sleepiness Scale; ESS), and insomnia (Insomnia Severity Index; ISI), anxiety (General Anxiety Disorder-7; GAD-7), and depression symptoms (Beck's Depression Inventory-II; BDI-II). Data were collected during the last week of February and the first 2 weeks of March, 2023.

RESULTS

Average sleep duration on school nights was 7 h, 15 min, with 18% of participants on average sleeping ≥ 8 h. Average sleep onset was significantly later on free nights (1 hour, 47 minutes; p < 0.0001) causing a high prevalence of moderate-severe SJL, in 71% of participants. Evening chronotypes (prevalence 15.4%) fell asleep later on free nights, causing them to have significantly more SJL (2 hours, 58 minutes) than morning chronotypes (1 hour, 32 minutes) and intermediary chronotypes (1 hour, 36 minutes). Evening chronotypes also had more severe insomnia (ISI + 4.4, p = 0.006; + 4.0, p = 0.001) and greater depressive symptoms (BDI-II + 21.6, p < 0.0001; + 17.1, p < 0.0001). A significant negative correlation was observed between MEQ scores and ESS (r =  - 0.287; p = 0.001), ISI (r =  - 0.343, p < 0.0001), GAD-7 (r =  - 0.185, p < 0.0001), BDI-II (r =  - 0.501, p = 0.0001), and suicidal thoughts (r =  - 0.294, p = 0.017).

CONCLUSION

Adolescents are sleep-deprived and have a high prevalence of SJL that is positively correlated with depressive symptoms and evening chronotype. That evening chronotypes have shorter sleep duration, more severe SJL, and significantly more sleepiness and insomnia, anxiety, and depressive symptoms may indicate possible benefits in identifying this group with the aim to assist them in improving their sleep habits with potentially positive effects on mental health.

Different correlation between depressive symptoms and sleep duration on weekdays/weekends among adolescents in Taiyuan, North China

OBJECTIVE

In Chinese adolescents, the co-occurrence of depressive symptoms and short sleep duration constitute a serious public health issue. This study investigates the association between depressive symptoms and sleep duration of Chinese adolescents on weekdays as well as weekends.

METHODS

A multistage random cluster selection was utilized to select 2660 adolescents in Taiyuan, China. The survey contents included demographic characteristics, sleep duration, and depressive symptoms.

RESULTS

About 41.95 % of students reported depressive symptoms with an average sleep duration of 7.71 ± 0.90 h. After adjusting for covariates, depressive symptoms were found to be positively correlated with sleep duration <6 h (OR = 1.88, 95 % CI: 1.20, 2.95) and 6 ~ h (OR = 1.61, 95 % CI: 1.18, 2.20) on weekdays, and sleep duration <6 h (OR = 2.10, 95 % CI: 1.17, 3.79) and 6 ~ hours (OR = 1.74, 95 % CI: 1.16, 2.62) on weekends compared with a sleep duration of 8 ~ hours. Only on weekdays, sleep duration of 7 ~ hours was positively correlated with depressive symptoms (OR = 1.39, 95%CI: 1.05, 1.84). On weekends, it was not associated with depressive symptoms (OR = 1.06, 95%CI: 0.82, 1.39). In subgroup analyses, female students (OR = 2.88, 1.97, 1.50) and middle school students (OR = 3.50, 2.07, 1.50) were more likely to experience depressive symptoms on weekdays with a sleep duration of <6 h, 6 ~ hours and 7 ~ hours.

LIMITATIONS

Sleep duration and depressive symptoms were self-reported measures.

CONCLUSION

The study highlights that short sleep duration (< 7 h) increases the risk of depressive symptoms among adolescents regardless of weekdays or weekends. Just on weekdays, the sleep duration of 7 ~ hours was a risk factor for depressive symptoms. Further, gender, grade, and the only-child played significant modification effects between depressive symptoms and sleep duration. To conclude, this study will assist in the effective promotion of the education of adolescents' sleep health.

Physical Activity Habits and Sleep Duration According to Gender: A Cross-Sectional Study of Elementary School Children

(1) Background: The main goals of this study were to describe the physical activity (PA) and sleep habits of 8-12-year-old children according to their gender and to evaluate the relationship between PA and sleep habits (i.e., duration and timing). (2) Methods: A total of 236 children (114 boys and 122 girls) completed the Physical Activity Questionnaire for Older Children (PAQ-C) and an ad hoc sleep habits questionnaire. (3) Results: Boys were more physically active than girls (2.62 ± 0.51 vs. 2.46 ± 0.48, p = 0.026) and enacted higher PA levels in school recess (3.82 ± 1.36 vs. 3.56 ± 1.38, p = 0.003), during the afternoon (3.37 ± 1.20 vs. 2.89 ± 1.12, p = 0.003), and during weekends (3.54 ± 1.20 vs. 3.18 ± 0.48, p = 0.009). Per sleep habits, boys had a significantly later bedtime (21:53 ± 2:08 vs. 21:34 ± 2:14, p = 0.009) and a significantly smaller total sleep duration (9.64 ± 0.86 vs. 9.89 ± 0.87 h, p = 0.023) than girls. No significant correlations between PA and sleep habits were found. (4) Conclusions: We found differences in the PA and sleep habits between school-age boys and girls. Institutions and entities should consider designing specific interventions to improve PA and sleep habits according to gender.

Intense and problematic social media use and sleep difficulties of adolescents in 40 countries

INTRODUCTION

Social media has become a ubiquitous part of everyday life; however, evidence suggests patterns of social media use can affect sleep health in children and adolescents. This study aimed to examine the associations of intense and problematic social media use (SMU) with sleep-onset difficulties in adolescence.

METHODS

We analysed data from 212,613 adolescents aged 11-15 years (51.1% girls) from 40 European and North American countries that participated in the 2017/2018 Health Behaviour in School-aged Children survey. Intense SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed by symptoms of addiction to social media. Sleep-onset difficulties were assessed using a self-reported item. Multilevel mixed-effects logistic regression was used to obtain the estimates.

RESULTS

Sleep-onset difficulties were more common among girls than boys (27.1% vs 20.8%). Intense SMU was significantly associated with sleep-onset difficulties in boys in 17 countries and in girls in 25 countries, while problematic SMU was significantly associated in most of the participating countries. Overall, exposure to problematic SMU alone was highly associated with sleep-onset difficulties both in girls (OR 2.20, 2.04-2.38) and boys (OR 1.88, 1.73-2.04), while the association estimates for intense SMU were smaller and comparable across gender (Girls: OR 1.27, 1.23-1.31; Boys: OR 1.22, 1.18-1.27). Sensitivity analyses supported the above findings.

CONCLUSIONS

Intense and/or problematic SMU were associated with sleep-onset difficulties across gender with associations being higher for problematic compared to intense SMU. Prospective research with objective measures is needed to understand the causal mechanisms underlying these relationships.

Inverse association between slow-wave sleep and low-grade inflammation in children and adolescents with major depressive disorder

OBJECTIVE

To investigate the relationship between both self-reported and objective sleep variables and low-grade inflammation in children and adolescents with major depressive disorder (MDD) of moderate to severe symptom severity.

METHODS

In this cross-sectional study, we examined twenty-nine children and adolescents diagnosed with MDD and twenty-nine healthy controls (HC). Following a one-week actigraphy assessment, comprehensive sleep evaluations were conducted, including a one-night sleep EEG measurement and self-reported sleep data. Plasma high-sensitivity C-reactive protein (hsCRP) was employed as a marker to assess low-grade inflammation.

RESULTS

No significant difference in hsCRP levels was observed between participants with MDD and HC. Furthermore, after adjusting for sleep difficulties, hsCRP exhibited no correlation with the severity of depressive symptoms. In HC, levels of hsCRP were not linked to self-reported and objective sleep variables. In contrast, depressed participants showed a significant correlation between hsCRP levels and increased subjective insomnia severity (Insomnia Severity Index; r = 0.41, p < 0.05), increased time spent in the N2 sleep stage (r = 0.47, p < 0.01), and decreased time spent in slow-wave sleep (r = - 0.61, p < 0.001). Upon additional adjustments for body mass index, tobacco use and depression severity, only the inverse association between hsCRP and time spent in slow-wave sleep retained statistical significance. Moderation analysis indicated that group status (MDD vs. HC) significantly moderates the association between slow-wave sleep and hsCRP.

CONCLUSION

Our findings suggest that alterations in the architecture of slow-wave sleep may have a significant influence on modulating low-grade inflammatory processes in children and adolescents with MDD.

A Bayesian nonparametric meta-analysis model for estimating the reference interval

A reference interval represents the normative range for measurements from a healthy population. It plays an important role in laboratory testing, as well as in differentiating healthy from diseased patients. The reference interval based on a single study might not be applicable to a broader population. Meta-analysis can provide a more generalizable reference interval based on the combined population by synthesizing results from multiple studies. However, the assumptions of normally distributed underlying study-specific means and equal within-study variances, which are commonly used in existing methods, are strong and may not hold in practice. We propose a Bayesian nonparametric model with more flexible assumptions to extend random effects meta-analysis for estimating reference intervals. We illustrate through simulation studies and two real data examples the performance of our proposed approach when the assumptions of normally distributed study means and equal within-study variances do not hold.

Characteristics of sleep in children with heavy prenatal alcohol exposure

BACKGROUND

Sleep plays an important role in neurodevelopment. However, the effects of prenatal alcohol exposure on sleep quality have been understudied, despite reports of sleep disturbance in infants prenatally exposed to alcohol and elevated levels of sleep problems reported by caregivers of children with fetal alcohol spectrum disorders. The current study characterizes sleep in children with prenatal alcohol exposure using both objective (actigraphy) and subjective (questionnaires, sleep diaries) methods.

METHODS

Participants aged 6-10 years, with and without prenatal alcohol exposure, were included in the study (alcohol-exposed [AE]: n = 35; control [CON]: n = 39). Objective sleep was measured via 24-h actigraphy for 2 weeks. Parents completed sleep diaries and sleep questionnaires (Children's Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences.

RESULTS

There were no group differences on actigraphy metrics averaged across 2 weeks. However, the AE group showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time, percent sleep, wake after sleep onset, and number of wake bouts. Parents reported significantly more sleep problems in the AE group than in the CON group, primarily driven by night wakings, parasomnias (e.g., sleepwalking), snoring, and daytime sleepiness. These effects were more severe in children >8.5 years of age.

CONCLUSIONS

Despite similar 2-week average sleep outcomes, children with prenatal alcohol exposure showed greater intraindividual sleep variability and parents reported more sleep problems related to sleep behavior and snoring. These difficulties with sleep may be related to other cognitive and behavioral outcomes. Importantly, sleep is a modifiable behavior, and interventions that focus on variability in sleep, particularly in sleep duration, can impact the quality of life in children with prenatal alcohol exposure and their families.

Self-reported and accelerometry measures of sleep components in adolescents living in Pacific Island countries and territories: Exploring the role of sociocultural background

OBJECTIVES

The objective of this study is to assess the concordance and its association with sociocultural background of a four-question survey with accelerometry in a multiethnic adolescent population, regarding sleep components. Based on questions from the Pittsburgh Sleep Quality Index and adapted to a school context, the questionnaire focussed on estimating sleep onset time, wake-up time and sleep duration on both weekdays and weekends. This subjective survey was compared with accelerometry data while also considering the influence of sociocultural factors (sex, place of living, ethnic community and socio-economic status).

METHODS

Adolescents aged 10.5-16 years (n = 182) in New Caledonia completed the survey and wore an accelerometer for seven consecutive days. Accelerometry was used to determine sleep onset and wake-up time using validated algorithms. Based on response comparison, Bland-Altman plots provided agreement between subjective answers and objective measures. We categorized participants' answers to the survey into underestimated, aligned and overestimated categories based on time discrepancies with accelerometry data. Multinomial regressions highlighted the sociocultural factors associated with discrepancies.

RESULTS

Concordance between the accelerometer and self-reported assessments was low particularly during weekends (18%, 26% and 19% aligned for onset sleep time, wake-up time and sleep duration respectively) compared with weekdays (36%, 53% and 31% aligned, respectively). This means that the overall concordance was less than 30%. When considering the sociocultural factors, only place of living was associated with discrepancies in onset sleep time and wake-up time primarily on weekdays. Rural adolescents were more likely to overestimate both onset sleep time (B = -1.97, p < 0.001) and wake-up time (B = -1.69, p = 0.003).

CONCLUSIONS

The study found low concordance between self-assessment and accelerometry outputs for sleep components. This was particularly low for weekend days and for participants living in rural areas. While the adapted four-item questionnaire was useful and easy to complete, caution should be taken when making conclusions about sleep habits based solely on this measurement.

Social interaction anxiety and sleep quality in youth: Individual difference in childhood adversity and cardiac vagal control

BACKGROUND

Social interaction anxiety and sleep problems are prevalent during adolescence. Social interaction anxiety undermines sleep quality, however, little is known whether the association between social interaction anxiety and sleep quality is moderated by environmental factors such as childhood adversity and individual factors such as cardiac vagal control. This study sought to investigate the moderating effects of childhood adversity and cardiac vagal control on the link between social interaction anxiety and sleep quality.

METHOD

The Social Interaction Anxiety Scale, the Pittsburgh Sleep Quality Index and the Childhood Trauma Questionnaire were administered to 274 adolescents, who received 3-min resting ECG recording to assess respiratory sinus arrhythmia (RSA) as an index of cardiac vagal control.

RESULTS

Social interaction anxiety was negatively associated with sleep quality, and this association was moderated by childhood adversity and cardiac vagal control. In specific, social interaction anxiety was negatively associated with sleep quality among adolescents with low childhood adversity regardless of cardiac vagal control. Sleep quality was generally disrupted when adolescents exposed to high childhood adversity, but the negative association between social interaction anxiety and sleep quality among adolescents with high childhood adversity could be amortized by high cardiac vagal control.

LIMITATIONS

Cross-sectional design precluded establishing causality among variables.

CONCLUSION

These findings suggest that high cardiac vagal control reflecting better self-regulation might buffer the negative effect of social interaction anxiety on sleep quality particularly among adolescents exposed to early life stress.

Sleep duration trajectories and cognition in early childhood: A systematic review

Sleep is dynamic in childhood and studies have shown the relationship between sleep and cognition in children. As the human brain is the most plastic during childhood, the study of longitudinal sleep patterns and neurocognition is an important research area. We aimed to systematically review studies that investigated sleep duration trajectories and cognition in typically-developing children. We searched four databases for articles published between 2003 to October 2023. We included observation studies of children with sleep duration trajectories as a predictor and outcomes related to cognition, memory, language, developmental milestones, intelligence or executive function. We excluded studies where children had atypical development or completed the sleep and neurocognitive assessments after six and 12 years of age respectively. Out of 752 articles identified, 511 were screened and 23 full texts were assessed. The selected studies included three single trajectory and four multiple group trajectories studies. We found associations between both types of trajectories and cognitive development. Overall, children with longer sleep trajectories or more mature sleep pattern with rapid decrease in sleep duration, had better performance scores in developmental assessment tools, and intelligence tests. Findings for language and executive functioning were mixed, whereby some studies found associations and others did not.

Predictors for achieving optimal sleep in healthy children: Exploring sleep patterns in a sleep extension trial

STUDY OBJECTIVES

Earlier bedtimes can help some children get more sleep, but we don't know which children, or what features of their usual sleep patterns could predict success with this approach. Using data from a randomized crossover trial of sleep manipulation, we sought to determine this.

METHODS

Participants were 99 children aged 8-12years (49.5% female) with no sleep disturbances. Sleep was measured by actigraphy at baseline and over a restriction or extension week (1 hour later or earlier bedtime respectively), randomly allocated and separated by a washout week. Data were compared between baseline (week 1) and extension weeks only (week 3 or 5), using linear or logistic regression analyses as appropriate, controlling for randomization order.

RESULTS

One hour less total sleep time than average at baseline predicted 29.7 minutes (95% CI: 19.4, 40.1) of sleep gained and 3.45 (95% CI: 1.74, 6.81) times higher odds of successfully extending sleep by >30 minutes. Per standardized variable, less total sleep time and a shorter sleep period time were the strongest predictors (significant odds ratios (ORs) of 2.51 and 2.28, respectively). Later sleep offset, more variability in sleep timing and lower sleep efficiency also predicted sleep gains. The sleep period time cut-point that optimized prediction of successful sleep gains was <8 hours 28 minutes with 75% of children's baseline sleep in that range.

CONCLUSIONS

Children with a baseline sleep period time <8½ hours a night obtained the most sleep from earlier bedtimes maintained over a week, demonstrating experimentally the value of earlier bedtimes to improve sleep.

CLINICAL TRIALS REGISTRY

Australian New Zealand Clinical Trial Registry, ACTRN12618001671257, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367587&isReview=true.

High levels of sleep disturbance across early childhood increases cardiometabolic disease risk index in early adolescence: longitudinal sleep analysis using the Health Outcomes and Measures of the Environment study

STUDY OBJECTIVES

This study examines the impact of sleep duration, bedtime, and sleep disturbance during early childhood on the risk of cardiometabolic disorder (CMD) in early adolescence.

METHODS

Within the Health Outcomes and Measures of Environment Study, we examined sleep patterns of 330 children from ages 2 to 8 years and the relationship of these sleep patterns with cardiometabolic risk measures at age 12 (N = 220). We used a group-based semi-parametric mixture model to identify distinct trajectories in sleep duration, bedtime timing, and sleep disturbance for the entire sample. We then examined the associations between sleep trajectories and CMD risk measures using general linear models using both an unadjusted model (no covariates) and an adjusted model (adjusting for child pubertal stage, child sex, duration of breastfeeding, household income, maternal education, and maternal serum cotinine).

RESULTS

In the unadjusted and adjusted models, we found significant differences in CMD risk scores by trajectories of sleep disturbance. Children in the "high" disturbance trajectory had higher CMD risk scores than those in the 'low' disturbance trajectory (p's = 0.002 and 0.039, respectively). No significant differences in CMD risk were observed for bedtime timing or total sleep time trajectories in the unadjusted or adjusted models.

CONCLUSIONS

In this cohort, caregiver-reported sleep disturbance in early childhood was associated with more adverse cardiometabolic profiles in early adolescence. Our findings suggest that trials to reduce CMD risk via sleep interventions-which have been conducted in adolescents and adults-may be implemented too late.

Comparison of actigraphy with a sleep protocol maintained by professional caregivers and questionnaire-based parental judgment in children and adolescents with life-limiting conditions

BACKGROUND

Actigraphy offers a promising way to objectively assess pediatric sleep. Aim of the study was investigating the extent to which actigraphy used in children and adolescents with life-limiting conditions is consistent with two other measures of sleep diagnostics.

METHODS

In this monocentric prospective study N = 26 children and adolescents with life-limiting conditions treated on a pediatric palliative care unit were assessed. For three consecutive nights they wore an actigraph; the 24-hours sleep protocol documented by nurses and the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC) answered by parents were analyzed. Patient characteristics and the parameters sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency (SE) were descriptively examined. Percentage bend correlations evaluated the three measures' concordance.

RESULTS

Descriptively, and except for the number of waking episodes, the different measures' estimations were comparable. Significant correlations existed between actigraphy and the sleep protocol for sleep onset (r = 0.83, p = < 0.001) and sleep offset (r = 0.89, p = < 0.001), between actigraphy and SCAC for SE (r = 0.59, p = 0.02).

CONCLUSION

Agreement of actigraphy with the focused sleep measures seems to be basically given but to varying degrees depending on the considered parameters.

Sleep and daytime functioning in children with tourette syndrome: A two-week case-control study with actigraphy and cognitive assessments

There is increasing recognition of the high prevalence of sleep issues in children with Tourette syndrome (TS), a condition characterised by motor and vocal tics. Overnight polysomnography (PSG) has been the primary mode of sleep assessment in the TS literature, despite the extensive use of actigraphy in other neurodevelopmental populations. As a result, there are existing research gaps surrounding day-to-day variability of sleep in TS and links to daytime functioning. This study adopts a naturalistic, intensive longitudinal design to examine sleep in children with TS while considering potential links to tic severity and daytime functioning. Participants were 34 children aged between 8 and 12 years (12 with TS, 22 neurotypical controls). Wrist actigraphs tracked sleep-wake cycles across two weeks and a battery of scales and cognitive assessments measured sleep disturbances and daytime functioning. Mixed models using N = 476 nights of actigraphy data found that relative to controls, children with TS had significantly increased time in bed, increased sleep onset latency, reduced sleep efficiency, lower subjective sleep quality, but comparable actual sleep time. Higher self-report tic severity at bedtime did not predict increased sleep onset latency. In the sleep disturbance scale, 83.33 % of children with TS met the clinical cut-off for a sleep disorder. Parent-report emotional, behavioural, and executive difficulties were greater in the TS group relative to controls, but performance on cognitive tasks was comparable between groups. Together, findings highlight sleep disturbances as an important clinical factor to consider in the management of TS, though further research is required to substantiate findings in larger-scale studies. This study demonstrates the feasibility of assessing sleep via actigraphy in children with TS, supporting more widespread use in the future.

From early birds to night owls: a longitudinal study of actigraphy-assessed sleep trajectories during the transition from pre- to early adolescence

STUDY OBJECTIVES

Pre- and early adolescence are believed to constitute periods of important age-related changes in sleep. However, much of the research on these presumed developmental changes has used cross-sectional data or subjective measures of sleep, limiting the quality of the evidence. In addition, little is known about the development of certain features of the sleep-wake cycle pertaining to regularity (e.g. weekend-weekday differences and intra-individual variability) or circadian rhythms (e.g. sleep midpoint).

METHODS

This study examined the sleep trajectories of 128 typically developing youth (69 girls) from ages 8 to 12 years on four sleep characteristics: sleep onset, sleep offset, total sleep time (TST), and sleep midpoint. For each of these characteristics, actigraphy-derived estimates of typical (i.e. mean) sleep and sleep regularity were obtained at each time point. Multilevel growth curves were modeled.

RESULTS

Overall, the sleep-wake cycle significantly changed between 8 and 12 years. Mean sleep onset, offset and midpoint exhibited an ascending curvilinear growth pattern that shifted later with age, while mean TST decreased linearly. Weekend-weekday differences (social jetlag) for sleep offset and midpoint became more pronounced each year. Weekday TST was longer than weekend TST, though this difference became smaller over time. Finally, intra-individual variability increased over time for all sleep characteristics, with variability in TST ascending curvilinearly. Important between-person and sex differences were also observed.

CONCLUSION

This study reveals the marked changes that occur in the sleep of typically developing pre- and early adolescents. We discuss the potential implications of these trajectories.

Sleep duration is associated with depressive symptoms in Chinese adolescents

BACKGROUND

Depressive symptoms have become one of the most common mental health problems in adolescents. Identifying potential factors associated with adolescent depressive symptoms could be practical and essential for early intervention programs. The association between sleep duration and depressive symptoms in adolescents is inconsistent and needs further exploration.

METHODS

A total of 7330 participants aged 10-19 years were included in this study. Sleep duration was categorized into <7 h, 7-8 h, 8-9 h, and ≥ 9 h per day. The Chinese version of the Center for Epidemiology Scale for Depression was used to assess depressive symptoms. Binary logistic regression analysis was performed to evaluate the association between sleep duration and the risk of depressive symptoms. Restrictive cubic spline analyses were conducted to evaluate the dose-response relationship between sleep duration and depressive symptoms.

RESULTS

Thirty-four percent of the participants suffered from depressive symptoms. The prevalence of depressive symptoms in adolescents with sleep durations of <7 h, 7-8 h, 8-9 h, and ≥9 h per day was 52.66 %, 37.80 %, 27.55 %, and 20.49 %, respectively. After adjusting for potential covariates, long sleep duration was significantly associated with a decreased risk of depressive symptoms in adolescents. A nonlinear relationship between sleep duration and depressive symptoms was identified.

CONCLUSIONS

Long sleep duration is independently associated with a decreased risk of depressive symptoms in Chinese adolescents.

Preliminary exploration of a multidimensional sleep health composite in adolescent females with frequent migraine

OBJECTIVE

This observational study aimed to: (i) describe and explore preliminary psychometric properties of a multidimensional sleep health composite score in adolescent females with frequent migraine; and (ii) examine associations between the composite score, headache characteristics, and emotional health.

BACKGROUND

Sleep health is a multidimensional construct comprised of various dimensions of sleep and circadian functioning, including Regularity, Satisfaction, Alertness, Timing, Efficiency, and Duration (Ru-SATED framework). The Ru-SATED sleep health composite score may provide a holistic perspective of sleep among adolescents with frequent migraine in the context of neurobiological and psychosocial impacts on sleep unique to this developmental period.

METHODS

In all, 60 female adolescents (aged 12-18 years) with high-frequency episodic or chronic migraine completed wrist-worn actigraphy for 10 days and concurrent daily electronic surveys assessing headache, sleep, and emotional health. A sleep health composite score was derived from empirically supported "healthy" versus "unhealthy" ratings on the six Ru-SATED sleep dimensions.

RESULTS

Half of participants (27/54 [50%]) had a composite score ≥4 (i.e., at least four of the six dimensions rated as poor). Convergent validity of the composite score was acceptable (rs = 0.30-0.56, all p < 0.05). Internal consistency among the dimensions was low (α = 0.45). Multivariate multiple regression models indicated that worse sleep health was associated with greater headache-related disability (B = 0.71, p = 0.018) and anxiety (B = 0.59, p = 0.010), and trended toward significance for sadness (B = 0.35, p = 0.052). The composite score was not significantly associated with headache frequency or severity.

CONCLUSIONS

A multidimensional sleep health composite score may provide an alternative, more comprehensive picture of sleep disturbance among adolescent females with frequent migraine. Larger studies are needed to examine psychometric properties more rigorously and further explore the composite score as a potentially unique predictor of headache outcomes.

Effects of emerging alcohol use on developmental trajectories of functional sleep measures in adolescents

STUDY OBJECTIVES

Adolescence is characterized by significant brain development, accompanied by changes in sleep timing and architecture. It also is a period of profound psychosocial changes, including the initiation of alcohol use; however, it is unknown how alcohol use affects sleep architecture in the context of adolescent development. We tracked developmental changes in polysomnographic (PSG) and electroencephalographic (EEG) sleep measures and their relationship with emergent alcohol use in adolescents considering confounding effects (e.g. cannabis use).

METHODS

Adolescents (n = 94, 43% female, age: 12-21 years) in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study had annual laboratory PSG recordings across 4-years. Participants were no/low drinkers at baseline.

RESULTS

Linear mixed effect models showed developmental changes in sleep macrostructure and EEG, including a decrease in slow wave sleep and slow wave (delta) EEG activity with advancing age. Emergent moderate/heavy alcohol use across three follow-up years was associated with a decline in percentage rapid eye movement (REM) sleep over time, a longer sleep onset latency (SOL) and shorter total sleep time (TST) in older adolescents, and lower non-REM delta and theta power in males.

CONCLUSIONS

These longitudinal data show substantial developmental changes in sleep architecture. Emergent alcohol use during this period was associated with altered sleep continuity, architecture, and EEG measures, with some effects dependent on age and sex. These effects, in part, could be attributed to the effects of alcohol on underlying brain maturation processes involved in sleep-wake regulation.

Changes in objectively measured sleep after a multidisciplinary lifestyle intervention in children with abdominal obesity: A randomized trial

BACKGROUND/OBJECTIVE

childhood obesity and sleep disorders have a well-established cross-sectional association, but lifestyle interventions' effects on sleep quality remain under-researched. This study aimed to evaluate the sleep quality of 122 participants (7-16 years) with abdominal obesity after a 2-year necessary lifestyle intervention.

PATIENTS/METHODS

participants were assigned to either the intervention group (moderate hypocaloric Mediterranean Diet) or the usual care group (standard recommendations on a healthy diet). Sleep was objectively assessed using triaxial accelerometry, and sleep parameters analyzed included latency, efficiency, wake after sleep onset, total time in bed, total sleep time, number of awakenings, and awakening duration.

RESULTS AND CONCLUSIONS

the results showed that the intervention group significantly improved sleep latency at 12 and 24 months and improved sleep efficiency at 2 and 12 months, compared to the usual care group. Wake after sleep onset and the number of awakenings were significantly reduced at 24 months in the intervention group. Wake after sleep onset and leptin levels were positively associated in all participants. Total time in bed was inversely associated with triglycerides and metabolic score, and total sleep time was inversely associated with leptin, triglycerides, and metabolic score after the 2-month intervention. Triglyceride levels were inversely associated with total time in bed and total sleep time at one year, while the metabolic score was directly associated with wake after sleep onset and the number of awakenings and inversely associated with efficiency. In conclusion, the multidisciplinary intervention in children and adolescents with abdominal obesity reduced anthropometric parameters and improved sleep habits.

At-home wearables and machine learning sensitively capture disease progression in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis causes degeneration of motor neurons, resulting in progressive muscle weakness and impairment in motor function. Promising drug development efforts have accelerated in amyotrophic lateral sclerosis, but are constrained by a lack of objective, sensitive, and accessible outcome measures. Here we investigate the use of wearable sensors, worn on four limbs at home during natural behavior, to quantify motor function and disease progression in 376 individuals with amyotrophic lateral sclerosis. We use an analysis approach that automatically detects and characterizes submovements from passively collected accelerometer data and produces a machine-learned severity score for each limb that is independent of clinical ratings. We show that this approach produces scores that progress faster than the gold standard Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (-0.86 ± 0.70 SD/year versus -0.73 ± 0.74 SD/year), resulting in smaller clinical trial sample size estimates (N = 76 versus N = 121). This method offers an ecologically valid and scalable measure for potential use in amyotrophic lateral sclerosis trials and clinical care.

Evaluation of a device-agnostic approach to predict sleep from raw accelerometry data collected by Apple Watch Series 7, Garmin Vivoactive 4, and ActiGraph GT9X Link in children with sleep disruptions

GOAL AND AIMS

Evaluate the performance of a sleep scoring algorithm applied to raw accelerometry data collected from research-grade and consumer wearable actigraphy devices against polysomnography.

FOCUS METHOD/TECHNOLOGY

Automatic sleep/wake classification using the Sadeh algorithm applied to raw accelerometry data from ActiGraph GT9X Link, Apple Watch Series 7, and Garmin Vivoactive 4.

REFERENCE METHOD/TECHNOLOGY

Standard manual PSG sleep scoring.

SAMPLE

Fifty children with disrupted sleep (M = 8.5 years, range = 5-12 years, 42% Black, 64% male).

DESIGN

Participants underwent to single night lab polysomnography while wearing ActiGraph, Apple, and Garmin devices.

CORE ANALYTICS

Discrepancy and epoch-by-epoch analyses for sleep/wake classification (devices vs. polysomnography).

ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES

Equivalence testing for sleep/wake classification (research-grade actigraphy vs. commercial devices).

CORE OUTCOMES

Compared to polysomnography, accuracy, sensitivity, and specificity were 85.5, 87.4, and 76.8, respectively, for Actigraph; 83.7, 85.2, and 75.8, respectively, for Garmin; and 84.6, 86.2, and 77.2, respectively, for Apple. The magnitude and trend of bias for total sleep time, sleep efficiency, sleep onset latency, and wake after sleep were similar between the research and consumer wearable devices.

IMPORTANT ADDITIONAL OUTCOMES

Equivalence testing indicated that total sleep time and sleep efficiency estimates from the research and consumer wearable devices were statistically significantly equivalent.

CORE CONCLUSION

This study demonstrates that raw acceleration data from consumer wearable devices has the potential to be harnessed to predict sleep in children. While further work is needed, this strategy could overcome current limitations related to proprietary algorithms for predicting sleep in consumer wearable devices.

Dysfunctional synaptic pruning by microglia correlates with cognitive impairment in sleep-deprived mice: Involvement of CX3CR1 signaling

Microglia are involved in sleep/wake cycles and the response to sleep loss. Synaptic pruning by microglia is necessary for central nervous system circuit refinement and contributes to cognitive function. Here, we investigated whether and how microglia-mediated synaptic pruning may be involved in cognitive deficits induced by sleep deprivation in mice. Mice were deprived of sleep by leaving them in a spontaneously rotating rod for 72 h, after which their cognitive function was assessed using an object location test, Y maze, and novel object recognition test. Sleep deprivation lowered the discrimination index for familiar locations in the object location test and Y maze. Microglial morphology was assessed using immunostaining Iba1, while microglia-mediated synaptic pruning was examined based on immunostaining PSD95, CD68, and Iba1. Sleep deprivation also activated microglial cells in the hippocampus, as reflected in bigger soma as well as fewer and shorter branches than normal sleep. Sleep deprivation downregulated phagocytic markers and internalization of postsynaptic protein 95 (PSD95), suggesting impaired synaptic pruning. CX3C motif chemokine receptor 1 (CX3CR1) signaling was detected in in vitro experiments. Sleep deprivation also downregulated CX3CR1. Activation of CX3CR1 signaling increased phagocytosis activity of BV2 microglia in vitro. Sleep deprivation dysregulates microglial CX3CR1 signaling and inhibits synaptic pruning, contributing to associated cognitive deficits. These findings identify CX3CR1-dependent synaptic pruning as a potential therapeutic target in which sleep deprivation causes recognition impairments.

Quantifying teenagers' sleep patterns and sex differences in social jetlag using at-home sleep monitoring

Sleep plays an important role in the formative developmental processes occurring during the teenage years. At the same time, teenagers' changing bioregulatory mechanisms and psychosocial factors converge into the so-called social jetlag, a sleep timing misalignment between weekdays and weekends. The aim of this study was to quantify the course of day-to-day changes in sleep/wake patterns and sleep stage distributions, and the sex differences in social jetlag among teenagers. We observed the sleep of 156 teenagers (58.3% girls, 15-16 years) using a novel sleep monitor over the course of up to 10 consecutive days. 1323 nights of data were analyzed using multilevel modeling. On average, participants went to bed at 23:41, woke up at 07:48, slept for 7.7 h and had 85.5% sleep efficiency. Sleep stage distributions were in line with normative data. We found later sleep onset and offset, longer time in bed, sleep duration, and sleep onset latency (p = .001), greater proportion of light sleep and lower proportion of deep sleep, and poorer sleep efficiency (all p < .001) on weekend nights starting on Friday and Saturday. On Friday nights, girls had longer time awake after sleep onset (p = .020) than boys. On Friday and Saturday nights, girls fell asleep earlier (p < .001 and p = .006, respectively). On Saturday nights, girls had shorter sleep latency (p = .024), and better sleep efficiency (p = .019) than boys. In sum, teenagers' sleep patterns reflected healthy, albeit somewhat short sleep. There was convincing evidence of social jetlag, and girls exhibited less severe social jetlag than boys.

An improved Bayesian approach to estimating the reference interval from a meta-analysis: Directly monitoring the marginal quantiles and characterizing their uncertainty

Reference intervals, or reference ranges, aid medical decision-making by containing a pre-specified proportion (e.g., 95%) of the measurements in a representative healthy population. We recently proposed three approaches for estimating a reference interval from a meta-analysis based on a random effects model: a frequentist approach, a Bayesian posterior predictive interval, and an empirical approach. Because the Bayesian posterior predictive interval becomes wider to incorporate estimation uncertainty, it may systematically contain greater than 95% of measurements when the number of studies is small or the between study heterogeneity is large. The frequentist and empirical approaches also captured a median of less than 95% of measurements in this setting, and 95% confidence or credible intervals for the reference interval limits were not developed. In this update, we describe how one can instead use Bayesian methods to summarize the appropriate quantiles (e.g., 2.5th and 97.5th) of the marginal distribution of individuals across studies and construct a credible interval describing the estimation uncertainty in the lower and upper limits of the reference interval. We demonstrate through simulations that this method performs well in capturing 95% of values from the marginal distribution and maintains a median coverage of near 95% of the marginal distribution even when the number of studies is small, or the between-study heterogeneity is large. We also compare the results of this method to those obtained from the three previously proposed methods in the original case study of the meta-analysis of frontal subjective postural vertical measurements.

Characteristics of 24-hour movement behaviours and their associations with mental health in children and adolescents

Background

Time-use estimates are typically used to describe 24-hour movement behaviours. However, these behaviours can additionally be characterised by other easily measured metrics. These include sleep quality (e.g., sleep efficiency), 24-hour rest-activity rhythmicity (e.g., between-day rhythm variability), and directly measured acceleration metrics (e.g., intensity gradient). Associations between these characteristics and youth mental health are unclear. This study aimed to [1] compare 24-hour movement behaviour characteristics by sex and age groups, [2] determine which movement behaviour characteristics were most strongly associated with mental health outcomes, and [3] investigate the optimal time-use behaviour compositions for different mental health outcomes.

Methods

Three-hundred-and-one children and adolescents (age 9-13 y; 60% girls) wore accelerometers for 24-hours/day over 7-days. Overall mental health, externalising, and internalising problems were self-reported using the Strengths and Difficulties Questionnaire. 24-hour movement behaviour characteristics were categorised as time-use estimates, sleep quality, 24-hour activity rhythmicity, and directly measured acceleration. Linear mixed models and compositional data analysis were used to analyse the data in alignment with the study aims.

Results

Time-use estimates, directly measured accelerations, and 24-hour rest-activity rhythm metrics indicated that children were significantly more physically active (p = .01-<0.001) than adolescents. Children were also less sedentary (p < .01), slept longer (p = .02-0.01), and had lower sleep efficiency. Boys were significantly more active than girls (p < .001) who in turn accrued more time in sleep (p = .02). The timing of peak activity was significantly later among adolescents (p = .047). Overall mental health and externalising problems were significantly associated with sleep, sedentary time, sleep efficiency, amplitude, and inter-daily stability (p = .04-0.01). The optimal time-use compositions were specific to overall mental health and externalising problems and were characterised by more sleep, light and vigorous physical activity, and less sedentary time and moderate physical activity than the sample's mean time-use composition.

Conclusions

Extracting and examining multiple movement behaviour characteristics from 24-hour accelerometer data can provide a more rounded picture of the interplay between different elements of movement behaviours and their relationships with mental health than single characteristics alone, such as time-use estimates. Applying multiple movement behaviour characteristics to the translation of research findings may enhance the impact of the data for research users.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-023-00021-9.

Objective and subjective sleep health in adolescence: Associations with puberty and affect

Sleep health tends to worsen during adolescence, partially due to pubertal-related changes that, in combination with social and psychological factors, can lead to long-lasting impairments in sleep health and affective functioning. Discrepant findings between subjective and objective measures of sleep in relation to affect have been reported in studies of adults; however, few investigations have assessed both subjective and objective sleep quality in a single sample, and fewer have examined this in the context of pubertal development. We aimed to (1) characterise pubertal associations with subjective sleep satisfaction, objective sleep efficiency, and objective and subjective sleep duration in adolescents; (2) examine the longitudinal association between daily affect and sleep metrics; and (3) test whether pubertal stage moderated this association. Eighty-nine participants (64% female, ages 13-20) completed an ecological momentary assessment (EMA) and actigraphy protocol. Independent of age, advanced pubertal stage was associated with lower subjective sleep satisfaction but not with objective sleep indices. Subjective sleep satisfaction was associated with within-person trajectories of negative affect, but not with positive affect. Pubertal stage and sleep satisfaction did not interact to predict within-day negative or positive affect. These findings are consistent with previous reports showing that objective and subjective sleep health are associated differently with puberty, and that subjective sleep health is associated with daily affect. Pubertal stage may be a more important indicator of subjective sleep quality in adolescence than is chronological age, most likely due to hormonal changes and psychological adjustment to the physical changes associated with the pubertal transition.

Characterizing rest-activity rhythms and sleep for children with and without tactile sensitivities: An observational study

STUDY OBJECTIVES

This cross-sectional, observational study aimed to characterize and compare movement-based rest-activity rhythms (RARs) and sleep period variables of children with tactile hypersensitivities (SS) and non-sensitive peers (NSS) to expand the understanding of experienced differences in sleep.

METHODS

Children (ages 6-10) wore Actigraph GT9X watches for 2 weeks and caregivers completed daily sleep diaries. RARs and sleep period variables (e.g., sleep efficiency, duration, wake after sleep onset) were analyzed and localized means were plotted to visualize average rhythms for each group. Groups were compared using Student's t tests, or non-parametric alternatives, and Hedge's g effect sizes.

RESULTS

Fifty-three children and their families participated in this study (nSS = 21 nNSS = 32). The groups had similar RARs and sleep period variables. In both groups, sleep efficiency was low (SESS = 78%, SENSS = 77%) and total sleep time was short (TSTSS = 7 hrs 26 mins, TSTNSS- 7 h, 33 min) compared to national recommendations. Despite these similarities, children with SS took noticeably longer to settle down and fall asleep (53 min) than children with NSS (26 min, p = .075, g = 0.95).

CONCLUSION

This study provides preliminary data describing RAR and sleep period variables in children with and without tactile hypersensitivities. While overall RAR and sleep variables were similar between groups, there is evidence that children with SS spend a longer time transitioning to sleep. Evidence is provided that wrist-worn actigraphy is tolerable and acceptable for children with tactile sensitivities. Actigraphy provides important, movement-based data that should be used in tandem with other measures of sleep health for future studies.