Sleep disturbance and injury risk in young children

Investigation of Factors Influencing Sleep Status in Beijing Children Aged 3 to 14 Years

OBJECTIVE

To investigate the current status of children's sleep in Beijing and analyze the factors that influence it.

MATERIALS AND METHODS

Using multi-stage stratified cluster random sampling, a total of 11 420 children aged 3 to 14 years in 7 districts of Beijing were included in this study. The Pediatric Sleep Questionnaire (PSQ) was used to investigate and analyze various factors influencing sleep.

RESULTS

The mean PSQ score of the children surveyed was 3.60 ± 2.69 points. The proportion of children with a score above 7 was 8.87%. Multi-level model analysis showed that the younger children had higher PSQ scores than older and that the boys had higher PSQ scores than the girls.

CONCLUSIONS

The sleep quality of children in Beijing is not optimistic. The PSQ score of preschool children is higher than school age children. It is recommended that parents pay attention to their children's sleep status and try to remove influencing factors.

Racial and ethnic disparities in insufficient sleep among US in infants and preschoolers

OBJECTIVE

To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged.

METHODS

We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR).

RESULTS

An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents' education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors.

CONCLUSIONS

More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.

Prospective association of short sleep duration in newborns with bruxism behavior in children: The Japan Environment and Children's Study (JECS)

BACKGROUND

Bruxism is defined as a repetitive masticatory muscle activity, characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Although the bruxism etiology can be bidirectionally described with sleep disorders, there are few studies available to understand the association of sleep duration with bruxism behavior in early childhood.

METHODS

A dataset of children (n = 90,148) from the Japan Environment and Children's Study (JECS) - an ongoing nationwide, prospective birth cohort study - was used to investigate the prospective association of the infant's sleep duration with bruxism behavior, which were acquired using self-reported questionnaire. After multiple imputation of data, the association between sleep duration and bruxism behavior in early childhood was examined using a binomial logistic regression analysis. It was conducted with adjustments for several maternal (e.g., age at delivery and sleep duration) and child-related (e.g., sex and sleep position) variables.

RESULTS

The prevalence of bruxism behavior at the ages of two and four were 16.2% and 22.5%, respectively. Using the shortest sleep duration group's participants (≤13 h) as the reference, the odds ratio (95% confidence interval) for prevalence of bruxism behavior decreased with longer sleep duration at one month of age, but not at 36 months of age, after covariate adjustments. Furthermore, in comparison with the impacts between daytime and nighttime sleep, nighttime sleep with longer duration were dominantly associated with bruxism behavior.

CONCLUSION

The sleep duration in infant stage, especially during newborn stage was associated with the prevalence of bruxism behavior in children.

A single-arm pilot study: can a parental sleep intervention for sleep-disturbed young children in individual settings improve children's sleep, crying, eating, and parental distress in mothers and fathers?

Background

Early sleep problems co-occur with crying, eating problems, and parental distress. This study investigates the impact of a parent-focused intervention to improve child sleep with the following aims: (1) To assess the impact on child sleep (sleep onset latency, frequency and duration of nighttime awakenings, frequency of bed-sharing, and nighttime food intake, total nighttime sleep duration, and sleep efficiency), child crying (frequency of crying episodes, of unexplained and unsoothable crying and of crying out of defiance), child eating difficulties, and parental distress of mothers and fathers. (2) To assess the maintenance of any changes in these areas longitudinally, at 3-month, 6-month, and 12-month follow-ups. (3) To explore at the within-subjects level, how children’s sleep, crying, eating, and parental distress changed together across all study measurement points.

Methods

In this single-arm pilot study, the parents of 60 children participated in six individual sessions of a parent-focused multimodal age-adjusted cognitive-behavioral intervention to improve child sleep. Parents of 39 children (46% girls, age in months M = 22.41, SD = 12.43) completed pre- and at least one measure after the intervention. Sleep diary, questionnaire for crying, feeding, sleeping, and parental stress index (short-form) were assessed pre, post, three, six, and 12 months after the intervention.

Results

Significantly, sleep (decreased sleep onset latency, frequency, duration of nighttime awakenings, bed-sharing, nighttime food intake; increased total nighttime sleep duration, sleep efficiency), crying (reduced frequency of crying episodes, unexplained and unsoothable crying), and parental distress (reduced) changed, which remained partially stable over follow-up. The frequency of crying episodes decreased with fewer nighttime awakenings; morning crying with increased nighttime feeding; unexplained and unsoothable crying with higher sleep efficiency; crying due to defiance with more nighttime awakenings, sleep efficiency, and bed-sharing. Eating problems decreased with shorter night awakenings and time; maternal distress with fewer nighttime awakenings, paternal with less child’s nighttime feeding, unexplained and unsoothable crying, and time.

Conclusions

A parental sleep intervention for sleep-disturbed young children could be promising to reduce children’s sleep problems, crying, eating problems and parental distress. Future studies should consider more personal contact during the follow-up to reduce the drop-out rate and a randomized-controlled design.

Trial registration

The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578, registration date: 21.03.2022).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03631-5.

Unraveling the Relationship between Sleep Problems, Emotional Behavior Disorders, and Stressful Life Events in Preschool Children

Objectives: The aims of this study were to: (1) explore sleep problems in preschool children with generalized anxiety disorder (GAD), selective mutism (SM), and oppositional defiant disorder (ODD) and (2) examine the relationship between stressful life events, sleep problems, and emotional behavior disorders in preschoolers. Methods: The parents of 213 preschool children with SM, GAD, ODD, and TD (typical development, age range 2–6 years) completed the Children’s Sleep Habits Questionnaire (CSHQ), the Coddington Life Events Scale, preschool version (CLES-P), and the CBCL 1½–5. Results: Eighty-three subjects reported sleep problems before the age of 2 years. Seventy-five children (86.14%) with a clinical diagnosis and eight children with TD (8.4%) exceeded the threshold level on the CSHQ. For the bedtime resistance (p = 0.042) and sleep duration subscales (p = 0.038), the SM group had significantly higher scores in comparison to the ODD group. The same pattern was also true for the sleep onset (p = 0.024) and sleep anxiety subscales (p = 0.019). The linear regression analysis model showed that the impact of stressful life events and internalizing problems could predict sleep habits in children. Conclusions: Emotional behavior disorders and stress factors should be regularly investigated in children who are referred to clinics for sleep problems. Clinicians should consider how these symptoms may exacerbate sleep problems and/or interfere with treatment.

Sleep and the Young Athlete

CONTEXT

Sleep plays a vital role in cognitive and physical performance. Teenage athletes (ages 13-19 years) are considered especially at risk for disordered sleep and associated negative cognitive, physical, and psychosomatic effects. However, there is a paucity of evidence-based recommendations to promote sleep quality and quantity in athletes who fall within this age range. We performed a review of the literature to reveal evidence-based findings and recommendations to help sports instructors, athletic trainers, physical therapists, physicians, and other team members caring for young athletes provide guidance on sleep optimization for peak sports performance and injury risk reduction.

METHODS

PubMed, Scopus, and Cochrane CENTRAL were searched on May 11, 2016, and then again on September 1, 2020, for relevant articles published to date.

STUDY DESIGN

Narrative review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Few studies exist on the effects disordered sleep may have on teenage athletes. By optimizing sleep patterns in young athletes during training and competitions, physical and mental performance, and overall well-being, may be optimized. Adequate sleep has been shown to improve the performance of athletes, although further studies are needed.

CONCLUSION

Twenty-five percent of total sleep time should be deep sleep, with a recommended sleep time of 8 to 9 hours for most young athletes. Screen and television use during athletes' bedtime should be minimized to improve sleep quality and quantity. For young athletes who travel, jet lag can be minimized by allowing 1 day per time zone crossed for adjustment, limiting caffeine intake, planning meals and onboard sleeping to coincide with destination schedules, timing arrivals in the morning whenever possible, and using noise-canceling headphones and eyeshades.

STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT)

B.

Sleep Deficiency in Young Children

There is growing public health concern about the high prevalence of sleep deficiency in early childhood and the associated risk for sleep-associated poor health outcomes, including metabolic, cardiovascular, and mental health. The recent shift to conceptualize sleep health as a multidimensional construct, influenced by socioecological factors, highlights the potential role of sleep in health disparities. Understanding the development of sleep health and the emergence of sleep disorders in early life is a current priority in pediatric sleep research. Future behavioral sleep interventions should consider the multiple socioecological influences on children's sleep health and be tested using inclusive sampling methods.

Longitudinal Examination of Sleep Problems and Symptom Severity in Children with Autism Spectrum Disorder

Up to 80% of children with autism spectrum disorder (ASD) experience sleep problems, which have been associated with more severe presentations of ASD symptoms. We examined the bidirectional link between sleep problems and specific ASD symptoms at two time points within 5 years in a well-characterized sample (659 children with ASD). Using cross-lagged panel analyses, we found evidence for a unidirectional link between baseline ASD symptoms (specifically repetitive behaviors, atypical behaviors, communication, and peer interactions) and future sleep problems, but did not find evidence of a bidirectional relationship. We did not find any longitudinal association between social reciprocity and sleep problems. It is important for providers and caregivers to understand and monitor the link between ASD symptoms and sleep problems.

Short or Irregular Sleep Duration in Early Childhood Increases Risk of Injury for Primary School-Age Children: A Nationwide Longitudinal Birth Cohort in Japan

The aim of this study was to investigate the longitudinal relationship between shorter or irregular sleep duration (SD) in early childhood and increased risk of injury at primary school age using data from a nationwide survey in Japan. We categorized SD into seven groups: 6 h, 7 h, 8 h, 9 hrs, 10 or 11 h, >12 h, and irregular, based on questionnaire responses collected at 5.5 years old. The relationship between SD and incidence of injury at 5.5–nine years of age is shown. In addition, we completed a stratified analysis on children with or without problematic behavior at eight years old. We included 32,044 children, of which 6369 were classified as having an injury and 25,675 as not having an injury. Logistic regression model showed that shorter or irregular SD categories were associated with an increased adjusted odds ratio (aOR) for injuries (6 h: aOR 1.40, 95% confidence interval (CI) 1.19–1.66, 7 h: aOR 1.10, 95% CI, 0.98–1.23, 8 h: aOR 1.13, 95% CI, 1.02–1.26, irregular: aOR 1.26, 95% CI 1.10–1.43). The same tendency was observed with shorter or irregular SD in subgroups with or without behavioral problems. Shorter or irregular sleep habits during early childhood are associated with injury during primary school age.

Sleep quality, functional skills, and communication in preschool-aged children with autism spectrum disorder

AIM

This study aimed to correlate sleep quality, the performance of functional skills (mobility, self-care, and social function), communication, independence, and severity of ASD in children with ASD.

METHOD

58 children between 3 and 5 years and 11 months old were investigated. The Childhood Autism Rating Scale was applied to determine the severity of autism; the Sleep Disturbance Scale for Children was used to investigate sleep quality, and the Pediatric Evaluation of Disability Inventory to investigate functional abilities and independence of the children.

RESULTS

68.9 % of the children showed indicative of sleep disorders. There was no correlation between the different sleep disorders and communication. Sleep disorders showed a negative correlation with functional performance and a positive correlation with ASD severity.

INTERPRETATION

The current study offers an exploration between sleep and functional skills in children with ASD. These findings provide important clinical implications in the diagnosis and intervention process of children with ASD and also stimulate reflections on the importance in minimize the impact of sleep disorders and functional abilities on the quality of life of these individuals and their families.

The Relationships Between Sport Specialization, Sleep, and Quality of Life in Female Youth Volleyball Athletes

BACKGROUND

Although sport specialization may be associated with stress and burnout among youth athletes, the relationship with quality of life (QOL) remains unknown. The purpose of this study was to evaluate the relationship between sport specialization, sleep, and QOL in female youth athletes.

HYPOTHESIS

Higher levels of specialization are associated with increased daytime sleepiness and worse QOL.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

Female high school volleyball players completed preseason surveys to determine sport specialization (low, moderate, high), injury history, QOL, sleep duration, and daytime sleepiness. QOL and sleep variables were compared across specialization groups. Multivariable linear regression models were developed to evaluate the associations between sleepiness, QOL, specialization, grade in school, and injury history.

RESULTS

Of 1482 participants, 591 (40%), 436 (29%), and 455 (31%) were categorized as low, moderate, and high specialization, respectively. Highly specialized athletes demonstrated worse QOL (median 91.3 [interquartile range 86-96]) than low (92.4 [88-97], P = 0.05) and moderate (93.5 [88-99], P = 0.05) specialization groups and greater daytime sleepiness (11 [7-15]) than low (10 [6-14], P < 0.001) and moderate (10 [6-14], P < 0.001) specialization groups. In the multivariable model, QOL was negatively associated with prior injury occurrence (β = -1.1 ± 0.5, P = 0.02), but not grade in school (β = -0.08 ± 0.2, P = 0.71) or specialization (moderate: β = 0.08 ± 0.5, P = 0.88; high: β = -0.70 ± 0.5, P = 0.18). Daytime sleepiness increased with high specialization (β = 1.12 ± 0.3, P < 0.001) and grade (β = 0.76 ± 0.1, P < 0.001), but not prior injury (β = 0.51 ±0.3, P = 0.10).

CONCLUSION

Highly specialized female volleyball athletes demonstrate decreased QOL, perhaps because of higher rates of prior injury. Specialization is also associated with increased daytime sleepiness.

CLINICAL RELEVANCE

Sport participation patterns and injury may have implications for QOL in youth athletes.

Reframing High-Quality Public Preschool as a Vehicle for Narrowing Child Health Disparities Based on Family Income

Past research shows that high-quality public preschool may disproportionately support low-income children's school readiness because low-income children tend to arrive at school with fewer of the academic skills needed for success. This suggests a compensatory process in human development in which the children who benefit most from a promotive factor are those who stand to gain the most. We propose that high-quality public preschool may similarly confer its greatest health rewards to low-income children, who are generally in poorer health than their peers. If that is true, preschool has the potential to narrow health disparities by income, which without intervention, persist into adulthood. To date, no one has articulated all the pathways through which high-quality public preschool may improve children's health, much less those that should disproportionately benefit those from low-income families. Drawing on the bioecological paradigm of human development, we propose a model identifying specific mechanisms likely to promote equity in child health. These mechanisms reflect core characteristics of high-quality public preschool that may disproportionately benefit low-income children's health. This model serves as a working template for a program of future research.

Association of sleep disorders with subfoveal choroidal thickness in preschool children

OBJECTIVE

To explore the association between sleep disorders and subfoveal choroidal thickness (SFCT) in preschool children.

METHODS

In this population-based cross-sectional study, children aged 60-72 months were measured for SFCT using spectral-domain optical coherence tomography (SD-OCT) and for sleep disorders using the Chinese version of Children's Sleep Habits Questionnaire (CSHQ). Multiple linear regression analyses were performed to assess the association between sleep disorders and SFCT.

RESULTS

A total of 1337 children (mean (SD) age: 66.88 (3.41) months) were included in the analyses. In multivariable linear analysis, a higher total CSHQ score (indicating higher likelihood of sleep disorders) was associated with a thinner subfoveal choroid (beta, -0.070; 95% CI, -0.141 to -0.001; P = 0.046). When each of eight CSHQ subscale scores was analysed by the multivariable model, only the Daytime Sleepiness subscale score was negatively associated with the SFCT (beta, -0.115; 95% CI, -0.183 to -0.046; P = 0.001). The children with clinically significant daytime sleepiness (n = 364, 27.2%) had significantly thinner subfoveal choroid than other children (295.47 vs. 308.52 μm, P = 0.007).

CONCLUSIONS

Only daytime sleepiness was significantly associated with SFCT in preschool children in this study. The potential relationship between sleep disorders during childhood and children's ocular development needs further research.

Outpatient health care utilization for sleep disorders in the Cerner Health Facts database

STUDY OBJECTIVES

Sleep disorders are common in the general population. This study aimed to identify direct health care utilization for sleep disorders using big data through the Cerner Health Facts database.

METHODS

The Cerner Health Facts database has 68.7 million patients in the data warehouse, documenting approximately 506.9 million encounters from 100 nonaffiliated health care systems. To identify sleep-related health care utilization, we examined the frequency of outpatient encounters related to sleep disorders between the years 2000 and 2017. Sleep disorders were grouped-based on the International Classification of Sleep Disorders-Third Edition.

RESULTS

Approximately 20.5 million patients were identified with a total of 127.4 million outpatient encounters. In pediatric patients (ages 0-18 years), health care utilization for major sleep diagnoses was measured per 100,000 encounters. Sleep-related breathing disorders ranked first among common sleep disorders for pediatric patients followed by parasomnia, insomnia, sleep movement disorders, hypersomnolence, then circadian rhythm disorders (820.1, 258.1, 181.6, 68.3, 48.1, and 16.2 per 100,000 encounters, respectively). However, in adult patients, the ranking was slightly different, with sleep-related breathing disorders ranked first, followed by insomnia, sleep-related movement disorders, hypersomnolence, parasomnia, then circadian rhythm disorders (1352.6, 511.6, 166.3, 79.1, 25.7, and 4.2 per 100,000 encounters, respectively). In general, there was a bimodal pattern with a clear dip in sleep-related health care utilization in young adults age (age 19-29 years), with the exception of insomnia.

CONCLUSIONS

Patients with sleep disorders show relatively low health care utilization despite a known high prevalence of sleep disorders in the general population. This finding may highlight under-recognition of sleep problems or decreased access to health care for sleep disorders. In addition, this study highlights the effect of age-based variation on different sleep disorders, which may have an impact on allocating resources.

Associations among Toddlers’ and Preschoolers’ Sleep Problems, Emotional Reactivity, Sleep Regime and Parental Applied Rules for Screen-Based Media Use

Background. Children’s sleep problems are associated with temperament. One of the dimensions of temperament – higher emotional reactivity – is defined as a risk factor for children’s emotional, behavioral, and sleep problems. Screen-based media use is a very common phenomenon among children that relates to sleep problems. Still there is a gap of research explaining the interactions between children’s sleep problems, temperament, and parental discipline (sleep regime and rules for screen-based media use). The aim of this study is to evaluate the relations between preschool children’s sleep problems and parents’ discipline (sleep regime and rules for screen-based media use), and the role of children’s emotional reactivity. Methods. This research is a part of the longitudinal study “Electronic Media Use and Young Children’s Health” conducted in the year 2017–2018 and funded by the Research Council of Lithuanian (agreement no. GER-006/2017). Participants are 876 children aged 2 to 5 years old and their parents. Children’s sleep problems and emotional reactivity were assessed using the Child Behavior Checklist (CBCL/1½-5). Information about rules for screen-based media use and sleep regime was obtained using the parent-report questionnaire. Results. Sleep problems are related to emotional reactivity, sleep regime, and rules for screen media use. Children without regular sleep regime and without constant rules for screen-based media use have higher sleep problems and emotional reactivity. The results of the regression analysis show that emotional reactivity, together with sleep regime and rules for screen-based media use, significantly explain one-fifth to one-third of children’s sleep problems at different ages of the preschool period. However, the prognostic value of emotional reactivity and parental discipline varies according to a child’s age, as they are significant predictors of sleep problems among two, three and four-year-olds, but no longer explain sleep problems of five-year-olds. The path analysis confirmed that emotional reactivity, directly and through mediating variables, e.g., parental reported child’s sleep regime and rules for screen-based media use, is significantly associated with children’s sleep problems. Conclusions. Emotional reactivity should be considered as a significant risk factor in the relation between children’s sleep problems, sleep regime and parental applied rules for screen-based media use. These results are important while identifying children at higher risk for sleep problems. The results also support that parental discipline, such as sleep regime and rules for screen-based media use, are significant for preventing sleep problems in children with higher emotional reactivity.

Relations Between Sleep and Temperament in Preschool Children With ADHD

Objective: The objective of this study was to assess the links between temperament and sleep in a group of preschoolers with ADHD. Method: Twenty-five ADHD (M = 5.37 years, SD = 1.09) and 22 typically developing (TD; M = 5.10, SD = 1.18) preschoolers participated in the study. Sleep was assessed with the Sleep Disturbance Scale and wrist actigraphy. The Preschool Temperament and Character Inventory (PsTCI) was used to evaluate the child temperament. Results: ADHD children showed a temperamental profile characterized by higher novelty seeking, lower persistence, self-directness, and cooperativeness and marginally lower harm avoidance (HA) compared with controls. HA was associated negatively to wakefulness after sleep onset and sleep fragmentation and positively with sleep efficiency and sleep time. Reward dependence was negatively associated with wake episode length. Conclusion: Sleep and temperament are correlated in preschoolers with ADHD and temperament might represent an intermediate endophenotype underlying the relation between ADHD and sleep disorders.

Parent Perspectives on Sleep and Sleep Habits Among Young Children Living With Economic Adversity

OBJECTIVE

To examine the perspectives of ethnically diverse, low-income parents of young children regarding sleep, sleep habits, and preferences for sleep promotion for themselves and their children.

METHOD

We recruited a sample of mothers who had a 15- to 60-month-old child enrolled in the Special Supplemental Nutritional Program for Women, Infants and Children in a Northeastern U.S. city. We used a convergent mixed-methods design to conduct semistructured interviews and questionnaires to measure parent sleep quality (Pittsburgh Sleep Quality Index), sleep apnea (Berlin Apnea Questionnaire), mood (Centers for Epidemiological Studies of Depression), children's sleep (Children's Sleep Habits Questionnaire), and behavior (Child Behavior Checklist).

RESULTS

Thirty-two mothers (M age = 30.97 [SD 6.34] years; n = 21 [65%] African American) and children (N = 14 [44% female]; M age =38 [SD 12.63] months) participated. Children's average sleep duration was 10 hr, which is below the recommendation for this age group; overall sleep difficulty was high despite most mothers reporting that their children had normal sleep. Five children had abnormal Child Behavior Checklist scores, suggesting internalizing and externalizing behaviors. More than half of the mothers had poor sleep quality and 24 (75%) were at high risk for sleep apnea. Mothers viewed sleep as important for themselves and their children and identified both effective and ineffective practices to promote sleep, including practices learned from their own families.

CONCLUSIONS

Ethnically diverse mothers who are living with economic adversity value sleep for themselves and their children. The high value placed on sleep, despite misconceptions about normal sleep, suggest opportunities to promote sleep interventions. The content and delivery methods should be tailored to their knowledge, preferences, and cultural practices.

"Their Sleep Means More Harmony": Maternal Perspectives and Experiences of Preschoolers' Sleep in Ethnically and Socioeconomically Diverse Families in Aotearoa/New Zealand

Viewing sleep through a socioecological lens, maternal perceptions, and experiences of preschoolers' sleep were explored using semistructured interviews with 15 Māori (indigenous) and 16 non-Māori mothers, with low- and high socioeconomic position. Thematic analysis identified four themes: child happiness and health, maternal well-being, comfort and connection, and family functioning and harmony. Mothers perceived healthy preschooler sleep as supporting children's mental and physical health, parents' sleep/wake functioning, family social cohesion and emotional connectedness, and poor preschooler sleep as negatively influencing child, maternal and family well-being. Although many experiences were shared, some perceptions of sleep and sleep practices differed between mothers. Influences included health paradigms, socioeconomic circumstances, maternal autonomy, employment, parenting approaches, and societal expectations. Healthy preschooler sleep is valued by mothers and may play a protective role in family health and resilience. Preschooler sleep initiatives need to be responsive to maternal perspectives and address societal drivers of sleep experiences.

Sleep disturbances and internalizing behavior problems following pediatric traumatic injury

OBJECTIVE

This prospective longitudinal study investigated sleep disturbance (SD) and internalizing problems after traumatic injury, including traumatic brain injury (TBI) or extracranial/bodily injury (EI) in children and adolescents, relative to typically developing (TD) children. We also examined longitudinal relations between SD and internalizing problems postinjury.

METHOD

Participants (N = 87) ages 8-15 included youth with TBI, EI, and TD children. Injury groups were recruited from a Level 1 trauma center after sustaining vehicle-related injuries. Parent-reported SD and internalizing problems were assessed at preinjury/baseline, and 6 and 12 months postinjury. Linear mixed models evaluated the relation of group and time of assessment on outcomes.

RESULTS

Controlling for age, the combined traumatic injury group experienced significantly higher postinjury levels of SD (p = .042) and internalizing problems (p = .024) than TD children; however, TBI and EI injury groups did not differ from each other. Injury severity was positively associated with SD in the EI group only, but in both groups SD was associated with additional postinjury sequelae, including fatigue and externalizing behavior problems. Internalizing problems predicted subsequent development of SD but not vice versa. The relation between injury and SD 1 year later was consistent with mediation by internalizing problems at 6 months postinjury.

CONCLUSIONS

Children with both types of traumatic injury demonstrated higher SD and internalizing problems than healthy children. Internalizing problems occurring either prior to or following pediatric injury may be a risk factor for posttraumatic SD. Consequently, internalizing problems may be a promising target of intervention to improve both SD and related adjustment concerns. (PsycINFO Database Record

What does sleep hygiene have to offer children's sleep problems?

Sleep hygiene practices have been described extensively in the literature. There is considerably less clarity about relationships between particular elements of sleep hygiene and particular sleep outcomes, and which intervention approaches using sleep hygiene principles are effective. In this review, we describe themes extracted from a systematic review of the sleep hygiene literature. We systematically searched Psycinfo, CINAHL, Cochrane, Ovid Medline, Embase, and Web of Science Search Engines up to August, 2017. We included all studies that associated sleep hygiene (behaviors adjacent to bedtime and during the night) with sleep duration and/or sleep onset latency and/or night waking or that used sleep-hygiene based interventions to improve sleep duration and/or sleep onset latency and/or night waking (n = 44). We organized our findings into themes by age group, sleep hygiene factors, and interventions. We provide evidence-based recommendations about areas of sleep hygiene that have significant empirical support and those that require urgent attention.

Evaluating Accessible Sleep Health Information in Rural and Urban Contexts: Delivery Face-to-Face or Online?

Objective

New parents need education about infant sleep but is not universally available especially not in regional and rural areas. We delivered sleep education both face-to-face and online to test sleep knowledge acquisition for parents wherever they reside. Best practice delivery of accessible sleep health information for new families needs to be investigated more carefully in order for specialist services to be universally available.

Methods

Pre- and post-information session questionnaires (n = 32) assessed levels of knowledge acquisition and comparisons tested differences between face-to-face seminars compared with an online webinar.

Results

Sleep knowledge across participants was low (69% scoring < 50%). Sleep knowledge significantly increased for both the webinar delivery group (P = .002) and face-to-face delivery group (P = .001). No significant differences in knowledge acquisition were found between face-to-face vs online delivery (P = .170), suggesting both modes of delivery were sufficient to improve parental sleep knowledge.

Conclusions

Parental sleep knowledge, while low, increased with education. Online delivery was similar to face-to-face delivery suggesting ease of access for rural and remote communities needing specialist sleep information.

Implications for public health

Information delivered online is effective and offers a health delivery solution to regional and remote parents unable to access sleep services and rendering sleep service accessibility more equitable.

Effects of the environment of a simulated shelter in a gymnasium on sleep in children

Effects of the environment of a simulated shelter in a gymnasium on sleep were investigated in 20 healthy school-aged children. Measurements were obtained during a one-night stay in a school gymnasium during the summer (C). Activity levels were monitored using a wrist actigraph, and temperature and humidity of the bedrooms in the subjects' homes were monitored from 3 days before to 3 days after C. The subjects were asked to provide information regarding subjective sleep estimations and thermal sensations. The results for the days before C (BC), C, the first day after C (A1), and the second day after C (A2) were compared. The bedroom temperature was significantly lower on BC than on the other nights. No significant difference was observed in bedtime, whereas wake-up time was significantly earlier on C and later on A1 than on the other nights. Total sleep time was significantly decreased on C (3.6 h) and increased on A1 when compared to the other nights. Daytime nap was significantly increased on A1 when compared to the other days. Subjective estimation of sleep quality was decreased and sweat sensation before sleep was increased on C when compared to the other nights. The main reason for sleep disturbances on C was heat. These results indicate that the environment of the simulated shelter in the gymnasium severely disturbed sleep in children. The resulting loss of sleep was compensated for by increased nocturnal sleep time and daytime napping on the next day.

Racial disparities and sleep among preschool aged children: a systematic review

Sleep disorders and sleep insufficiency are common among preschool-aged children. Studies among school-aged children show disordered sleep is often more prevalent among racial minority groups. The primary aim of this systematic review was to critically appraise empirical data to elucidate the relationship between race and key sleep variables among children aged 2 to 5 years old. By systematically searching PubMed, Web of Science, and EBSCO databases, we identified empirical research articles conducted in the United States that investigate this relationship. We searched for variables relevant to (1) insufficient sleep duration, (2) poor sleep quality, (3) irregular timing of sleep, including sleep/wake problems and irregular bedtime onset and wake times (4) and sleep/circadian disorders. Nine studies satisfied the criteria for inclusion: five investigated nocturnal sleep duration, five investigated bedtime-related variables, four investigated daytime sleep (napping), three investigated total sleep, two investigated sleep quality, and one investigated wake times. Four studies specifically addressed racial and demographic differences in sleep variables as the primary aim, while the remaining five contained analyses addressing racial and demographic differences in sleep as secondary aims. Non-Hispanic white, white, or European-American race was used as the reference category in all studies. The results provided consistent evidence that white, non-Hispanic children were more likely to go to bed earlier and more regularly, have longer nocturnal sleep, and nap less than most racial and ethnic minorities. Combined, this literature presents a compelling narrative implicating race as an important factor in sleep patterns among a preschool age population.

The association of childhood sleep problems with the prevalence of traumatic dental injury in schoolchildren

BACKGROUND/AIM

Sleep quality exerts an influence on attention level and motor skills and is associated with accidental injuries in children. The aim of this study was to evaluate the association between traumatic dental injury and sleep behaviour in children.

MATERIAL AND METHODS

A cross-sectional study was conducted in a small city in southern Brazil with a representative sample of schoolchildren aged 8-10 years (n = 537). Weight and height were measured, and examinations were performed for the determination of clinical occlusion and traumatic dental injury. The parents answered the Sleep Behaviour Questionnaire and questions addressing socio-demographic characteristics.

RESULTS

The prevalence of traumatic dental injury was 22% (95% CI: 19-26) and was higher among children who woke three to four times per night (PR = 3.30; 95% CI: 2.47-4.39), those who fell asleep in the parental bed (PR = 1.41; 95% CI: 1.09-1.83), those who were not in a good mood on waking up in the morning (PR = 1.30; 95% CI: 1.02-1.65), those who became sleepy while sitting and/or studying (PR = 1.57; 95% CI: 1.09-2.24) and while watching TV (PR = 1.41; 95% CI: 1.0005-1.97) and those who had bad dreams (PR = 1.35; 95% CI: 1.04-1.76). The Poisson multiple regression model with a multilevel approach revealed that the prevalence of traumatic dental injury was 1.51-fold higher among children with daytime drowsiness (PR = 1.51; 95% CI: 1.11-2.04) after adjusting for socio-demographic, occlusal and anthropometric variables.

CONCLUSION

Sleep problems were associated with a higher prevalence of traumatic dental injury among the children analysed.

Real-World Implementation of Infant Behavioral Sleep Interventions: Results of a Parental Survey

OBJECTIVE

To describe parental practices implementing behavioral sleep intervention (BSI) outside a clinical setting.

STUDY DESIGN

Parents (n = 652), recruited through a Facebook group designed as a peer support group for parents using BSI, completed an online survey about their experience using BSI with their infant or toddler.

RESULTS

On average, parents implemented BSI when their infant was 5.6 (±2.77) months. Parents most often used modified (49.5%) or unmodified extinction (34.9%), with fewer using a parental presence approach (15.6%). Regardless of BSI type, more parents endorsed "a great deal of stress" during the first night (42.2%) than 1 week later (5.2%). The duration of infant crying was typically greatest the first night (reported by 45%; M = 43 minutes) and was significantly reduced after 1 week (M = 8.54 minutes). Successful implementation of BSI on the first attempt was reported by 83%, with a median and mode of 7 days until completion (79% by 2 weeks). Regardless of BSI type, after intervention parents reported their infant had less difficulty falling asleep, fewer night awakenings, and were more likely to sleep in their room and/or in their own crib/bed.

CONCLUSIONS

The majority of parents report successfully implementing BSI, with significantly reduced infant crying by the end of 1 week and success within 2 weeks. Few differences were found between behavioral approaches.

Agreement between parent-reports and child self-reports of sleep problems in Chinese children

Sleep problems are major concerns for parents, health professionals, and children and youths themselves. For assessing sleep problems, both parent and child reports are important, with each having its unique features. However, little is known about the correlates of the agreement between parent and child self-reports. This study evaluated the agreement between the youth self-report sleep questionnaire (YSRSQ) and the parent-reported children's sleep habits questionnaire (CSHQ) and assessed the associated sociodemographic factors, as well as the underlying discrepancies. The participants included 3143 pairs of Chinese preadolescents (mean age = 11.03, SD = 0.98) and parents. Sleep-disordered breathing (SDB), daytime sleepiness, and parasomnia were assessed by both the YSRSQ and CSHQ. Significant but low correlations were present between parent report and preadolescent self-report items on SDB problems, daytime sleepiness, and parasomnias. Although the agreement between SDB symptoms and parasomnias was stronger for girls than for boys, the degree of concordance between SDB symptoms and parasomnia increased with preadolescent age, with the highest agreement achieved among preadolescents aged 12 years or older for SDB problems and 11 years or older for parasomnias. Findings underscore the importance of utilizing both parental and preadolescent self-reports in accurately assessing and diagnosing sleep impairment in pediatric samples.

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.

Community partnership for healthy sleep: Research protocol

Beginning early in life, sleep health, including adequate quality, quantity, and consistent sleep routines, is critical to growth and development, behavior, and mental and physical health. Children who live in economically stressed urban environments are at particular risk for sleep deficiency and its negative consequences. Although efficacious sleep health interventions are available, few address the context of economically stressed urban environments. The purpose of this paper is to describe a two-phase protocol for an ongoing NIH/NINR-funded community-engaged study designed to understand the perspectives of parents, community child care and pediatric health care providers about sleep habits, factors that contribute to sleep and sleep habits, sleep difficulty, and potentially useful sleep promotion strategies among children living in economically stressed urban environments. The social-ecological model guides this study. Phase I employs a convergent mixed-methods design, in which we are conducting semi-structured interviews with parents, childcare providers, and primary health care providers. We are collecting 9 days of objective sleep data (wrist actigraphy) from children who are 6-18 months (n = 15) and 19-36 months of age (n = 15) and parent reports of sleep and sleep-related factors using standard questionnaires. In Phase I, we will use a qualitative descriptive approach to analyze the interview data, and descriptive statistics to analyze the survey and actigraph data. In Phase II, we will use the information to develop a contextually relevant program to promote sleep health. Our long-term goal is to improve sleep health and sleep-related outcomes in these children.

Systematic review of the relationships between sleep duration and health indicators in the early years (0-4 years)

Background

The objective of this systematic review was to examine for the first time the associations between sleep duration and a broad range of health indicators in children aged 0 to 4 years.

Methods

Electronic databases were searched with no limits on date or study design. Included studies (published in English or French) were peer-reviewed and met the a priori determined population (apparently healthy children aged 1 month to 4.99 years), intervention/exposure/comparator (various sleep durations), and outcome criteria (adiposity, emotional regulation, cognitive development, motor development, growth, cardiometabolic health, sedentary behaviour, physical activity, quality of life/well-being, and risks/injuries). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Due to high levels of heterogeneity across studies, narrative syntheses were employed.

Results

A total of 69 articles/studies (62 unique samples) met inclusion criteria. Data across studies included 148,524 unique participants from 23 countries. The study designs were randomized trials (n = 3), non-randomized interventions (n = 1), longitudinal studies (n = 16), cross-sectional studies (n = 42), or longitudinal studies that also reported cross-sectional analyses (n = 7). Sleep duration was assessed by parental report in 70% of studies (n = 48) and was measured objectively (or both objectively and subjectively) in 30% of studies (n = 21). Overall, shorter sleep duration was associated with higher adiposity (20/31 studies), poorer emotional regulation (13/25 studies), impaired growth (2/2 studies), more screen time (5/5 studies), and higher risk of injuries (2/3 studies). The evidence related to cognitive development, motor development, physical activity, and quality of life/well-being was less clear, with no indicator showing consistent associations. No studies examined the association between sleep duration and cardiometabolic biomarkers in children aged 0 to 4 years. The quality of evidence ranged from “very low” to “high” across study designs and health indicators.

Conclusions

Despite important limitations in the available evidence, longer sleep duration was generally associated with better body composition, emotional regulation, and growth in children aged 0 to 4 years. Shorter sleep duration was also associated with longer screen time use and more injuries. Better-quality studies with stronger research designs that can provide information on dose-response relationships are needed to inform contemporary sleep duration recommendations.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4850-2) contains supplementary material, which is available to authorized users.

Sleep problems and injury risk among juveniles: A systematic review and meta-analysis of observational studies

Recent studies have reported inconsistent results regarding the association between sleep problems and injury risk among juveniles. Moreover, the extent of this risk remains largely unexplored. Thus, a systematic review and meta-analysis was conducted by our team to determine whether sleep problems increase the incidence of injuries among juveniles. PubMed, PsycINFO, Embase, and Cochrane Library databases were searched for relevant studies that explored the association between sleep problems and injury risk and have been published before July 2016. Multivariate adjusted odds ratio (OR) and associated 95% confidence intervals (CIs) were extracted and pooled using random-effects models. A total of 10 observational studies involving 73,418 participants were identified. Meta-analysis findings suggested that juveniles with sleep problems held a 1.64 times higher risk of injury than that of juveniles without sleep problems (OR: 1.64, 95% CI: 1.44–1.85). This relationship was also supported by subgroup analyses, which were based on different countries and study designs. The current evidence indicates that sleep problems are significantly associated with injury risk among juveniles. Sleep problems are highly important for young people; hence, sleep researchers and occupational physicians should focus on this aspect. Nevertheless, high-quality and adequately powered observational studies are still needed.

Association Between Night Waking and Child Health During the First 3 Years of Life

OBJECTIVE

Night awakening is a common concern for parents and professionals in early childhood and a risk factor for child growth and development. This study examined the concurrent and longitudinal associations of night awakening with child health and illness during the first 3 years of life.

METHODS

Longitudinal data from 1364 infants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used in this study. At ages 6, 15, 24, and 36 months, mothers reported on the frequency of their child's night awakening in the past week, overall health, and occurrences of illness. Information on demographic factors, including child sex and ethnicity/race, maternal education, and family income as well as child breastfeeding status was obtained at 1 month. Structural equation modeling, including latent growth curve modeling, was performed.

RESULTS

Age-related changes in weekly frequency of night awakening and overall child health were characterized by curvilinear patterns between 6 and 36 months. Although more frequent night awakenings were associated with poorer health at 6 months, a faster decline in night awakenings was associated with a slowed health decline over time. Furthermore, more frequent night awakenings were concurrently associated with more occurrences of illness at ages 6, 15, and 24 months. The association between night awakening and illness dissipated by 36 months.

CONCLUSION

Night awakening is concurrently and longitudinally associated with poorer health and more illnesses in early childhood.

Environmental and behavioural factors associated with school children's sleep in Aotearoa/New Zealand

AIM

To collect objective and subjective sleep data on 6- to 8-year-old children across the week and to identify factors within the family environment associated with sleep differences.

METHODS

Data were collected (n = 52) using actigraphy and diaries for 7 consecutive days and nights and a questionnaire incorporating the Children's Sleep Habits Questionnaire was completed by parents.

RESULTS

Children's actigraphic sleep periods averaged 10 h on school nights and 9.5 h on non-school nights and parents over-estimated children's sleep compared with actigraphy. One third (37%) of children had potential sleep problems. Children who shared a bedroom (31%) had shorter sleep onset latencies and those who consumed caffeinated drinks (33%) went to sleep and awoke later. Increased screen time was associated with later bedtimes on school nights and children with screens in bedrooms (12%) went to bed later and slept less on school nights, and had higher Children's Sleep Habits Questionnaire scores. Children living with a shift-working adult (27%) slept longer on non-school nights and had shorter sleep onset latencies on school nights.

CONCLUSIONS

It is important to consider children's sleep within the wider family context and to be aware that parents may over-estimate their children's sleep. Simple strategies to promote sleep health in clinical settings or education programmes include regular weekend bedtimes that align with those on school nights, removing technology from bedrooms and minimising caffeine consumption. An awareness of potential sleep differences associated with shift-working adults may ensure children are supported to have consistent sleep routines that promote adequate sleep.

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department

OBJECTIVES

To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers).

METHODS

A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011-2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit.

RESULTS

23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school.

CONCLUSIONS

These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

Relationships between Sleep Behaviors and Unintentional Injury in Southern Chinese School-Aged Children: A Population-Based Study

The purpose of this study is to explore the relationships between sleep behaviors and injury occurrence among Chinese school-aged children. Data were collected with self-administered questionnaires of a cross-sectional survey which covered the school-aged children from southeastern Chinese urban and rural areas in April 2010. Information was collected on unintentional injury in the past year, sleep duration, napping and daytime fatigue, sleeping pill use, and social-demographic variables. Multivariable logistic regression analyses, controlling for confounding factors, were conducted to assess sleep-related variables that were associated with injuries. Students who slept for less than 8 h had a 30% increased risk of injury (OR: 1.30; 95%CI: 1.01-1.69) compared with those who slept for 8-9 h. Lack of napping, snoring and use of sleeping pills were significantly associated with injury. Among different genders, the slight difference in sleep behaviors predicted the occurrence of injury. Rural children displayed more sleep behaviors associated with injury than urban children. The sleep behaviors of primary school students were more negatively correlated with injury occurrence than junior/senior high school children. Consideration should be given to the prevention of problematic sleep behaviors as a potential risk factor in order to decrease injury rates and promote the health of school-aged children.

Sleep Deprivation Is Associated with Bicycle Accidents and Slip and Fall Injuries in Korean Adolescents

Objective

This study sought to evaluate associations between sleep time and bicycle accidents, falls under various circumstances, and dental injuries in adolescents.

Methods

A total of 61,696 participants ranging from 12 to 18 years of age who completed the Korea Youth Risk Behavior Web-based Survey (KYRBWS) in 2013 were enrolled in this study. Bicycle riding accidents were analyzed for 17,232 bicycle-riding participants. Data were collected regarding the weekday sleep duration for the most recent 7 days, which was categorized as < 5.5 h, 5.5–6.5 h, 6.5–7.5 h, or ≥ 7.5 h per day, and the incidence of bicycle accidents, slips and falls under various circumstances, and dental injuries in the most recent 12 months. Adjusted odds ratios (aORs) were calculated among sleep groups for bicycle accidents, slips and falls, and dental injuries using simple and multiple logistic regression analyses with complex sampling.

Results

Bicycle riding accidents and slips and falls in classrooms, corridors, the ground, toilets, stairs, and other unspecified situations showed positive correlations with sleep deprivation. Comparisons of groups with ≥ 7.5 h sleep, < 5.5 h, 5.5–6.5 h sleep, and 6.5–7.5 h sleep revealed increased associations with slips and falls under various circumstances. In particular, the aORs were higher in the groups with less sleep (aOR of the 5.5 h group > the 5.5–6.5 h group > the 6.5–7.5 h group). There was no significant relationship between sleep deprivation and dental injury.

Conclusions

This study demonstrated that sleep deprivation among Korean adolescents was associated with bicycle accidents and falls at home and school. Thus, adequate sleep may be needed to prevent accidents and falls.

Behavioral symptoms and sleep problems in children with anxiety disorder

BACKGROUND

Sleep disorders are frequently associated with childhood behavioral problems and mental illnesses such as anxiety disorder. To identify promising behavioral targets for pediatric anxiety disorder therapy, we investigated the associations between specific sleep and behavioral problems.

METHODS

We conducted retrospective reviews of 105 patients aged 4-12 years who met the DSM-IV criteria for primary diagnosis of generalized anxiety disorder (n = 33), separation anxiety disorder (n = 23), social phobia (n = 21), or obsessive compulsive disorder (n = 28). Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) and behavioral problems by the Spence Children's Anxiety Scale, Oppositional Defiant Behavior Inventory (ODBI), and Depression Self-Rating Scale for Children.

RESULTS

Depressive behavior was weakly correlated with CSHQ subscores for sleep onset delay and night waking but not with total sleep disturbance. Anxiety was correlated with bedtime resistance, night waking, and total sleep disturbance score. Oppositional defiance was correlated with bedtime resistance, daytime sleepiness, sleep onset delay, and most strongly with total sleep disturbance. On multiple regression analysis ODBI score had the strongest positive association with total sleep disturbance and the strongest negative association with total sleep duration.

CONCLUSIONS

Sleep problems in children with anxiety disorders are closely related to anxiety and oppositional defiant symptoms.

Bedtime problems and night wakings in young children: an update of the evidence

Bedtime problems and night wakings in infants and young children are prevalent, persistent, and associated with a variety of impairments in youth and their families. Assessment strategies include clinical interview, sleep diaries, actigraphy, and subjective measures. A number of treatment approaches with varying degrees of empirical support are available, and several novel strategies have been evaluated in recent years. Appropriate sleep scheduling and a bedtime routine are important components of any treatment program.

Sleep patterns in children with and without autism spectrum disorders: developmental comparisons

The present study examined age-related changes in the sleep of children with autism spectrum disorders (ASD) compared to age-related changes in the sleep of typically developing (TD) children. Participants were 108 mothers of children with ASD and 108 mothers of TD children. Participants completed a questionnaire on children's overall sleep quality that also tapped specific sleep-domains (i.e., bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, disordered breathing, daytime sleepiness). Results confirm significantly poorer sleep quantity and quality in children with ASD, particularly children age 6-9 years. Unlike TD children, the sleep problems of children with ASD were unlikely to diminish with age. Our findings suggest that it is important to exam specific domains of sleep as well as overall sleep patterns. Finding of significant age-related interactions suggests that the practice of combining children from wide age-ranges into a single category obfuscates potentially important developmental differences.

Assessment of sleep problems in preschool aged children: an adaptation of the children's sleep habits questionnaire

The purpose of the present study was to evaluate the factor structure of the children's sleep habits questionnaire (CSHQ) when used with preschool and toddler age children. Mothers of 105 children ages 2-5 completed the CSHQ, the child behavior checklist (CBCL), and a sleep diary. Internal consistency for the original subscales on the CSHQ ranged from .55 to .82 and factor analysis resulted in four factors that tap into critical aspects of sleep. The concurrent validity of the revised scales of the CSHQ was adequate. Overall the results from this study suggest a revised factor structure may be more appropriate for use with preschool and toddler age children.

The effects of acute sleep restriction on adolescents' pedestrian safety in a virtual environment

PURPOSE

Over 8,000 American adolescents ages 14-15 years require medical attention owing to pedestrian injury annually. Cognitive factors contributing to pedestrian safety include reaction time, impulsivity, risk taking, attention, and decision making. These characteristics are also influenced by sleep restriction. Experts recommend that adolescents obtain 8.5 hours of uninterrupted sleep each night, but most American adolescents do not. Inadequate sleep may place adolescents at risk for pedestrian injury.

METHODS

Using a within-subjects design, 55 14- and 15-year-olds engaged in a virtual reality pedestrian environment under two conditions, scheduled a week apart: sleep-restricted (4 hours' sleep the previous night) and adequate sleep (8.5 hours). Sleep was assessed using actigraphy and pedestrian behavior via four outcome measures: time to initiate crossing, time before contact with vehicle while crossing, virtual hits or close calls and attention to traffic (looks left and right).

RESULTS

While acutely sleep restricted, adolescents took more time to initiate pedestrian crossings, crossed with less time before contact with vehicles, experienced more virtual hits or close calls, and looked left and right more often compared with when adequately rested. Results were maintained after controlling for age, gender, ethnicity, and average total sleep duration before each condition.

CONCLUSIONS

Adolescent pedestrian behavior in the simulated virtual environment was markedly different, and generally more risky, when acutely sleep restricted compared with adequately rested. Inadequate sleep may influence cognitive functioning to the extent that pedestrian safety is jeopardized among adolescents capable of crossing streets safely when rested. Policy decisions might be educated by these results.

The Association between Sleep and Injury among School-Aged Children in Iran

Background. A good night's sleep plays a key role in diseases resistance, injury prevention, and mood stability. The objective of this study was to examine relationship between sleep problems and accidental injury occurrences in school-aged children. Method. A retrospective study was conducted for comparing two groups of children. Children who have experienced injuries for at least two times during an academic year are the participants in the injury group (IG) and those who have not experienced any kind of injuries are placed in the noninjury group (NIG). Data was collected through parent-reported sleep patterns and problems using Children's Sleep Habits Questionnaire (CSHQ). Findings. The findings showed that global sleep problems were more in the IG than in the NIG. Multivariate logistic regression analysis showed that the daytime sleepiness and sleep duration are the two major reasons for accidental injury. In addition, significant difference was seen between the sleep patterns of the two groups. Sleep duration was also shorter in the IG, and this group had a greater percentage (63% versus 41.1%) of “short sleepers” (<9 h). Conclusion. There is a significant relationship between injury occurrence and sleep problems and sleep duration in Iranian school-aged children.

Sleep disorders in children with developmental delay

Developmental disorders in children are common. Associated demanding co-morbidities that include sleep problems are prevalent in this group. In turn, these are linked to daytime performance issues, reduced developmental and academic growth, and considerable familial psychopathology. Behavioral modification measures are and should be the first line approach to management. Medications for sleep disorders have an important role in addition to behavioral modification therapy. This literature review looks into the occurrence and severity of sleep problems in children with developmental disorders. The probable advantages of using medications, mainly focusing on the neurohormone melatonin (a sleep inducer), are also explored.

A wicked problem: early childhood safety in the dynamic, interactive environment of home

Young children being injured at home is a perennial problem. When parents of young children and family workers discussed what influenced parents' perceptions and responses to child injury risk at home, both "upstream" and "downstream" causal factors were identified. Among the former, complex and interactive facets of society and contemporary living emerged as potentially critical features. The "wicked problems" model arose from the need to find resolutions for complex problems in multidimensional environments and it proved a useful analogy for child injury. Designing dynamic strategies to provide resolutions to childhood injury, may address our over-dependence on 'tame solutions' that only deal with physical cause-and-effect relationships and which cannot address the complex interactive contexts in which young children are often injured.