Evaluation of Sleep Habits and Their Relationship With Quality of Life in Children With Epilepsy

BACKGROUND

The aim of this study was to investigate sleep habits, quality of life (QoL), and the relationship between them in children with epilepsy.

METHODS

In this cross-sectional study, children aged two to 18 years being followed up for epilepsy were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and the Pediatric Quality of Life Inventory (PedsQL). Pearson or Spearman correlation analysis was performed to examine the relationship between normally distributed and non-normally distributed variables, respectively. Linear regression analysis was used to examine independent variables associated with PedsQL total scale score. Level of significance was accepted as P < 0.05.

RESULTS

The study included 112 children with a mean age of 10.5 ± 4.4 years (51.8% female). The frequency of poor sleep habits was 96.4%. There was a good level of agreement between children's and parents' PedsQL total, physical health, and psychosocial health scores (P < 0.001). Correlation analysis between QoL and sleep parameters revealed negative correlations between total sleep score and self-assessed PedsQL total scale, physical health, and psychosocial health scores (P < 0.05) and parent-assessed PedsQL total scale and psychosocial health scores (P < 0.05). The results of linear regression analysis indicated that the factors most significantly associated with lower QoL were high CSHQ total sleep score and exclusively daytime seizures (P < 0.001).

CONCLUSIONS

It was found that children with epilepsy had poor sleep habits and low QoL and that poor sleep habits have a negative impact on QoL.

Comparison of Sleep Quality Between Outpatient and Hospitalized Children with Respiratory Tract Dysfunction

OBJECTIVES

The main objective of the study to compare the effect of hospitalized and outpatient settings on quality of sleep in children with respiratory tract dysfunction.

METHODOLOGY

A descriptive correlational study was carried out at Dhi-Qar Health Directorate pediatric hospitals. The period of the study was from the November 19, 2023 to March 10, 2024. Purposive sample (non-probability) of 250 children (male and female). A total of (125) children were chosen from the children whose admitted to the hospitals, and a total of (125) children were chosen from the outpatient settings. The study instrument consisted of three parts: the sociodemographic sheet, clinical diagnosis sheet, and sleep quality scale. The questionnaire was modified according to experts' recommendation to use it for children with respiratory tract dysfunction. The questionnaire was evaluated by a panel of 15 experts from diverse medical and nursing professions. Both descriptive and inferential statistics were used to analyze the data.

RESULTS

The study findings that effect outpatient settings have more effect from hospitalized settings on quality of sleep in children with respiratory tract dysfunction (M ±SD=1.322±0.1522).

CONCLUSION

A study showed that the quality of sleep in children with respiratory tract dysfunction was generally average, whether in hospitalized or outpatient settings, outpatient settings had greater difficulties falling asleep and waking than children in hospitalized.

The effect of exercise on sleep habits of children with type 1 diabetic: a randomized clinical trial

BACKGROUND

Adequate sleep and exercise are important components of the human lifestyle. Paying attention to these two factors is very important to improve the condition of children with type 1 diabetes. Therefore, this study aimed to investigate the effect of exercise on sleep habits in children with type 1 diabetes.

MATERIAL & METHODS

62 children with type 1 diabetes participated in this clinical trial. They will be divided into the intervention group (31) and the control group (31). Sleep habits were measured using the Children's Sleep Habits Questionnaire (CSHQ). All children's parents completed the CSHQ. The intervention for the experimental group consisted of 8 weeks of regular exercise program. The exercise program was prepared as an educational video and provided to parents. Paired sample t-test and ANCOVA test were used with SPSS 23.

RESULTS

62 children with an average age of 9.32 ± 2.02 were studied. Fifty-four and eight% of the children were girls and the rest were boys. The analysis of the variance test showed a significant difference (F = 144.72, P ≤ 0.01) between the average score of the sleep habits of the control group (62.45 ± 5.12) and the experimental group (47.06 ± 4.39).

CONCLUSION

Sleep habits in the experimental group improved after 8 weeks of exercise training using educational videos. Exercise as a non-pharmacological treatment is an effective way to manage diabetes and improve sleep quality in diabetic children.

The effects of the posttraumatic stress and general health status on paediatric burns and their sleep habits

BACKGROUND

Burns are serious injuries that can require hospitalization and have physical and emotional sequelae. Sleep disturbance can occur after trauma as evidenced by posttraumatic stress symptoms such as re-experiencing of a trauma with repetitive dreams, memories and flashbacks. This area has been minimally examined with pediatric burn survivors; therefore, the aim of this study was to investigate the effects of posttraumatic stress and general health on sleep habits of pediatric burn survivors from.

METHOD

This is a correlational descriptive study. Its sample included 7-18-year-old inpatients at the burn clinic of a university hospital from January to November 2019. This study used the Posttraumatic Stress Disorder Reaction Index, the General Health Questionnaire (12) and the Children's Sleep Habits Questionnaire for data collection.

RESULTS

Of the participants, 58.6% were male, 46.5% were primary school students, and 62.6% had no diseases other than their burns. 20.2% of the children had epilepsy, 14.2% had diabetes and 3% had pneumonia. Of the child burn victims, 45.5% were brought to the hospital because of contact with fire. All of them had first-degree burns, 59.6% had second-degree burns, and 80.8% had third-degree burns. After their burns, infections developed in 20.2% during trauma and in 43.4% during burn treatment. A structural equation model indicated that the child burn victims' general health perceptions did not significantly affect their sleep habits (p > 0.05). A significant correlation was found between the children's posttraumatic stress disorder and their sleep habits (p < 0.05). Posttraumatic stress disorder explained 7.2% of their sleep habits. A positive and significant correlation was found between the children's general health perceptions and posttraumatic stress disorder (r = 0.74, p < 0.05).

CONCLUSION

Burns of any kind can cause posttraumatic stress, sleep disorders and impairment of health status in children.

An exploratory study of sleep habits in school-aged survivors of retinoblastoma

OBJECTIVE/BACKGROUND

Retinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits.

PATIENTS/METHODS

Sixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data.

RESULTS

Greater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent.

CONCLUSIONS

Survivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.

Questionnaire survey on sleep habits of 3-year-old children in Asahikawa City: Comparison between 2005 and 2020

BACKGROUND

Good sleep is essential for children's healthy growth. In 2005, we conducted a questionnaire survey on children's sleep habits and their background, targeting parents who attended health checkups for their 3-year-old children in Asahikawa City, Hokkaido. In 2020, we performed a secondary survey, including additional questions regarding media usage. We analyzed changes in children's sleep environment by comparing the results of both surveys.

METHODS

Children from 500 families (n = 420; 219 males, 201 females; mean age, 3.6 years) who underwent 3.5-year-old health checkups (per the changed schedule in 2015) in Asahikawa City from July 2020 to November 2020 and their parents who had completely answered the questionnaire were included.

RESULTS

The proportion of children who used childcare support system such as nursery schools or kindergarten increased from 30% in the previous survey to 95% in the present survey. The mean nocturnal sleep duration of children was 9.33 h in the present survey, 0.77 h shorter than that in the previous survey; similar to the previous survey results, it was significantly short (8.71 h) in children who went to bed after 10 PM. Moreover, it was significantly short in children who watched television for more than two hours or used media within two hours before going to bed or if parents used smartphones or watched motion pictures for >30 min/day. The rate of consulting pediatricians regarding sleep problems decreased from 3% to 2.4%.

CONCLUSION

Parents' lifestyles greatly influenced children's sleep habits in 2020. Pediatricians should actively participate in managing children's sleep problems.

Sleep quality of medical students and relationships with academic performances

OBJECTIVE

Sleep health is a major public health concern because of its correlation with physical and mental health, and it may be particularly altered in medical students. This study aims: i) to examine the sleep characteristics of French medical students and their knowledge about basic sleep hygiene rules and; ii) to examine the correlations between sleep quality and academic performances, as well as between sleep quality and sleep knowledge.

METHODS

Students from 4th, 5th and 6th years of medicine, of the Faculty of Paris Diderot, voluntarily responded to an online questionnaire including PSQI and multiple-choice quizzes (MCQ) about basic sleep hygiene rules.

RESULTS

From the 177 participants, 49.7% had a poor sleep (PSQI>5). Regarding sleep latency, 44.6% needed>30min to fall asleep at least once a week, 26.5% slept 6 hours or less by night, 42.4% of them qualified their sleep quality as bad or very bad. A serious lack of knowledge about basic sleep hygiene rules was observed, with an average score at the MCQ of 6.61/10, and only 31% of medical students were aware of basic good sleep habits. Significant correlations were observed between sleep efficiency and all academic mean scores (both regarding the morning, afternoon, and pooled mean scores), and between sleep disturbances and the morning mean score.

CONCLUSIONS

French medical students have a poor sleep quality, correlating with academic performances, and present a poor knowledge of basic sleep rules. These findings are a call to improve medical training schedules and to develop prevention and training programs.

Sleep hygiene in paramedics: What do they know, and what do they do?

OBJECTIVES

Shift workers routinely obtain inadequate sleep, which has major health and well-being consequences. Sleep hygiene describes a range of behaviors, lifestyle and environmental factors that can support optimal sleep. To date, limited research has examined sleep hygiene in shift workers. This study aimed to 1) assess the knowledge and understanding of sleep hygiene amongst shift working paramedics, as well as the perceived impact on sleep, and 2) investigate paramedics engagement with sleep hygiene practices.

STUDY DESIGN

Participants completed an online, cross-sectional survey.

PARTICIPANTS

Queensland Ambulance Service paramedics (n = 184) who work shift work.

MEASURES

The online survey included questions from the Standard Shiftwork Index and Sleep Hygiene Index.

RESULTS

Most participants reported little or no understanding or knowledge of "sleep hygiene" as a concept. Participants reported that sleep scheduling and bedroom environment (temperature, light, and noise) were the most impactful on sleep. Few participants reported nicotine and alcohol consumption, or daytime napping, whereas caffeine consumption and mentally-stimulating bedtime activities were more common. Participants who were young, single, and worked all shift types (day, afternoon, and night) as part of their regular rosters, demonstrated less knowledge regarding sleep hygiene, and were more likely to be exhibiting poor sleep hygiene engagement.

CONCLUSIONS

Paramedics demonstrated a limited level of understanding of sleep hygiene as a concept, and varied knowledge about the impacts of individual sleep hygiene factors. Further, paramedics demonstrated varied engagement with individual sleep hygiene practices. Future research should focus on the development of sleep hygiene interventions to optimize sleep in paramedics.

What happened among Japanese children from school closure due to COVID-19 after school re-opening? Changes in sleep habits and dietary intake

The present study aimed to (1) examine the changes in sleep habits and dietary intake among school-aged children after the school re-opening from a 3-month closure (without school lunch) due to the COVID-19 pandemic, and (2) examine whether the changes differ between those with different temporal patterns of sleep and eating during school closure, namely, 'Very early', 'Early', 'Late' and 'Very late'. The latter patterns were characterised by later timings of wake up, breakfast and lunch. Questionnaires were answered twice by 4084 children (aged 8-15 years), themselves and/or their parents: first in June 2020 (for assessing lifestyle during school closure) and second, from July 2020 to February 2021 (for assessing lifestyle after school opening). After school re-opening, the participants' wake-up time became an hour earlier (95 % CI 1⋅0, 1⋅1) and sleep duration got 0⋅94 h shorter (95 % CI 0⋅91, 0⋅97) than during school closure. An increase in dietary intake was observed for thiamine, vitamin B6, potassium, fruits and dairy products, and a decrease was observed for sugars (as foods) and confectioneries and sweetened beverages, despite small effect sizes (Cohen's d: 0⋅20-0⋅30). Significant changes in wake-up time, sleep duration and sweetened beverage intake were observed among children with the latter temporal patterns. Thus, children wake up earlier and sleep for shorter durations after school re-opening than during school closure; however, changes in dietary intake were generally insignificant. Dietary intake among school-aged children in Japan during school closure (without school lunch) might not be worse than that during school days with universal school lunch.

Patterns and Predictors of Multimorbidity in the Azar Cohort

BACKGROUND

The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort.

METHODS

We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires.

RESULTS

The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM.

CONCLUSION

The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.

Translation and adaptation into Brazilian Portuguese and investigation of the psychometric properties of the Children's Sleep Habits Questionnaire (CSHQ-BR)

OBJECTIVES

To translate to Brazilian Portuguese, culturally adapt and confirm the psychometric parameters of validity and reliability of the Children's Sleep Habits Questionnaire (CSHQ-BR) in children.

METHODS

A sample of 314 typically developing children, 51% girls, mean age 7.12 years (SD = 2.04 years) were assessed, comprising 227 from São Paulo and 87 from the Amazon region. Translation, back translation, cultural adaptation, a pilot study and item review were carried out, yielding the final version of the CSHQ. Psychometric parameters were determined based on content validity coefficient (CVC), test-retest, internal consistency, evidence of convergent validity and internal structure.

RESULTS

The final CVC for the scale was 0.88. Intraclass correlation was 0.98 for the overall questionnaire and ranged from 0.88 to 0.98 for subscales. CSHQ-BR internal consistency was α = 0.81 for the CSHQ-BR total score (95% CI) and from 0.51 to 0.75 for subscales. Exploratory factor analysis suggested a novel 4-factor structure. A positive correlation was found between the CSHQ and the Questionnaire on Sleep Behavior. Mean total CSHQ score in Brazilian children was 46.85 (SD = 9.43), and boys had a higher mean total score than girls, although not statistically significant.

CONCLUSION

The CSHQ-BR exhibited satisfactory equivalence for the original English abbreviated form and the Brazilian Portuguese version, proving a useful sleep screening instrument for identifying sleep problems in Brazilian children aged 4-10 years.

Association between sleep habits and behavioral problems in early adolescence: a descriptive study

Background

Sleep habits are related to children's behavior, emotions, and cognitive functioning. A strong relationship exists between sleep habits and behavioral problems. However, precisely which sleep habits are associated with behavioral problems remains unclear. Therefore, the purpose of this study is to clarify the relationship between sleep habits and behavioral problems in early adolescence.

Methods

This study used data from a larger longitudinal research, specifically, data from the year 2021. First-year junior high school students (12–14 years) in Japan were surveyed; their parents (N = 1288) completed a parent-report questionnaire. The main survey items were subject attributes, the Pittsburgh Sleep Quality Index (PSQI), and the Strength and Difficulties Questionnaire (SDQ).

Results

Of the 652 valid responses received, 604 individuals who met the eligibility criteria (no developmental disability in the child and completion of all survey items) were included in the analysis. To examine the relationship between sleep habits and behavioral problems, logistic regression analysis using the inverse weighted method with propensity score was conducted with sleep habits (sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep difficulty, use of sleeping pills, difficulty waking during the day, and sleep disturbances) as explanatory variables and behavioral problems (overall difficulty in SDQ) as objective variables. The propensity score was calculated by employing the logistic regression using the inverse weighted method based on propensity scores. Propensity scores were calculated based on gender, family structure, household income, and parental educational background. The results showed that behavioral problems tended to be significantly higher in the group at risk for sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances than in the group with no risk.

Conclusion

The results suggest that deterioration in sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances may increase the risk of behavioral problems in adolescents.

Sleep quality and emotion recognition in individuals with and without internalizing psychopathologies

BACKGROUND AND OBJECTIVES

Separate lines of research indicate sleep quality may impact recognition of facial expressions in anxious or depressed individuals. This study examined facial emotion recognition ability in the context of self-perceived sleep quality and anxiety and depression symptom levels in individuals with and without internalizing psychopathologies.

METHODS

Seventy anxious and/or depressed patients and 24 demographically matched healthy controls completed the Pittsburgh Sleep Quality Index (PSQI), standard measures of anxiety and depression, and an Emotion Recognition Task comprising negative and positive facial expressions.

RESULTS

Analyses of variance results revealed patients reported worse sleep quality than controls. Linear mixed-effects models indicated that all participants demonstrated better emotion recognition abilities in identifying positive versus negative emotions. For reaction time, but not accuracy, regression results revealed significant individual differences, with worse sleep quality predicting slower reaction times for positive faces, specifically for happiness.

LIMITATIONS

The use of a subjective measure of sleep quality and a specific behavioral paradigm for emotion recognition may impact the generalizability of the findings.

CONCLUSIONS

Associations between task performance and emotional valence of facial expression implies that poor sleep quality, beyond internalizing symptom severity, may disrupt emotion processing.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Weekend catch-up sleep is associated with the alleviation of non-alcoholic fatty liver disease

INTRODUCTION AND OBJECTIVES

Recently, interest in the relationship between weekend catch-up sleep (WCUS) and chronic diseases is increasing. We aimed to study the correlation between sleep duration and non-alcoholic fatty liver disease (NAFLD), an emerging metabolic disease.

MATERIALS AND METHODS

Data on sleep duration from the Korea National Health and Nutrition Examination Survey was recorded. The subjects were divided into three groups according to the duration of WCUS: Group 1, those who slept for less than 7 hours in a week; Group 2, those who slept for less than 7 hours on weekdays but more than 7 hours on weekends (those with WCUS pattern); and Group 3, those who slept for more than 7 hours in a week. Multivariate logistic regression analysis was used to analyze the correlation between sleep duration and NAFLD.

RESULTS

A mean sleep time of 7 hours or more showed a significant negative relationship with NAFLD (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.79-0.89 in all; OR 0.91, 95%CI 0.84-0.99 in males; OR 0.86, 95%CI 0.79-0.94 in females). Groups 2 and 3 showed significant negative relationships with NAFLD when Group 1 was used as a reference (Group 2; OR: 0.80, 95%CI: 0.70-0.92, Group 3; OR: 0.73, 95%CI: 0.66-0.82). WCUS showed similar correlations with NAFLD, regardless of sex.

CONCLUSIONS

WCUS and sleep duration are significantly associated with NAFLD. A prospective cohort study is needed to prove the causal effects.

Effects of sleep habits on acute myocardial infarction risk and severity of coronary artery disease in Chinese population

Background

Growing evidence indicates that poor sleep harms health. Early to bed and early to rise is considered as a healthy lifestyle in Chinese population. The current study aimed to examine the effects of sleep habits on acute myocardial infarction (AMI) risk and severity of coronary artery disease (CAD) in Chinese population from two centers.

Methods

A total of 873 patients including 314 AMI cases and 559 controls were recruited from the inpatient cardiology department of the Affiliated Jiangning Hospital and the First Affiliated Hospital of Nanjing Medical University. 559 controls included 395 CAD cases and 164 non-CAD cases. We used a 17-item sleep factors questionnaire (SFQ) to evaluate sleep habits comprehensively by face-to-face interview. The severity of CAD was assessed by Gensini score in AMI and CAD groups. The effects of sleep factors on AMI risk and Gensini score were examined by unconditional logistic regression.

Results

After mutually adjustment for other sleep factors and demographic characteristics, the timing of sleep (24:00 and after) and morning waking (after 7:00) and sleep duration (< 6 h) were associated with increased risk of AMI (OR = 4.005, P < 0.001, OR = 2.544, P = 0.011 and OR = 2.968, P < 0.001, respectively). Lower level of light exposure at night was correlated with reduced risk of AMI (OR = 0.243, P = 0.009). In subgroup analysis by age, both late sleep timing and short sleep duration were associated with increased risk of AMI regardless of age. In subjects with age ≤ 65 years, daytime napping was related to reduced risk of AMI (OR = 0.645, P = 0.046). In subjects with age > 65 years, the frequency of night-time waking (3 times) was associated with increased risk of AMI (OR = 3.467, P = 0.035). Short sleep duration was correlated with increased risk of high Gensini score (OR = 2.374, P < 0.001).

Conclusion

Sleep insufficiency is an important risk factor both for AMI risk and CAD severity. Late sleeping is also associated with increased risk of AMI. In young and middle-aged people, regular naps may have a protective effect.

Graphic abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02251-8.

Sleep habits and weight status in Brazilian children aged 4-6 years of age: the PREDI study

OBJECTIVES

To evaluate the association of sleep habits with the weight status of children aged 4-6 years.

METHODS

Data were obtained from the PREDI Study, a Brazilian birth cohort study. The current study was carried out in the homes of the participants during two follow-ups: 2016/17 and 2018. The participants were submitted to anthropometric assessment and demographic, socioeconomic and sleep data were obtained. The child's sleep habits were self-reported by the mother or caregiver on the day of the visit and included information on the following sleep habits during the past week: bedtime routine, rhythmicity, and separation affect determined with the Sleep Habits Inventory for Preschool Children and the Sleep Habits Inventory. Logistic regression and gamma-log regression analyses were used to examine the association of sleep habits with excess body weight of children in the two follow-ups according to sex.

RESULTS

Of the 217 and 185 children included in 2016/17 and 2018, respectively, 66 (30.6%) and 48 (25.9%) had a BMI >85th percentile at 4-6 years, respectively. The median rhythmicity score was higher in children with excess body weight (p = 0.05). Adjusted analysis showed that rhythmicity was associated with excess body weight of girls at ages 4-5 years (OR = 1.42, 95% CI: 1.09-1.86, p = 0.009) and 6 years (OR = 1.32, 95% CI: 1.06-1.65, p = 0.015), even after adjustment for other important covariates. Additionally, the sleep habit "separation affect" was inversely associated with the child's BMI in boys (β = -0.005, 95% CI: -0.010-0.000, p = 0.037).

CONCLUSIONS

In the present study, rhythmicity problems were associated with increased odds of girls aged 4-6 years having excess body weight. These results are important from a public health perspective since strategies aimed at preventing excess body weight in children need to consider the child's sleep quality as a potential risk factor, especially rhythmicity.

Sleep during COVID-19 lockdown: A cross-cultural study investigating job system relevance

Our study aimed to assess the change in the sleep patterns during the Coronavirus lockdown in five regions (Austria/Germany, Ukraine, Greece, Cuba and Brazil), using online surveys, translated in each language. Part of the cohort (age 25-65, well-educated) was collected directly during lockdown, to which retrospective cross-sectional data from and after lockdown (retrospective) questionnaires were added. We investigated sleep times and sleep quality changes from before to during lockdown and found that, during lockdown, participants had (i) worse perceived sleep quality if worried by COVID-19, (ii) a shift of bedtimes to later hours during workdays, and (iii) a sleep loss on free days (resulting from more overall sleep during workdays in non-system relevant jobs), leading to (iv) a marked reduction of social jetlag across all cultures. For further analyses we directly compared system relevant and system irrelevant jobs, because it was assumed that the nature of the lockdown's consequences is dependent upon system relevance. System relevant jobs were found to have earlier wake-up times as well as shorter total sleep times on workdays, leading to higher social jetlag for people in system relevant jobs. Cultural differences revealed a general effect that participants from Greece and Ukraine had later bedtimes (on both work and free days) and wake-up times (on workdays) than Cuba, Brazil and Austria, irrespective of COVID-19 lockdown restrictions.

Effects of sleep intervention on glucose control: A narrative review of clinical evidence

BACKGROUND

Optimizing sleep has been recently gained exposure as a promising lifestyle consideration to aid in the control of diabetes. The evidence to support the impact of sleep quantity and quality on blood glucose control is largely acknowledged. This study aimed to review all published randomized controlled trials (RCTs) investigating the relationship between sleep and glucose control to synthesize an accurate overview.

METHOD

Literature from PubMed and Google Scholar was searched using the listed search terms to obtain RCTs on the role of sleep in glucose homeostasis. Seven RCTs were eligible and included in our review. References in these RCTs were screened for the presentation of the pathophysiology of metabolic disturbances relating to the sleep duration, and the relevant factors affecting blood glucose concentration.

RESULTS

Sleep deprivation and poor sleep quality are connected with blood glucose disturbance and reduction of insulin sensitivity. This leaves diabetic patients at an increased risk of glucose level fluctuations. However, the function of β-cells was likely to be conserved after 14-days of sleep deprivation. Sleep extension from 7 to 14 days improved blood glucose control and insulin sensitivity in both healthy and diabetes participants. Diabetes sleep education and personalized interventions that reduced stress and improved sleep quality contributed to glucose homeostasis in diabetic patients. Overall improving one's sleep hygiene was found to improve glucose control in diabetic patients.

CONCLUSION

Longer or short-term sleep deprivation may negatively affect glucose homeostasis, although the body temporarily compensates for the impaired function of β-cells when reduced sleep lasted up to 14 days. Thus, we recommend optimum sleep duration and optimistic sleep duration and sleep quality for decreasing risk and progression of diabetes.

The mediating effect of cognitive appraisal on the relationship between sleep habits and the stress response among Japanese female college students

Background

Undergraduate students tend to develop “evening-type” sleep patterns. Recent research has reported that evening-type and irregular sleep habits are related to physical and mental stress responses, particularly in female students. Although the connection between sleep habits and the stress response has been well documented, the mechanism behind this relationship is currently unknown. Using the transactional model as a framework and female students as our target population, we examined whether sleep habits predict the stress response through the mediation of cognitive appraisals of one’s own sleep habits.

Methods

Three hundred twenty-one Japanese female college students participated in this study. Participants completed measures of their sleep habits (sleep patterns and sleep irregularity), cognitive appraisals of their sleep habits (including four subscales: commitment, appraisal of influence, appraisal of threat, and controllability), stress responses (depression and anxiety), and control factors. The reliability and validity of the scales used in this study, except for sleep pattern and sleep irregularity, were confirmed in previous studies.

Results

Multiple-mediation-model analysis indicated that commitment mediates the relationship between sleep pattern and anxiety. Meanwhile, cognitive appraisals, as a whole, were found to have a mediating effect on the relationship between sleep irregularity and depression.

Conclusions

Our study revealed that cognitive appraisals mediated the relationship between sleep habits and the stress response. The findings also suggest that maintaining a low level of commitment might be effective for reducing anxiety, especially considering the difficulty associated with changing lifestyles. The findings of the present study should be useful for health education related to lifestyle.

Relationship between sleep habits and academic performance in university Nursing students

Background

Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students.

Methods

This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the ‘Morningness and Eveningness scale’, an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the ‘sleep habits questionnaire’ was assessed with the Cronbach’s alpha test.

Results

Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the ‘sleep habits questionnaire’ was appropriate (Cronbach’s alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01–2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11–2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30–3.98) were independently associated with a higher probability of poor academic performance.

Conclusions

Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00635-x.

The effects of Ramadan intermittent fasting on sleep-wake behaviour and daytime sleepiness in team sport referees

The aim of the present study was to evaluate the impact of Ramadan fasting on sleep quality and daytime sleepiness in team sport referees. Seventy-eight male amateur team sport referees (age: 31.1 ± 10.8 years) participated in this study. Participants responded to the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth sleepiness scale (ESS) questionnaires before (10-days prior) and during (last 7-days) the month of Ramadan.PSQI and ESS scores increased significantly during Ramadan (both p < .001, ES = 0.56 and 0.54, respectively) with 83.3% of participants scoring ≥5 in the PSQI. The percentage of participants suffering from severe excessive daytime sleepiness (ESS score ≥ 16) was 3.8% before vs. 7.7% during Ramadan (p < 0.001). Sleep duration decreased by ~ 1 h during Ramadan (p < .001, ES = 0.61) and was associated with a delay in bedtime of ~ 2 h (p < 0.001, ES = 0.7) and of wake-up time of ~ 1 h (p < 0.001, ES = 0.5). The score for daytime dysfunction and subjective sleep perception, as components of the PSQI, increased (both p < 0.001; ES = 0.79, ES = 0.57, respectively), whereas the score for the use of sleep medication decreased during vs. before Ramadan (p = 0.041, ES = 0.47). Ramadan fasting impaired sleep quality and increased daytime sleepiness in team sport referees. Future studies, using objective assessment tools, are warranted.

Mental health and sleep habits/problems in children aged 3-4 years: a population study

Background

Sleep is essential for mental health at all ages, but few studies have investigated the importance of sleep for mental health in early childhood. Therefore, this study examined the association between mental health and sleep habits/problems in children aged 34 years.

Methods

Children aged 3 to 4 years who were living in the community (n=415; 211/204 boys/girls) were recruited for this study. Their mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and their sleep habits/problems were evaluated using the Child and Adolescent Sleep Checklist.

Results

Based on the total difficulties score of the SDQ, the children were divided into two groups: a poor mental health group (n=76) and a control group (n=339). In terms of sleep habits, which included total sleep time, bedtime, wake time, and nap conditions, there were no differences between the two groups. Regarding sleep-related problems, however, anxiety before going to sleep (p=0.026), circadian rhythm abnormalities (p=0.014), and sleepiness during classes outside of naptimes (p=0.031) were significantly higher in the poor mental health group than in the control group. Multiple regression analysis showed that poor mental health status was significantly associated with sleepiness and snoring (p=0.017 and p=0.018, respectively).

Conclusions

The mental health status of 34-year-old children was associated with sleep-related problems, namely sleepiness and snoring. Healthcare providers should pay attention to childrens irregular sleep-wake patterns; moreover, interventions for appropriate sleep hygiene will reduce the psychological burden on both children and their families.

Circadian typology and implications for adolescent sleep health. Results from a large, cross-sectional, school-based study

STUDY OBJECTIVES

To investigate circadian typology in a large, representative sample of Norwegian adolescents, and its implications for sleep health.

METHODS

The sample included 3920 1^st year high school students aged 16-17 years. Respondents completed a web-based survey, including the short version of the Horne-Ostberg Morningness-Eveningness Questionnaire (rMEQ), the Munich Chronotype Questionnaire (MCTQ) and items on sleep-related behaviors (eg electronic media usage in bed, consumption of caffeinated beverages), sleep beliefs and daytime sleepiness. Data were analyzed using one-way ANOVAs and Chi-squared tests.

RESULTS

In all, 7.8% were categorized as morning, 52.3% as intermediate and 39.9% as evening types, respectively. Evening types had later sleep timing, longer sleep latency, more social jetlag and shorter school day sleep duration than morning types, with intermediate types displaying a sleep pattern between these two extremes. None of the circadian types met the minimum recommended amount of sleep on school nights (ie 8+ hours), and only morning types had a mean sleep duration of 7+ hours (7:19 h, nearly 1 h more than evening types who slept 6:20 h, p < 0.001). Evening types reported more use of electronic media in bed, more consumption of caffeinated beverages and more daytime sleepiness than the other circadian types. They were also less satisfied with their school day sleep duration and perceived it more difficult to change their sleep pattern.

CONCLUSIONS

Results from this study suggest that eveningness represents a sleep health challenge for older adolescents.

The effect of water-based intervention on sleep habits and two sleep-related cytokines in children with autism

OBJECTIVE

Previous studies have shown that children with autism have sleep disturbances and elevated levels of pro-inflammatory cytokines. This study aimed to evaluate the effect of aquatic exercise on sleep habits and two certain sleep-related cytokines of children with autism spectrum disorders (ASD).

METHODS

Forty boys with ASD (aged 6-14) were recruited and randomly assigned to an aquatic exercise (n = 20) or a control group (n = 20). Participants in aquatic exercise group performed water-based activities for 10 weeks/2 sessions per week/60 min, while control group didn't get any intervention. The serum levels of Interleukin-1 beta (IL-1β) and Tumor necrosis factor-α (TNF-α) and sleep quality were measured before and after the intervention.

RESULTS

Results revealed that aquatic exercise may improve sleep quality and reduce the serum levels of IL-1β and TNF-α in children with ASD compared to control group.

CONCLUSIONS

Overall, it is recommended that physicians and educators should provide a safe and effective exercise environment for ASD children to alleviate sleep issues and inflammatory biomarkers.

Sleep habits and circadian preferences in school-aged children attending a Mexican double-shift school system

OBJECTIVE

To determine the differences between sleep habits and circadian preference in school-aged children attending a Mexican double-shift school system.

METHODS

This cross-sectional study consisted of 400 elementary public-school children (mean age = 10.77, SD = 0.70 y, from fourth, fifth and sixth grades) in Reynosa, Tamaulipas, in northeastern Mexico. Attending a double-shift school system: 200 from the morning shift and 200 in the afternoon shift. Specific questions regarding sleep habits were collected and for circadian preference, the Morningness-Eveningness Scale for Children (MESC) was used.

RESULTS

Multivariate analysis reported no sex differences. Children attending at the morning shift during weekdays rose earlier, reported shorter time in bed and earlier midpoint of sleep than those in the afternoon shift. On weekends, morning shift children went to bed later than afternoon shift. Morning shift reported greater social jetlag, shorter average sleep length and more sleep deficit than afternoon shift. During weekdays and weekends evening type children went to bed later, rose later and reported later midpoint of sleep. Also, evening type reported more social jetlag than morning types.

CONCLUSION

This study suggests that early school start times can have a detrimental effect on Mexican children. Moreover, the morning shift children may be at more risk of poor health due to the higher social jetlag, as well as a higher tendency to be sleep deprived. On the other hand, the afternoon shift represents an important social environment that allows children to follow their natural physiological needs and a more optimal sleep health.

Sleep disordered breathing in children: which symptoms do parents consider a problem?

STUDY OBJECTIVE

Parents tend to under-report symptoms suggestive of sleep disordered breathing (SDB) at medical consultation. It is thought that a contributing factor may be whether parents view SDB symptoms as a problem. The aim of the study was to examine to what extent parents view SDB symptoms as a problem in children recruited from the general community and especially in children who currently have symptoms suggestive of SDB.

METHODS

Parents of 1639 children aged 5-10 y attending middle school in South Australia completed a questionnaire which included demographics and assessed the frequency over the previous school week of 32 sleep habits including six SDB sleep habit items. The sample was restricted to typically developing children and excluded children with medical problems likely to impact SDB. The final sample included 1610 children without a prior diagnosis of SDB and 29 with a prior diagnosis and/or treatment of SDB. Parents were asked to rate children's sleep habits using a 4-pt scale (never, rarely, sometimes and usually) and if the sleep habit was perceived to be a problem (yes/no). Children who sometimes or usually reported a sleep habit item were labelled as symptomatic.

RESULTS

Parents of children with, compared to those without, a prior diagnosis of SDB, were more likely to report the presence of SDB symptoms which were more frequently viewed as a problem. In children without a prior diagnosis of SDB, parents of symptomatic children viewed most SDB symptoms as a problem ranging from 91% for apnoea, 63% snorted/gasped, 63% watched child breathing at night, 58% snored loudly, 49% snored to 32% breathing heavily at night. Additional analyses in the combined sample revealed that a prior diagnosis of SDB, gender, socioeconomic status and ethnicity were weak predictors of whether parents viewed SDB sleep symptoms as a problem.

CONCLUSION

In children with symptoms suggestive of SDB, most parents viewed most SDB symptoms as a problem especially apnoea. The high frequency is contrary to that expected given the under-reporting of SDB symptoms at medical consultation. This suggests that additional factors other than whether parents consider SDB symptoms as a problem might better explain the under-reporting of SDB symptoms at medical consultation. Given the important impact on child health and medical service provision, future studies examining the factors that prompt parents to discuss SDB symptoms at medical consultation are warranted.

Stay-at-home circumstances do not produce sleep disorders: An international survey during the COVID-19 pandemic

OBJECTIVE

The anxiety-related insomnia and other sleep disorders were mentioned as possible side effects of quarantine and stay-at-home conditions. The questions to be explored were: Are there discernable differences in hours of sleep and sleep habits between the normal operational environment and the stay-at-home condition? and How seriously anxiety-induced insomnia or other sleep disorders may affect individuals during the stay-at-home?

METHODS

This international prospective study analyzed results from the sleep-wake patterns questionnaire, daily logs, and interviews. During COVID-19 pandemic, surveys were administered to the healthy volunteers with stay-at-home for 14 days or more, without previous sleep disorders; volunteers were not involved in online education/work daily timetable-related activities.

RESULTS

We analyzed 14,000 subjects from 11 countries with average stay-at-home of 62 days. The most significant changes in sleep occurred during the first 14 days of stay-at-home. The difference in the sleep duration between weekdays and weekends disappeared. Most of the participants discontinued using alarm clocks. The total sleep time increased in duration up to 9:10 ± 1:16 to the end of the quarantine/stay-at-home (+1:34, p = 0.02). The age-dependent changes in napping habits occurred. Only 1.8% of participants indicated insomnia during the first 14-day period with a decline to 0.5% after two months of stay-at-home.

CONCLUSION

During the stay-at-home situation, both duration and timing of sleep significantly differ from those of daily routine and most humans sleep longer than in a schedule-dependent operational environment. An appearance of anxiety-induced insomnia is extremely rare if a healthy individual is already in the stay-at-home situation.

The importance of cardiorespiratory fitness and sleep duration in early CVD prevention: BMI, resting heart rate and questions about sleep patterns are suggested in risk assessment of young adults, 18-25 years : The cross-sectional lifestyle, biomarkers and atherosclerosis (LBA) study

Background

Cardiorespiratory fitness (CRF) and sleep habits are lifestyle factors with potential to prevent cardiovascular disease (CVD). CVD is the leading cause of death worldwide. It is therefore important to establish a healthy lifestyle at a young age. In the Lifestyle, Biomarkers and Atherosclerosis (LBA) study we have examined 834 healthy non-smoking adults, aged 18–25 years. The general purpose of the LBA study was to study the effect of lifestyle on traditional biomarkers known to influence CVD risk. The aims of the present study were to evaluate sleep habits of young adult women and men participating in the LBA study, and to compare the importance of sleep and other lifestyle habits on clinically relevant biomarkers for CVD. An additional aim was to find easy and reliable non-invasive biomarkers to detect young adults with increased risk of developing CVD later in life.

Methods

The participants had previously been examined for lifestyle factors, biomarkers and CVD risk score. They filled in a validated computerized questionnaire about their general physical and mental health. The questionnaire included questions on sleep duration and experienced quality of sleep.

Results

In total 27% of the young adult participants reported difficulties falling asleep or experienced troubled sleep with frequent awakenings per night. The experienced troubled sleep was not related to a higher CVD risk score, but sleep quality and duration were correlated. Shorter sleep duration was significantly associated to higher body mass index (BMI), body fat (%), homeostasis model assessment of insulin resistance (HOMA-IR) and CVD risk. The modifiable lifestyle factor with the highest odds ratio (OR) for CVD risk was CRF. Sleep duration was the second most influential lifestyle factor, more important than moderate- and vigorous physical activity (MVPA) and food habits. Correlations between CRF and heart rate (HR), (P < 0.01) and HOMA-IR and BMI (P < 0.01) were observed, indicating that BMI and resting HR in combination with questions about sleep patterns are easy and reliable non-invasive biomarkers to detect young adults who need counselling on a healthy lifestyle.

Conclusion

Decreased sleep duration in combination with decreased CRF, in young adults, is a serious health issue.

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study

STUDY OBJECTIVES

To examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children.

METHODS

The current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015-2016 on 736 children aged 3-6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling.

RESULTS

An hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders.

CONCLUSIONS

Increased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.

Comparison of sleep problems between term and preterm born preschool children

OBJECTIVES

Sleep disorders are common problems among all age groups. If sleep problems detected in childhood are not resolved successfully, they become sleep disorders and a chronic state. In this study, we aimed to compare sleep problems between preterm-born and term-born preschool-age children.

METHODS

In the cross-sectional study, children were grouped according to whether they were born preterm or at term. The preterm group included 137 children aged four to six years. The control group comprised 145 age-matched term-born preschool children. The prenatal, natal, demographical, and clinical characteristics of preterm- and term-born preschool-age children were compared. The Children's Sleep Habits Questionnaire (CSHQ) was used to identify sleep problems. The total score and subscores of the CSHQ were compared between the groups.

RESULTS

The percentage of gastroesophageal reflux (GER) symptoms and obstructive sleep apnea (OSA) symptoms were significantly higher in the preterm group. According to the cutoff point of the CSHQ, 97 children in the preterm group (70.8%) and 88 children in the control group (60.7%) had a sleep disorder. The total score of the CSHQ was significantly higher in the preterm group compared with the control group; however, the scores of the subscales were similar between the groups. In the regression analysis, a significant association was found between being born preterm and having sleep disorder (β = 0.308, OR = 1.36, p = 0.04).

CONCLUSIONS

Our study reported a high percentage of sleep problems in preterm-born preschool children. We suggest that prematurity is associated with sleep problems even if the etiology of sleep problems is heterogeneous. Symptoms regarding GER and OAS should be investigated, and precautions, such as prohibiting maternal cigarette smoking, should be taken in preterm infants.

Owls and larks do not exist: COVID-19 quarantine sleep habits

Background

The coronavirus pandemic presented a unique opportunity to study the daily temporal patterns and sleep habits of humans. The question to be explored was: Are there discernible differences in sleep between the normal operational environment and the stay-at-home condition?

Methods

This international prospective study analyzed results from the sleep-wake patterns questionnaire, daily logs, and interviews. Surveys were administered to the healthy volunteers (age 15–60 y) with stay-at-home for a month or more, without previous sleep disorders and mood-related complaints; volunteers were not involved in online education/work daily timetable-related activities.

Results

We analyzed 3787 subjects with average stay-at-home of 65 ± 9 days. The most significant changes in sleep occurred during the first ten days when the difference between weekdays and weekends disappeared and changes occurred in napping habits. The majority of the participants (66.8%) shifted toward eveningness when the self-selected sleep was possible and 1869 volunteers appeared to be owls (49.4%), 823 (21.7%) exercised “typical” sleep, 478 (12.6%) were larks, and 617 (16.3%) participants were completely desynchronized to the end of stay-at-home. In addition, 497 participants (13.1%) alternated their sleep habits. The most of the desynchronized participants (n = 414) were older than 50 years (age correlation r = 0.80), and predominantly males (n = 297, r = 0.76).

Conclusion

In self-selected sleep conditions, the timing of sleep and sleep habits significantly differ from those of socially and economically fixed daily routine conditions. The changes in daily temporal patterns of humans during a prolonged stay-at-home situation indicate that human sleep habits may change according to existing living conditions.

Sleep hygiene in paramedics: What do they know and what do they do?

OBJECTIVES

Shift workers routinely obtain inadequate sleep, which has major health and wellbeing consequences. Sleep hygiene describes a range of behaviours, lifestyle and environmental factors that can support optimal sleep. To date, limited research has examined sleep hygiene in shift workers. This study aimed to 1) assess the knowledge and understanding of sleep hygiene amongst shift working paramedics, as well as its perceived impact on sleep, and 2) investigate paramedics' engagement with sleep hygiene practices.

STUDY DESIGN

Participants completed an online, cross-sectional survey.

PARTICIPANTS

Queensland Ambulance Service paramedics (n = 184) who engage in shift work.

MEASURES

The online survey included questions from the Standard Shiftwork Index and Sleep Hygiene Index.

RESULTS

Most participants reported little or no understanding or knowledge of 'sleep hygiene' as a concept. Participants reported that sleep scheduling and bedroom environment (temperature, light, and noise) were the most impactful on sleep. Few participants reported nicotine and alcohol consumption, or daytime napping, whereas caffeine consumption and mentally-stimulating bedtime activities were more common. Participants who were young, single, and worked varying shift types (day, afternoon, and night) as part of their regular rosters demonstrated less knowledge regarding sleep hygiene, and were more likely to be exhibiting poor sleep hygiene engagement.

CONCLUSIONS

Paramedics demonstrated a limited level of understanding of sleep hygiene as a concept, and varied knowledge about the impacts of individual sleep hygiene factors. Further, paramedics demonstrated varied engagement with individual sleep hygiene practices. Future research should focus on the development of sleep hygiene interventions to optimise sleep in paramedics.

Sleep hygiene in shift workers: A systematic literature review

In response to demand for the '24/7' service availability, shift work has become increasingly common. Given their non-traditional working hours, shift workers sleep at non-traditional times, with significant research undertaken to understand shift worker sleep. However, sleep hygiene in shift workers has been paid little research attention. To investigate shift worker engagement with sleep hygiene, a systematic review using the databases Sage, ScienceDirect, and Scopus was undertaken. The search terms utilised were: shift work, shiftwork, shift-work, sleep hygiene, sleep routine, and sleep habit. Sixteen studies were included for review. Findings show that shift workers frequently report caffeine consumption and daytime napping, in line with best-practice fatigue-management strategies, but contrary to existing sleep hygiene recommendations. Shift workers also altered their bedroom environment to optimise sleep. Diet, exercise, alcohol and nicotine consumption were investigated minimally from a sleep hygiene perspective. Given that shift workers are engaging in practices in-line with current fatigue-management strategies, but contrary to sleep hygiene recommendations, further research is required. Specifically, assessment of the applicability of current sleep hygiene guidelines to shift workers (particularly caffeine and napping recommendations) is required, in addition to the development of shift work-specific sleep hygiene guidelines and interventions for this sleep-vulnerable population.

[The effects of quarantine for SARS-CoV-2 on sleep: An online survey]

Objectif

Déterminer l’évolution du sommeil chez les Français pendant le confinement motivé par la pandémie du SARS-CoV-2 et définir les facteurs comportementaux associés à un sommeil détérioré.

Méthodologie

Une enquête en ligne via les réseaux sociaux pendant la période de confinement. Les questions ont ciblé les conditions de confinement, les comportements relatifs au sommeil et les éléments de l’environnement potentiellement perturbateurs du sommeil (exposition à la lumière et activités sportives).

Résultats

Au total, 1777 participants ont été inclus dont 77 % femmes, 72 % âgés de 25–54 ans. Les conditions de confinement les plus fréquentes étaient en couple avec enfants (36 %) et en maison avec jardin (51 %). Quarante-sept pour cent rapportent une diminution de la qualité du sommeil en confinement. Les facteurs associés à une détérioration du sommeil retenus par l’analyse multivariée sont une diminution de la durée du sommeil (OR 15,52 — p < 0,001), un coucher plus tardif (OR 1,72 — p < 0,001), un lever plus matinal (2,18 — p = 0,01), des horaires plus irréguliers (OR 2,29 — p < 0,001), une diminution de l’exposition à la lumière du jour (OR 1,46 — p = 0,01) et une augmentation de l’utilisation des écrans le soir (OR 1,33 — p = 0,04).

Conclusion

La mauvaise qualité subjective du sommeil en confinement est associée à une modification des comportements relatifs au sommeil et de l’exposition à la lumière (moins de lumière du jour et plus d’écran le soir). Pour optimiser le sommeil en confinement, des horaires adaptés et réguliers, une exposition de plus d’une heure/jour à la lumière du jour et l’éviction des écrans le soir sont à conseiller.

Factors associated with autism severity among Malaysian children with Autism Spectrum Disorder

BACKGROUND

Children with Autism Spectrum Disorder (ASD) of different levels of symptom severity may exhibit a wide range of behaviours and characteristics. There is a limited nutrition-related study on children with ASD of different severity in Malaysia.

AIMS

This cross-sectional study aims to determine the association between sociodemographic factors, parental factors, and lifestyle factors with autism severity in children with ASD.

METHODS AND PROCEDURES

A total of 224 children with ASD were included in this study. Their mothers completed a self-administered questionnaire on sociodemographic characteristics, autism severity, parenting style, parental feeding practices, parenting stress, child's sleep habits and eating behaviours.

OUTCOMES AND RESULTS

As high as 78.1 % of the children with ASD demonstrated a high level of autism severity. Multiple linear regression showed that father's employment status (B = 6.970, 95 % CI = 3.172, 10.768, p < 0.001) and perceived child weight (B = 3.338, 95 % CI = 1.350, 5.327, p = 0.001) predicted autism severity.

CONCLUSIONS AND IMPLICATIONS

Children with ASD in this study had a high level of autism severity. Regular anthropometric measurements by healthcare professionals should be conducted at the autism intervention centres. It is important to have multidisciplinary collaboration in future research to develop customised guidelines for parents with autistic children.

[Relationship among sleep quality, sleep habits and school adjustment in adolescents from an urban district of Galicia.]

OBJECTIVE

The duration and the sleep quality are related to the emotional status and the academic performance in adolescents. The objective of this study was to evaluate the quality of sleep in a group of adolescents, and to explore its relationship with school adjustment and performance.

METHODS

A cross-sectional descriptive study was made with 56 adolescents aged 13-17 years from a high school institute in an urban district of La Coruña city was performed during the scholar´s year 2016-2017. The participants completed the Pittsburgh Sleep Quality Index (ICSP) and the Brief School Adjustment Scale, and a brief questionnaire about their sleep habits and school scores. Descriptive analysis and different comparative parametric or not parametric statistical tests were applied according to type of variable; statistical significant value was considerate for p<0.10.

RESULTS

The 35.7% of sample was poor sleepers and sleepiness was the most altered variable in ICSP. The female participants tended to sleep less than the male participants, and all of them went to sleep 100 minutes later on the weekend. Being a good or bad sleeper did not affect academic performance. Globally the school adjustment was satisfactory. Diurnal dysfunction was related to a worse adolescent-teacher and adolescent-classmate relationship. Diurnal dysfunction was also related to a poor motivation to perform academic tasks.

CONCLUSIONS

Sleepiness is the most relevant problem in poor sleepers. Sleepiness has a negative influence on school adjustment and motivation for school activities of all adolescents; it is frequent and underestimated in most of the cases.

Association between Sleep Habits and Problems and Internet Addiction in Adolescents

OBJECTIVE

This study examined the association between sleep habits and problems and Internet addiction in adolescents.

METHODS

Junior high school students from a local town in Japan (n=853; male/female, 425/428) were the subjects of this study, and were assessed for severity of Internet addiction and sleep habits and problems using the self-reported version of the Young's Internet Addiction Test (IAT) and Child and Adolescent Sleep Checklist (CASC).

RESULTS

The wake time on weekdays was not significantly different among the three groups; addicted, possibly-addicted, and non-addicted. In the addicted group, the total night sleep time was significantly shorter, and the bedtime was significantly delayed on both weekdays and weekends compared with those in the possibly-addicted and non-addicted groups. The wake time of the addicted group was significantly later than that of the other groups. The total scores of sleep problems measured by the CASC were significantly higher in the addicted and possibly-addicted groups than in the non-addicted group.

CONCLUSION

Internet addiction is strongly associated with sleep habits and problems in adolescents. These findings suggest that internet addiction should be considered while examining adolescent lifestyle.

The Effect of Nutrition and Sleep Habits on Predisposition for Metabolic Syndrome in Greek Children

PURPOSE

To investigate the effect of lifestyle habits in childhood Metabolic Syndrome (MTS).

DESIGN AND METHODS

Descriptive correlation study with 480 participants (5-12 years old) using a specially designed questionnaire was conducted. Anthropometric and biochemical analyses were performed.

RESULTS

Fifteen percent of children exhibited predisposition for MTS. Regarding sleep habits, logistic regression analysis (LRA) showed that hour of sleep -before 22:00- was associated with decreased waist circumference (WC%) (p = .026). Midday siesta was negatively correlated with systolic (SBP) (p = .001) and diastolic blood pressure (DBP) (p = .046). In children without MTS, lack of sleep and night time sleep was positively correlated with DBP (p = .044) and fasting blood glucose (FBG) (p = .005). Regarding nutrition habits, fast food consumption was positively correlated with SBP (p = .006) and meat consumption was positively correlated with both Body Mass Index% (BMI%) (p = .038) and WC% (p = .023). LRA showed that fruit (p = .001) and legume (p = .040) consumption was associated with decreased FBG; fish consumption with decreased Low Density Lipoprotein (LDL) cholesterol (p = .031), vegetable (p = .054) and cereal consumption (p = .012) with decreased DBP. In children with MTS, fruits were associated with increased FBG (p = .034). In children without MTS, meat consumption was associated with increased LDL (p = .024), cereal with increased WC% (p = .002) and olive products with increased High Density Lipoprotein (HDL) cholesterol and BMI% (p = .037).

CONCLUSIONS

The adoption of both balanced diet and sleep habits seemed to be crucial for the prevention of MTS.

PRACTICE IMPLICATIONS

Clinical health nurses could develop and implement preventive intervention programs in order to avoid metabolic complications in adulthood.

Sleeping Habits among School Children and their Effects on Sleep Pattern

Introduction: Sleep problems can occur at any age. Inadequate sleep affects the physiological as well as psychological well-being of an individual. Thus, the objective of the present study is, to determine the pre sleep habits, duration and pattern of sleep among school children and to determine association between their sleep schedules and sleep habits.

Methods: This cross-sectional study comprised of 1050 children attending the government school. Based on inclusion and exclusion criteria children were from three age groups: 4-5 years, 6-10 years and 11-15 years of age. A questionnaire about demographical data, sleep problems and habits, was duly filled by the parents. The parents of children were questioned for bed time, wakeup time, sleep time and sleep duration during both weekdays and weekends.

Results: Total sleep time during weekdays was 8.9 (1.2) hours and 10.7 (1.1) hours during weekends. The wakeup time was significantly delayed during weekends in all age groups. Moreover, total sleep time increased significantly during weekends in all age groups. Children using media after 8 pm and sleeping alone are also in significant sleep debt. Screen activities such as TV, internet and cellular phones in a child’s bedroom had a negative effect on children’s sleep/wake patterns and duration of sleep. Children in higher grades are sleep debt compared to younger ones. Practices such as co sleeping and sharing bed with parents significantly improve the duration and quality of sleep.

Conclusion: The sleep durations reported in the present study were lower than recommended sleep duration for children.

Sleep characteristics associated with drowsy driving

OBJECTIVE

The aim of this study was to evaluate sleep characteristics associated with drowsy driving in an adult population.

METHODS

The study subjects consisted of 1675 adults aged 19 years or older who completed a population-based questionnaire survey on sleep habits. Experiences of drowsy driving were obtained from self-reported data. We investigated sleep-related variables including sleep duration, sleep efficiency, chronotype, subjective sleep perception, daytime sleepiness, sleep quality, and snoring. We performed multivariate logistic regression analysis to determine sleep characteristics independently associated with drowsy driving.

RESULTS

The mean age of the subjects was 43.2 years, and 66.3% were men. The prevalence of self-reported drowsy driving was 23.6% (396 of 1675), and 33.1% of subjects experienced dozing at the wheel at least once a month. Multivariate analysis demonstrated that men, office and manual workers, excessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were independently associated with drowsy driving. Subgroup analyses revealed that reduced weekday sleep duration was a risk factor of drowsy driving in adults with perceived sufficient sleep. On the other hand, frequent alcohol drinking significantly increased risk of drowsy driving in the subgroup with perceived sleep insufficiency. Furthermore, ordinal regression analyses confirmed the association between sleep characteristics and drowsy driving across different drowsy driving frequencies.

CONCLUSION

Excessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were sleep-related risk factors for drowsy driving. In addition to maintaining healthy sleep habits, individuals at high risk should be encouraged to evaluate underlying sleep disorders or psychiatric problems to prevent drowsy driving.

The association between chronotype and sleep problems in preschool children

OBJECTIVE

Adolescents and adults who are evening-types exhibit shorter sleep duration and more sleep problems than individuals with an earlier chronotype. We hypothesized that already at a preschool age, evening-types would exhibit more sleep problems relative to children who are morning or intermediate chronotypes. The aim of this study was to examine the association between chronotype and sleep problems among preschool children.

METHODS

We studied a subset of typically-developing 4.5-year-olds taking part in the Growing Up in Singapore Towards healthy Outcomes birth cohort study (n = 244). The Children's Chronotype Questionnaire (CCTQ) was used to categorize children into morning-, intermediate-, and evening-types. Sleep problems were measured using the Children's Sleep Habits Questionnaire (CSHQ), with higher scores corresponding to greater sleep problems. The relation between chronotype, sleep-wake timing, and nocturnal sleep time was also evaluated in a subsample of 117 children using actigraphy recordings with parent-reported sleep diaries.

RESULTS

After controlling for potential confounders (maternal education, child's sex, birth order, and ethnicity), a significant main effect of chronotype on sleep problems was observed, in which evening-types exhibited greater CSHQ scores compared to morning- and intermediate-types (all p < 0.001). Actigraphy data in the subsample confirmed that evening-types had later bedtimes (p < 0.001) and get-up times (p = 0.02) during weekdays and weekends, but shorter nocturnal sleep time (p = 0.034) only during weekdays, compared to children who had earlier chronotypes.

CONCLUSIONS

In preschool children, sleep problems were greater in evening-types compared to morning- and intermediate-types, suggesting that chronotype could be a contributing factor to sleep disturbances in early childhood.

Differences in sleep habits, study time, and academic performance between US-born and foreign-born college students

PURPOSE

To inform the design of a sleep improvement program for college students, we assessed academic performance, sleep habits, study hours, and extracurricular time, hypothesizing that there would be differences between US-born and foreign-born students.

METHODS

Questionnaires queried participants on bedtimes, wake times, nap frequency, differences in weekday and weekend sleep habits, study hours, grade point average, time spent at paid employment, and other extracurricular activities. Comparisons were made using chi square tests for categorical data and t tests for continuous data between US-born and foreign-born students.

RESULTS

Of 120 participants (55 % women) with racial diversity (49 whites, 18 blacks, 26 Hispanics, 14 Asians, and 13 other), 49 (41 %) were foreign-born. Comparisons between US-born and foreign-born students showed no differences in average age or gender though US-born had more whites. There were no differences between US-born and foreign-born students for grade point averages, weekday bedtimes, wake times, or total sleep times. However, US-born students averaged 50 min less study time per day (p = 0.01), had almost 9 h less paid employment per week (14.5 vs 23.4 h per week, p = 0.001), and stayed up to socialize more frequently (63 vs 43 %, p = 0.03). Foreign-born students awakened an hour earlier and averaged 40 min less sleep per night on weekends.

CONCLUSIONS

Cultural differences among college students have a profound effect on sleep habits, study hours, and extracurricular time. The design of a sleep improvement program targeting a population with diverse cultural backgrounds must factor in such behavioral variations in order to have relevance and impact.

Impact of sleep on osteoporosis: sleep quality is associated with bone stiffness index

OBJECTIVE

The aim of the present study was to investigate the impact of sleep on osteoporosis.

METHODS

The study used a baseline examination of the Hiroshima Sleep and Healthcare study, which was a cross-sectional and cohort study that addressed the association of sleep habits with lifestyle-related diseases. A total of 1032 participants (25-85 years of age) who underwent health examinations were included. Sleep habits, including its timing (bed time), quantity (time in bed [TIB]), and quality, were assessed using the Pittsburgh Sleep Quality Index (PSQI). The bone stiffness index (SI), a marker of osteoporosis, was measured using quantitative ultrasound systems.

RESULTS

Bed time (r = 0.065, p <0.05), TIB (r = -0.064, p <0.05), and global PSQI score (r = -0.126, p <0.0001) significantly correlated with SI. Multiple regression analyses revealed that after adjusting for age, sex, body mass index, smoking, and alcohol intake, the global PSQI score (β = -0.053, p <0.05) was significantly associated with SI, whereas bed time or TIB was not. Among each component of PSQI, sleep disturbances (β = -0.084, p <0.005) were significantly associated with SI.

CONCLUSION

Poor sleep quality may be associated with osteoporosis. In particular, increased sleep disturbances may be a key factor in the association between poor sleep quality and osteoporosis.

Extreme late chronotypes and social jetlag challenged by Antarctic conditions in a population of university students from Uruguay

In humans, a person’s chronotype depends on environmental cues and on individual characteristics, with late chronotypes prevailing in youth. Social jetlag (SJL), the misalignment between an individual׳s biological clock and social time, is higher in late chronotypes. Strong SJL is expected in Uruguayan university students with morning class schedules and very late entertainment activities. Sleep disorders have been reported in Antarctic inhabitants, that might be a response to the extreme environment or to the strictness of Antarctic life. We evaluated, for the first time in Uruguay, the chronotypes and SJL of 17 undergraduate students of the First Uruguayan Summer School on Antarctic Research, using Munich Chronotype Questionnaire (MCTQ) and sleep logs (SL) recorded during 3 phases: pre-Antarctic, Antarctic, and post-Antarctic. The midsleep point of free days corrected for sleep debt on work days (MSFsc,) was used as proxy of individuals’ chronotype, whose values (around 6 a.m.) are the latest ever reported. We found a SJL of around 2 h in average, which correlated positively with MSFsc, confirming that late chronotypes generate a higher sleep debt during weekdays. Midsleep point and sleep duration significantly decreased between pre-Antarctic and Antarctic phases, and sleep duration rebounded to significant higher values in the post-Antarctic phase. Waking time, but not sleep onset time, significantly varied among phases. This evidence suggests that sleep schedules more likely depended on the social agenda than on the environmental light–dark shifts. High motivation of students towards Antarctic activities likely induced a subjective perception of welfare non-dependent on sleep duration.

Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey

OBJECTIVE

Behavioral problems are often associated with poor sleep habits in children. We investigated whether undesirable toddler-age sleep schedules may be related to school-age behavioral problems.

METHODS

We analyzed the data of a nationwide longitudinal survey with available results from 2001 to 2011. The participants were 41,890 children. The predictors were waking time and bedtime at 2years of age, and the outcomes were assessed by determining the presence or absence of three attention problems and four aggressiveness problems at 8years of age. In logistic regression models with adjustments for confounding factors, we estimated odds ratios (ORs) and confidence intervals (CIs) for the association between toddler sleep schedules and behavior during primary-school age years.

RESULTS

The outcomes of attention problems and aggressiveness problems were observed in 1.7% and 1.2% of children, respectively, at 8years of age. The OR of an irregular or late morning waking time at 2years of age with the outcome of aggressiveness problems was 1.52 (95% CI, 1.04-2.22) in comparison to an early waking time. The OR of an irregular or late bedtime with attention problems was 1.62 (95% CI, 1.12-2.36), and the OR of an irregular or late bedtime with aggressiveness problems was 1.81 (95% CI, 1.19-2.77) in comparison to an early bedtime.

CONCLUSION

Poor toddler-age sleep schedules were found to predict behavioral problems during primary-school age years. Thus, good and regular sleep habits appear to be important for young children's healthy development.

Influence of sleep timing behavior on weight status and activity patterns in adults with intellectual disabilities

The aim was to explore the relationship between sleep habits and overweight/obesity, physical activity and sedentary behaviors in French adults with intellectual disabilities. This observational study was conducted on 570 French adults with intellectual deficiency. Sleep habits were analyzed and related to anthropometric measures, physical activity and sedentary behaviors. The study was conducted using a self-administered questionnaire. Participants completed the questionnaire during an interview with the principal investigator. Sleep timing behavior was classified into 4 sleep patterns: Early-bed/Early-rise, Early-bed/Late-rise, Late-bed/Late-rise, and Late-bed/Early-rise. Of 570 eligible participants, 61 were excluded because of missing data on age, weight or height. The number of participants identified in each of the four sleep patterns was as follows: Early-bed/Early-rise, N = 119 (23%), Early-bed/Late-rise, N = 171 (34%), Late-bed/Early-rise, N = 100 (20%), Late-bed/Late-rise N = 119 (23%). Participants who wake up earlier are more active than those who rise late (p < 0.02). Participants who slept later spent more time in sedentary activities than those in the Early rise groups (p < 0.01). The number of obese/overweight participants was also higher in Late-bed/Late rise group. Sleep behavior was associated with overweight/obesity, physical activity and sedentary behavior in adults with intellectual deficiency, independently the sleep duration. Implementing intervention or promotion programs on sleep behaviors should be considered in order to meet the objectives of promoting health on anthropometric characteristics and increased physical activity among these disabled adults.

Study of sleep habits and sleep problems among medical students of pravara institute of medical sciences loni, Western maharashtra, India

BACKGROUND

Good quality sleep and adequate amount of sleep are important in order to have better cognitive performance and avoid health problems and psychiatric disorders.

AIM

The aim of this study was to describe sleep habits and sleep problems in a population of undergraduates, interns and postgraduate students of Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, India.

SUBJECT AND METHODS

Sleep habits and problems were investigated using a convenience sample of students from Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, India. The study was carried out during Oct. to Dec. 2011 with population consisted of total 150 medical students. A self-administered questionnaire developed based on Epworth Daytime Sleepiness Scale and Pittsburgh Sleep Quality Index was used. Data was analyzed by using Statistical Package of Social Sciences (SPSS) version 16.0.

RESULTS

In this study, out of 150 medical students, 26/150 (17.3%) students had abnormal levels of daytime sleepiness while 20/150 (13.3%) were border line. Sleep quality in females was better than the male.

CONCLUSION

Disorders related to poor sleep qualities are significant problems among medical students in our institution. Caffeine and alcohol ingestion affected sleep and there was high level of daytime sleepiness. Sleep difficulties resulted in irritability and affected lifestyle and interpersonal relationships.