Bedtime Routines Research Articles

0104 Greater sleep regularity among adolescents predicts less daytime video game playing

Abstract Introduction Daytime video game playing is a sedentary behavior that has been associated with worse adolescent health outcomes, including obesity, mood disorders, and poor sleep. However, few studies have explored the influence of sleep on time spent engaged in screen-based activities. This is the first study to examine whether sleep regularity, a measure that encapsulates within-person sleep timing, duration, and disruption across successive days of actigraphy, is associated with daytime video gaming among adolescents. Methods We analyzed sleep sub-study data from the age 15 wave of the Fragile Families and Child Wellbeing Study (n=314 adolescents, 15.4±0.5 years old). Adolescents wore wrist actigraphy devices and concurrently completed daily surveys reporting how many hours they played video games. The sleep regularity index (SRI) was calculated as the percentage probability of an individual being in the same sleep/wake state at any two times 24 hours apart across seven consecutive days of valid actigraphy (range 0-100). Multilevel Poisson models with random intercepts for daily video gaming adjusted for school days, sex, ethnoracial group, bedtime routines, parent education, family poverty, and family structure. The stability of the association between SRI and video gaming was additionally tested using the first two to six consecutive days of actigraphy. Results Every 10 units increase in SRI was associated with 9% fewer daily hours of video gaming on average (OR=0.91, CI=0.84, 0.998, p=0.046). Findings were consistent when SRI was calculated using the first four or more consecutive days of actigraphy (8-10%, p≤0.043), and the association was nonsignificant when using the first two or three days. Conclusion Adolescents who had greater sleep regularity tended to spend less time playing video games. Future research should consider interventions that target the consistency of sleep patterns across the week. Improving the regularity of sleep timing and duration may reduce video game playing and confer positive downstream effects on adolescent health. Support (if any) R01HD073352, R01HD36916, R01HD39135, R01HD40421, T32DA017629

0767 INSIGHT Responsive Infant Parenting Intervention and Child Sleep at Age 6 Years

Abstract Introduction The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers resulted in more responsive bedtime parenting and longer infant sleep duration in the first year after birth. The current analysis evaluates intervention effects on parent-reported sleep behaviors and objectively-measured sleep at child age 6 years. Methods Mothers (n=279) were randomized to the RP or control intervention, delivered by nurses at home and clinic visits through child age 2.5 years. Sleep content focused on establishing bedtime routines, age-appropriate bedtimes, and promoting self-soothing at bedtime and after night wakings. At 6 years, children completed wrist actigraphy (Spectrum Plus) for 7 days during the school year. Children with ≥3 valid days were included in analyses (n=162). Mothers (n=173) completed the Children’s Sleep Wake Scale and Children’s Sleep Hygiene Scale. Study group differences for 10 sleep actigraphy variables (M/SD of onset, offset, and midpoint of sleep timing, sleep maintenance efficiency, and total sleep time), as well as survey scores, were examined. Results Children (mean age 6.7 years, 96% non-Hispanic White) slept on average 8.8 hours ± 33 minutes per night, with 40% meeting the minimum recommendation of 9 hours. The mean sleep onset time was 9:14 pm ± 50 minutes. There were no significant study group differences in any actigraphy variables. RP mothers reported higher scores for Total Sleep Quality (4.6 ± 0.5 vs. 4.4 ± 0.6, p=0.03), ‘Going to Bed’ subscale (4.3 ± 0.8 vs. 4.0 ± 0.9, p=0.03), which captures child compliance with bedtime, and ‘Reinitiating Sleep’ subscale (4.6 ± 0.9 vs. 4.2 ± 1.1, p=0.005), which captures the child’s ability to go back to sleep on their own after waking. Total Sleep Hygiene score did not differ between groups. Conclusion The INSIGHT intervention targeting sleep in infancy was associated with improved parental perception of bedtime stalling and self-soothing behaviors at age 6 years. However, this did not translate into differences in sleep duration, timing, or quality measured by actigraphy. Future research should examine strategies to maintain the impacts of the RP intervention on infant sleep into middle childhood. Support (if any) R01DK088244, KL2TR002015

0197 To delay perchance to sleep: The daily association between pre-sleep arousal and bedtime procrastination

Abstract Introduction Bedtime procrastination, a behavior associated with poor sleep health and wellbeing, refers to voluntary delays of bedtime. Although bedtime procrastination is often defined as a needless or mindless delay, bedtime procrastinators often report delaying their bedtime strategically to regulate sleep-interfering processes. One such process is pre-sleep arousal, an important vulnerability for and perpetuating factor in insomnia. Preliminary evidence supports this association, as some bedtime procrastinators report delaying bedtime to avoid anxiety-producing bedtime routines. However, this association has not been directly examined. To further investigate strategic delay in bedtime procrastination, the current study examined the association between pre-sleep arousal and bedtime procrastination using a daily diary design. Methods 390 young adult participants (Mage = 24.4, SD = 6.5) completed 14-days of experience sampling procedures, including completing self-report measures of nightly pre-sleep arousal and morning ratings of prior-night bedtime procrastination. Associations between pre-sleep arousal and bedtime procrastination were estimated with multilevel models using centering procedures which disaggregated between- and within-person covariance. Gender and age were entered into each model as covariates. Results Pre-sleep arousal was associated with increased bedtime procrastination both within- (B = 0.01, p < 0.001) and between-persons (B = 0.02, p < 0.001). Additionally, cognitive pre-sleep arousal was more strongly associated with bedtime procrastination (Bwithin = 0.014, p < 0.001; Bbetween = 0.032, p < 0.001) than somatic arousal (Bwithin = 0.007, p = 0.165; Bbetween = 0.038, p < 0.001). Conclusion The results suggest that pre-sleep arousal is a putative mechanism for bedtime procrastination. Cognitive arousal, including worry and rumination, may be particularly relevant for the development of this behavior. This finding supports the notion that bedtime procrastination may occur as a (maladaptive) strategy to regulate pre-sleep arousal. Alternatively, findings may suggest that bedtime procrastinators engage in arousing pre-sleep activities. Regardless, the association between bedtime procrastination and pre-sleep arousal suggests that bedtime procrastination is relevant in the development and/or maintenance of sleep-related disorders. Treatment of bedtime procrastination may be enhanced by considering the role this behavior has in regulating pre-sleep arousal. Support (if any)

0239 Perceptions of Sleep Health among Black Americans: Recommendations for Improving Sleep

Abstract Introduction Despite African Americans having a high prevalence of poor sleep health, the determinants remain understudied. Sleep disparities research mainly examines quantitative data, with little attention to qualitative data, which can inform targeted interventions. We aimed to qualitatively identify 1) perceptions of sleep; 2) facilitators/barriers to healthy sleep; and 3) preferences for receiving sleep recommendations in a socioeconomically diverse sample of African Americans. Methods Participants (N=36 individuals divided into 11 groups) attended online focus groups and discussed the following topics: attitudes and beliefs about sleep, facilitators and barriers to sleep, and knowledge and attitudes about sleep recommendations. Self-reported sleep was measured via the Pittsburgh Sleep Quality Index. The focus group data were analyzed using a rapid analytic approach. Results The sample had a mean age of 34 (13.1), and 64% identified as female. The overall prevalence of poor sleep quality, short sleep duration, and long sleep duration was 39%, 24%, and 15%, respectively. Participants defined healthy sleep as a matter of quality over quantity and waking up feeling well-rested. Women, men, and gender non-conforming individuals reported average sleep durations of 6.3 hours, 5.9 hours, and 8 hours, respectively. Women, but not men or gender non-confirming individuals reported disturbed mood because of poor sleep. Regardless of gender, participants reported anxiety, stress, and daily responsibilities such as work, taking care of family, and sudden changes in plans as barriers to healthy sleep. A subset of respondents (25.5%) reported screen time and feeling unsafe as barriers. Men and women reported listening to music, aromatherapy, relaxing, and limiting phone use before bedtime as facilitators to healthy sleep. Men preferred information on how to achieve and maintain deep/quality sleep, whereas women preferred more personalized information on sleep and the sleep-mental/physical health relation. Social media was generally the preferred avenue for receiving sleep recommendations. Conclusion Mood, stress, screen time and lack of safety were identified barriers to healthy sleep patterns. Participants were interested in strategies for improving sleep health. Future studies should consider targeting relaxing bedtime routines and enhanced safety as sleep interventions. Support (if any) National Institutes of Health, National Institute for Heart Lung and Blood 1R01HL157954 and K01HL138211.

0781 Relationship between Bedtime Routines with Sleep, Development, and Parenting Stress in Toddlers

Abstract Introduction Institution of a nightly bedtime routine is a key component of sleep health and is likely to foster positive early childhood development. The current study investigated the longitudinal and concurrent relationships between a bedtime routine and sleep, social-emotional development, and parenting stress in toddlers living in lower income homes and/or neighborhoods. Methods Caregivers of 78 toddlers (56.4% female; M=12.87 mos; 67.9% Black; 73.1% WIC) reported on their child’s bedtime routine at their 12-month well-child visit. At their child’s 15- and 24-month well visit, caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R SF), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Parenting Stress Index (PSI-SF). Results were considered significant at p<.05. Results Toddlers with a consistent bedtime routine (5+ nights per week) at 12 months had significantly earlier bedtimes (20:54 vs 21:24) and waketimes (7:21 vs 8:48) at 24 months compared to those without a consistent routine. At 15 months, a more frequent bedtime routine was associated with fewer concurrent social-emotional problems (r = -.32) and decreased bedtime difficulty (r = -.34). At 24 months, toddlers with a consistent bedtime routine (33.3%) were less likely to exhibit concurrent BITSEA social-emotional competency concerns (66.7%). Caregivers also reported better nighttime sleep in toddlers with a consistent routine at 24 months. Additionally, caregivers whose child had a consistent routine at 15 and 24 months perceived their child as less difficult (PSI) at 24 months. However, no associations emerged between bedtime routine frequency and consistency at 12, 15, and 24 months with ASQ communication and personal-social concerns. Conclusion Bedtime routine frequency and consistency in toddlers was associated with better caregiver-perceived sleep, social-emotional development, and lower parental stress regarding their child being perceived as difficult, but not communication and personal-social concerns. A bedtime routine may be a cost-effective strategy to promote toddlers’ sleep, overall development, and family’s functioning. Support (if any) This study was partially funded by the Simms/Mann Institute

0183 Bedtime Routine Stability in the Context of Developmental Risk

Abstract Introduction Consistent bedtime routines are an important promoter of child sleep health. This is particularly true for children developing at elevated risk for sleep and developmental challenges. Consistent and calming bedtime routines are associated with fewer parent-reported night wakings, shorter sleep onset times, and (for some) longer nighttime sleep bouts. However, few studies systematically address bedtime consistency within the context of developmental risk. To inform future sleep promotion in children with developmental concerns, this study assessed bedtime routine consistency. Methods Across two video-recorded bedtimes, this study assessed the consistency of routines for children (n = 40) with social communication concerns from ages 8-61 months, M(SD)= 28.14(11.76). Each child was enrolled in an eight-session Family Routines Intervention (FRI). The goals of this intervention were to improve family social communication scaffolding within family routines. Bedtime routines were coded for caregiver involvement, sleep onset location, and dyad actions. Results Mothers were the most common bedtime caregiver (93-95%) and her involvement was consistent for most children (96%). Father involvement was less common (present for 25-38% of recordings) and was less consistent at 56%. Other caregivers were present for roughly 18% of dyads, but their involvement was not as consistent (13%). Sleep onset location varied widely with only 33-38% sleeping in a crib, yet crib placement was moderately consistent (64%). Roughly 20% of children slept in an adult bed, with similar consistency (63%). Book reading was the most common (40-43%) and consistent (73%) bedtime action. Bedtime media use was uncommon (8-15%) but surprisingly consistent (44%). Conclusion For children at elevated risk for sleep and developmental concerns, bedtime routines were notably diverse and inconsistent. Although bedtime routines were not the focus of the FRI study, it afforded a unique opportunity to objectively assess how families prepare their child for bed on distinct nights across a relatively short time (8-12 weeks). Not surprisingly, mothers were the primary caregiver, highlighting her potential role in future interventions. The variability in sleep onset location and bedtime actions were notable. These areas reflect clear targets for future interventions designed to promote relatively short, calming, and consistent bedtime routines. Support (if any) Purdue Research Foundation and the Gadomski Foundation

Preschoolers’ Bedtime Routine and Emotion Regulation

Preschoolers’ Bedtime Routine and Emotion Regulation

Qualitative Exploration Toward the Development of a Parent-Rated Scale for Insomnia in Children with Autism Spectrum Disorder.

Toward the development of a new parent-rating for insomnia, this multi-site qualitative study explored sleep problems and related impacts in children with autism spectrum disorder (ASD) and their families. To ensure content validity of the measure, we conducted six focus groups with caregivers (N = 25) of 24 children (age 3 to 18 years) with ASD. Based on parent report, all children had a history of mild or greater insomnia. The focus group transcripts were systematically coded to identify major themes. Verbatim comments from caretakers were used to generate 134 candidate items. Further review by the research team and an expert panel followed by individual cognitive interviews with 12 parents reduced the item bank to 40. The thematic analysis of focus group transcripts identified 7 categories: (1) Trouble falling asleep; (2) trouble staying asleep; (3) early morning waking; (4) bedtime routines; (5) parental strategies for bedtime management; (6) impact of sleep problems on the child; and (7) impact of sleep problems on the family. The Flesch Kincaid Grade Level of the 40-item version was 7.2 (seventh grade reading level). Insomnia in children with ASD shares features in common with insomnia in the general pediatric population. However, perhaps owing to autistic features such as insistence on sameness, sensory sensitivities, communication impairments, insomnia in children with ASD appears to have unique behavioral manifestations. Content validity and item clarity of the 40-item bank were supported by expert panel review and cognitive interviews with caregivers of children with ASD.

Understanding drivers of micro-level disparities in childhood body mass index, overweight, and obesity within low-income, minority communities

The focus of childhood obesity disparities has been mainly on macro-level disparities, such as, between lower versus higher socioeconomic groups. But, less is known about micro-level disparities, that is disparities within minority and low-income populations. The present study examines individual and family level predictors of micro-level obesity disparities. We analyze data on 497 parent–child dyads living in public housing communities in Watts, Los Angeles. Cross-sectional multivariable linear and logistic regression models were estimated to examine whether individual and family level factors predict children’s BMI z-scores, overweight, and obesity in the sample overall and separately by child’s gender and age group. Child characteristics of our study sample included mean age 10.9 years, 74.3% Hispanic, 25.7% Non-Hispanic Black, 53.1% female, 47.5% with household income below $10,000, 53.3% with overweight or obesity, and 34.6% with obesity. Parental BMI was the strongest and most consistent predictor of child zBMI, overweight, and obesity, even after controlling for parent’s diet and activity behaviors and home environment. The parenting practice of limiting children’s screentime was also protective of unhealthy BMI in younger children and females. Home environment, parental diet and activity behaviors, and parenting practices related to food and bedtime routines were not significant predictors. Overall, our findings show that there is considerable heterogeneity in child BMI, overweight, and obesity even within low-income communities with similar socioeconomic and built environments in their neighborhoods. Parental factors play an important role in explaining micro-level disparities and should be an integral part of obesity prevention strategies in low-income minority communities.

Behavioural sleep problems in children.

Behavioural sleep problems are very common in children and are concerns for many parents. This review discusses normal sleep physiology and sleep development and focuses on common behavioural sleep problems in childhood, including behavioural insomnia of childhood, parasomnias and sleep-related movement disorders, highlighting their clinical features and management. Behavioural insomnia of childhood is characterised by learned difficulties in falling asleep and/or staying asleep. Management includes establishing bedtime routines and behavioural techniques. Parasomnias include confusional arousals, sleepwalking, sleep terrors and nightmares, and these usually resolve with time. Management includes parental reassurance and behavioural interventions such as scheduled awakening. With regards to sleep enuresis, management includes behavioural modifications, enuresis alarm and desmopressin. Sleep-related movement disorders include sleep-related bruxism and sleep-related rhythmic movements, of which body rocking is the most common. Early identification and management of behavioural sleep problems may prevent their negative impact on children as well as their families.

P079 A new lens on preschool sleep: Using wearable cameras to capture pre-bedtime activities

Abstract Introduction While bedtime routines are often recommended to address behavioural sleep problems in young children, these recommendations are based on parental subjective assessment of behaviours which may not be accurate. The aim of this study was to establish the feasibility of using wearable cameras to objectively measure bedtime routines and pre-bedtime screen use in preschool-aged children. Methods Sixteen children aged 3-4 years wore a GoPro video camera for two hours prior to bedtime on three consecutive evenings. Subsequent sleep parameters were monitored for seven nights by actigraphy. Standardised questionnaires and a sleep diary provided traditional measures of child sleep behaviours. Feasibility was determined by adherence to protocol and ability to develop a reliable behavioural coding scheme from the video data. Acceptability was determined through feedback questionnaires and exit interviews. Results Participant families found the cameras acceptable, with the majority of parents agreeing the cameras were easy to use (94%) and keep on their child (81%). Parents felt that wearing the camera did not change how they parented their child (88%), or their child’s behaviours (81%). A behavioural coding scheme incorporating self-care activities, nutrition, reading, physical contact and screen use (time, device type, media content) was successfully developed with interrater reliability established by two independent coders (kappa >0.8). Conclusions Wearable cameras provide a feasible and acceptable method to measure bedtime routines and screen use in preschool-aged children. This appears to be is the first study to use wearable cameras to objectively measure pre-bedtime activities in this age-group.

Turkish children’s bedtime routines during the COVID-19 pandemic: preliminary evaluation of the bedtime routines questionnaire

ABSTRACT Children’s routines, including bedtime, have been disrupted during the COVID-19 pandemic. How parents engage in their children’s bedtime routines has not yet been examined in Turkey. The purpose of the current study was to understand the nature of children’s bedtime routines and how these routines contributed to their sleep behaviors during the COVID-19 pandemic. Mothers of 313 (143 girls) children aged between 16 and 84 months old (M = 52.42, SD = 12.36) completed questionnaires regarding children’s bedtime routines and sleep behaviors. The structure of the bedtime routines questionnaire was confirmed. Results from the regression analyses showed that routine environment was related to both bedtime resistance and sleep duration. Reactivity during bedtime was related to bedtime resistance. Results highlight the importance of consistent bedtime routines for quality sleep.

Factors that are hindering and facilitating sleep quality of children with intellectual disabilities and their mothers: A qualitative study

Accessible summary We asked mothers of children with intellectual disability about the factors that affected their and their children's sleep quality. We found that factors in the body, mind and environment all affect sleep quality. We suggest that parents would benefit from education and counselling to help establish good bedtime routines and manage stress.

An overview of reviews for preventing and treating sleep problems in infants.

Parents and professionals receive conflicting recommendations about management of infant sleep problems. The aim of this umbrella review was to provide an overview of summarised research on the prevention and treatment of sleep problems in infants (0-1year), content of the interventions and the conditions under which they are delivered. The umbrella review included five systematic reviews of 24 individual studies, mainly randomised controlled trials. Searches were conducted in PsycINFO, Cochrane, Campbell, Epistemonikos, PDQ-Evidence, IN SUM and the Norwegian Institute of Public Health, for reviews published during 2010-2021. The systematic reviews showed that behavioural interventions increased sleep in infants and parents. Interventions entailed reducing parental disturbances during sleep onset and enabling the infant to fall asleep and maintain sleep on their own. Knowledge about infant sleep and the establishment of positive bedtime routines seemed crucial for preventing and treating sleep difficulties. The interventions can be delivered in a few sessions, typically one-on-one during the postnatal period. Behavioural interventions can be recommended and adapted to the individual family. Positive outcomes for the infant and the family depend on a close and coordinated collaboration between child health clinics, community psychologists, general physicians and other services.

0512 Concurrent and longitudinal linkages between bedtime routines and social-emotional development in toddlers

Abstract Introduction Sleep is important for optimal development in early childhood. Instituting a consistent bedtime routine is an empirically supported behavioral intervention to promote early childhood sleep health. However, prior work has focused on the benefits of a bedtime routine for sleep outcomes, with little research on its potential benefits to social-emotional development. Thus, the current study examined concurrent and longitudinal associations between a consistent bedtime routine (defined as 5 or more nights per week) and social-emotional development in toddlers (ages 12.0 to 19.9 months). Methods Caregivers of 32 infants (M = 12.5mos, 59.4% female) completed baseline questionnaires about the frequency of their child’s bedtime routine and other evening activities at their scheduled 12-month well-child visit. At their child’s 15-month well visit, caregivers completed questionnaires including items on bedtime routine frequency, the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Results Over half (59.4%) of caregivers reported a consistent child bedtime routine at 12 months and nearly three quarters (71.9%) reported a consistent bedtime routine at 15 months. Linear regression showed that having a consistent bedtime routine at 15 months was significantly associated with fewer concurrent social-emotional problems on the BITSEA, B = -2.40, p = .009, 95% CI [-3.86, -.94]. Toddlers who scored above the BITSEA cutoff for social-emotional concerns (31.3%) were engaged in a consistent bedtime routine less frequently (M = 4.50 nights/week) than those below the cutoff (M = 6.18 nights/week), p = .004, η2 = .24. However, bedtime routine frequency at 12 months did not predict 15-month BITSEA concerns, p>.05. No associations emerged between bedtime routine frequency at 12 or 15 months and the communication and personal-social ASQ scores. Conclusion A consistent bedtime routine is concurrently, but not longitudinally, associated with positive social-emotional development, including less frequent clinically significant concerns, in toddlers at 15 months of age. Bedtime routine frequency was not linked to communication or personal-social interactions. Implementing a consistent bedtime routine may be a feasible method to promote toddlers’ social-emotional development within the context of concerns. Support (If Any) This study was partially funded by the Simms/Mann Institute

0507 Prevalence and Components of Naptime vs. Bedtime Routines in Young Children

Abstract Introduction Bedtime routines are a well-established sleep-promoting practice for young children; however, little is known about the prevalence or components of naptime routines. Thus, the aim of this study was to explore the prevalence and activities (e.g., feeding, hygiene components) of home-based naptime routines for infants and toddlers. Methods Mothers of 465 infants and toddlers (4-36mos; M=18.5mos) completed an online questionnaire addressing questions about naptime routines and behaviors, as well as the Brief Infant Sleep Questionnaire–Revised (BISQ-R). The sample included infants (4-11.9m; n=147), younger 1-year-olds (12-17.9m; n=87), older 1-year-olds (18-23.9m; n=75), and 2-year-olds (24-36m; n=156). Results Overall, 95% (n=440) reported that their child naps at home, and 65% (n=301) indicated having a naptime routine lasting approximately half an hour (M=29.0 minutes; SD=31.0). As compared to 54% reporting a consistent naptime routine (³5 times per week), ranging from 50% in 2yos to 62% in younger-1yos, 81% had a consistent bedtime routine. Overall, mothers reported a mean 69.0% (SD=24.4) similarity between naptime and bedtime routine steps. A bath (18% at naptime vs. 90% at bedtime), washing-up (30% vs. 56%), lotion use (23% vs. 80%), breastfeeding/breastmilk (21% vs. 37%), and feeding to sleep (44.% vs. 47%) were less prevalent at naptime than bedtime.Prevalence ranges by age group were: bath 12% (2yos) to 23% (infants) at naptime and 84% (infants) to 93% (2yos) at bedtime; washing-up, 28% (infants) to 34% (older-1yos) at naptime and 54% (younger-1yos) to 58% (infants) at bedtime; lotion application, 19% (2yos) to 29% (younger-1yos) at naptime and 78% (2yos) to 83% (younger-1yos) at bedtime; breastfeeding, 8% (2yos) to 35% (infants) at naptime and 13% (2yos) to 65% (infants) at bedtime; and feeding to sleep, 31% (2yos) to 57% (infants) at naptime and 35% (2yos) to 58% (infants) at bedtime. Conclusion Overall, nearly all infants and toddlers napped, and just over half reported having a naptime routine. Naptime routines were much less prevalent than bedtime routines, but overall contained similar activities. Feeding behaviors across naptime and bedtime routines were more similar than hygiene components (e.g., bath), with slight variation by age. Psychoeducation about a naptime routine’s potential benefit may be warranted. Support (If Any) Johnson & Johnson Consumer Inc., Skillman, NJ, USA

0187 Brain Connectivity and Parenting: Association between Familial Factors and Sleep EEG Coherence in Infancy

Abstract Introduction Brain connectivity is tied to cognitive development and behavior. Previous work suggests that interactions with the environment tune the maturing patterns of brain connectivity. As the relevant environmental factors remain largely unknown, we examined whether the sleep-related familial context is associated with infant brain functional connectivity measured through sleep EEG coherence. Methods At-home 124-channel sleep EEG was recorded in 31 healthy infants aged 5.5 to 7.4 months (mean age=5.9±0.5mo; 15 females). Coherence was calculated for the first 80 20-second epochs of NREM sleep in delta (0.75–4.25Hz) and sigma (9.75–14.75Hz) bands, frequencies undergoing pronounced maturational dynamics. We averaged coherence within three regions over the frontal lobe (left, central, right) identified as regions with the strongest connectivity through data-driven clustering. For these regions and bands, linear regression models quantified the association between coherence and familial context, i.e., scores from the Brief Infant Sleep Questionnaire (i.e., sleeping arrangement and bedtime routine), Baby Care Questionnaire (i.e., Structure and Attunement subscales reflecting parental principles regarding infant sleep regularity), Maternal Cognitions about Infant’s Sleep (i.e., total score), age and sex. The best-fitting model was selected through backward selection (Akaike information criterion). Results Surprisingly, sex was the most consistent contributor across regions and bands, with girls exhibiting greater coherence than boys (FDR-corrected 0.004≤p≤0.038). Furthermore, older infants showed lower sigma coherence over the right frontal lobe (FDR-corrected 0.002≤p≤0.004). Additionally, infants co-sleeping with parents or siblings demonstrated lower delta and sigma coherence over the right frontal lobe than infants sleeping in their own bed (FDR-corrected 0.001<p≤0.025). Similarly, fewer maternal worries regarding the infant’s sleep were associated with lower sigma coherence in the right frontal region (FDR-corrected p=0.014). Finally, more regular bedtime routines were linked to increased delta coherence over the left frontal lobe (FDR-corrected p=0.014). Conclusion Based on previous observations indicating that in healthy children the right hemisphere develops first with a subsequent shift in asymmetry to the left, we propose that environmental factors such as co-sleeping, fewer parental worries, and more structured sleeping routines in infancy may serve as targets for early interventions to support this process and thereby healthy brain development. Support (If Any) This work was supported by the Swiss National Science Foundation (PCEFP1 181279) and the University of Zurich (Medical Faculty; Forschungskredit FK 18 047; Stiftung für wissenschaftliche Forschung STWF 17 008).

0510 Parent and Child Perception of Sleep for Children with Sensory Processing Difficulties

Abstract Introduction Roughly 5.3 million elementary children in the United States experience sensory processing (SP) difficulties, like sensitivity to touch and overstimulation with movement. These difficulties cause high levels of daytime stress and daytime dysfunction (e.g., difficulties with attention, academics, and emotional regulation). In typically developing children (without SP difficulties), high levels of daytime stress impact sleep; however, research has yet to explore sleep health in children with SP difficulties. Our study aims to use validated self- and parent-reported questionnaires to characterize differences in sleep health for children with and without SP difficulties. Methods Children (ages 6-10) with (n=22) and without (n=33) SP difficulties (per parent report; Autism and ADHD diagnosis excluded) were recruited for this convergent mixed-methods study. Sleep was assessed using validated self- and parent-report questionnaires, the Sleep Self-Report (SSR) and Children’s Sleep Habits Questionnaire (CSHQ), and through qualitative interviews with parents. Groups were compared using t-test and Mann-Whitney U tests, with significance set a priori at α=0.05. A rapid qualitative analysis produced themes and were integrated with the quantitative data. Results Parents of children with SP report significantly worse sleep quality on the CSHQ difficulties (MedianSP= 50.5, SDSP= 11.45) than parents of children without SP difficulties (MedianCON=43.0, SDCON=7.27, U= -2.92, p=.004). Children with SP deficits also report significantly worse sleep on the SSR (MSPD=42.18, SDSPD=8.26) compared to their peers (MCON=33.55, SDCON=6.71, t(53)= -4.26, p<.001). Qualitative themes highlight the higher prevalence of rigid, lengthy bedtime routines and adaptations within the sleep environment (e.g. specific pajamas, special bedding) to support sleep for children with SP difficulties. Parents of children with SP difficulties also report higher frequencies of an adult being in the room while the child falls asleep and co-sleeping in the middle of the night. Conclusion Parents and children both report poorer sleep in children with SP difficulties when compared to peers. Future studies should incorporate other sleep health measurement tools (e.g. actigraphy) to further understand areas to target for intervention. Support (If Any) Sensory Integration Education Network PhD Grant (PI: Hartman, 2021); University of Pittsburgh’s School of Health and Rehabilitation Science’s PhD Student Award (PI: Hartman, 2021).

A Pilot Study: The Effect of Sunnah Bedtime Routines on the Memorizing and Problem-Solving Skills of University Students

Quality sleep is essential to maintain normal levels of cognitive skills. During sleep, electroencephalogram (EEG) is used to study brain activity to detect disorders. However, the effect of Sunnah bedtime routines on the brain cognitive performance is rarely studied. Therefore, this study was conducted to compare the effect of Sunnah bedtime routines on cognitive performance of ten male college students using cortical information pathway. The students were divided into Group 1 (control) and Group 2 (Sunnah bedtime routine). Members of Group 2 performed Sunnah bedtime routines for six weeks whereas members of Group 1 were not assigned to any particular routine. The participants’ memorizing and problem- solving abilities were assessed in the first and final week of the experiment. The subjects’ brain signals were recorded using EEG and Partial Directed Coherence (PDC) was applied to extract the cortical information pathway. The cortical connectivity and test scores between the two groups were compared. Members of Group 2 were shown to perform better than Group 1 in both abilities and EEG analysis show that the two groups were utilizing different parts of the brain region. In conclusion, this study highlighted the probable impact of Sunnah bedtime routines on the two cognitive skills.

Bedtime Routines Intervention for Children (BRIC) project: results from a non-randomised feasibility, proof-of concept study

BackgroundBedtime routines are highly recurrent family activities with implications for children’s wellbeing, development and health.AimsThe objective of this study is to co-develop and test in a feasibility, proof-of-concept study a bedtime routines intervention using text messages aimed at first-time parents with young children.MethodsFifty first-time parents with children aged 1–3 years were recruited for this study. Parents received a text message-based intervention for 7-consecutive nights which provided support and information on achieving optimal bedtime routines. Parents completed pre- and post-intervention questionnaires focusing on children’s sleep, bedtime routines and parental mood disturbance. Feedback was provided at the end of the study.ResultsRecruitment target and high retention with 98%, or 49 out of 50 participants completing the study were achieved. Pre- and post-intervention, there were improvements in total children’s sleep with children sleeping longer and having less disrupted sleep overall (MD = − 7.77 (SD = 17.91), t(48) = − 3.03, p = .004, CI (− 12.91, − 2.63) and in overall quality of bedtime routines (MD = − 5.00, SD = 7.01, t(48) = − 4.98, p < .001, CI (− 7.01, − 2.98). Parental mood disturbance decreased pre- to post-intervention (MD = 5.87, SD = 15.43, t(48) = 2.66), p = .010, CI (1.44, 10.30). Parents provided positive feedback about the intervention and valued the support that was provided to them.ConclusionsBedtime routines were successfully altered with short-term benefits for children’s sleep and parental mood. Future research will need to utilize a more robust, longitudinal approach for a definite exploration of sustained changes in bedtime routines and their long-term implications for children and parents.