Consistent Bedtime Research Articles

Early bedtime routines and behavioral outcomes among children from low-income families: Mediating role of emotion regulation.

The establishment of early bedtime routine is essential for children's emotion and behavioral outcomes. Less is known, however, about the longitudinal effects and mechanisms predicting behavioral outcomes through early bedtime routine and emotion regulation in school-age children from low-income families. Thus, the present study examined emotion regulation at age three as a potential mediator in the longitudinal links between early bedtime routine and behavioral outcomes among racially diverse school age children from low-income families. Participants include a subsample of families (n = 2977) participating in the Early Head Start Research and Evaluation Project (EHSRE). Structural equation modeling with bootstrapping techniques was used to examine the models. The early bedtime routine index was created from parents' reports at 14, 24, and 36 months. Children's emotion regulation was drawn from interviewer assessments at 36 months and problem behaviors were reported by mothers when the child was approximately at age 10. Results indicated that children with consistent early bedtime routine were better able to regulate their emotions at age three. Also, emotion regulation at age three mediated the associations between early bedtime routine at 14-36 months and internalizing and externalizing behaviors among fifth-grade children. Findings indicated that consistent early bedtime routine helps children to regulate their emerging emotions which in turn has long-term benefits on their emotional and behavioral outcomes. These findings have important implications for pediatricians, nurse practitioners, nurses, and early childhood educators who can provide education and resources to support families in establishing consistent bedtime routine for their young children.

Moving beyond moderate-to-vigorous physical activity: A longitudinal study on adherence to 24-hour Movement Guidelines in adolescents

ObjectivesLow adherence to 24-hour Movement Guidelines for moderate-to-vigorous physical activity, screen time and sleep during adolescence is well documented, yet recommendations regarding light physical activity, vigorous physical activity and muscle and bone strengthening activities have received less attention. This study comprehensively examined adherence to seven components of the movement guidelines in adolescents and analysed disparities by age and gender. DesignLongitudinal study with two assessment time points, separated by one year. MethodsData were collected in 216 New Zealand adolescents aged 12–17 years, and at 1-year follow-up in 167 participants (77 %), using thigh-worn accelerometers and a self-reported diary. ResultsAdherence rates were 3.7 % for moderate-to-vigorous physical activity, 13.0 % for screen time, 44.0 % for sleep, 14.4 % for light physical activity, 36.1 % for vigorous physical activity, 30.6 % for bone and muscle strengthening activities, and 4.6 % for consistent bedtimes. Less than 1 % of participants met all seven recommendations. Adherence was disproportionately low amongst older adolescents for light physical activity, screen time and consistent bedtimes, and amongst girls for vigorous physical activity and muscle and bone strengthening activities. Over one year, adherence declined for light physical activity (15.0 %–7.2 %) and screen time (15.6 %–6.0 %). ConclusionsNew Zealand adolescents are not adhering to recommendations for a healthy balance of time use outlined in the 24-h Movement Guidelines. These findings highlight the need for adolescents to increase their daily movement, with a particular focus on light physical activity amongst older adolescents and muscle and bone strengthening activities amongst girls.

Bedtime music therapy for college students with insomnia: A randomized assessor-blinded controlled trial

BackgroundInsomnia, a prevalent sleep disorder in contemporary society, frequently coexists with other mental health conditions such as depression, schizophrenia, and obsessive-compulsive disorder. Sleep disorders can compromise daytime functioning and overall quality of life. While music has been explored as an adjunct therapy for insomnia, its efficacy in improving insomnia among students remains unclear. MethodsSeventy-five students, aged between 18 and 30 years with an average age of 20.97 years (SD: 1.92), presenting sleep issues were randomly allocated to one of three groups: the classical music group, the jazz music group, and the control group, each with 25 participants. Participants in the classical and jazz music group were instructed to listen to classical or jazz music for a minimum of 30 min preceding bedtime. This was paired with deep breathing and relaxation techniques, practiced two consecutive nights per week from 23:00 to 01:00 over a five-week intervention period. Conversely, participants in the control group were only directed to follow the deep breathing and relaxation techniques before sleep on two consecutive nights weekly.Insomnia severity with the Insomnia Severity Index (ISI), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms with the Beck Depression Inventory-II (BDI- II), and anxiety symptoms with the Self-rating Anxiety Scale (SAS). Measurements were taken at baseline, after the second week of intervention, at the intervention's conclusion (five weeks), and two months post-intervention (follow-up). Results1. The music groups showed a significant difference in insomnia severity compared with the control group after five weeks of intervention(p < .05). 2. music groups exhibited significant enhancements in sleep quality relative to the control group after a five-week intervention (p < .05). 3. Regarding mood enhancement, music groups showed significant improvements in depression and anxiety symptoms compared to the baseline after the five-week intervention. Notably, the control group also displayed improvements in these symptoms post-intervention. Conclusion1. Integrating music into a consistent bedtime routine ameliorates sleep quality and insomnia severity. However, no specific genre of music emerged as the superior choice for pre-sleep listening. 2. While music can considerably enhance mood indicators like depression and anxiety, techniques such as deep breathing and mindfulness also contribute positively. 3. Incorporating music before sleep tangibly elevates overall quality of life and daytime functioning. Trial registrationChiCTR2300073953.

Do later school start times improve adolescents' sleep and substance use? A quasi-experimental study

ObjectiveA later school start time policy has been recommended as a solution to adolescents' sleep deprivation. We estimated the impacts of later school start times on adolescents' sleep and substance use by leveraging a quasi-experiment in which school start time was delayed in some regions in South Korea. MethodsA later school start time policy was implemented in 2014 and 2015, which delayed school start times by approximately 30–90 minutes. We applied difference-in-differences and event-study designs to longitudinal data on a nationally representative cohort of adolescents from 2010 to 2015, which annually tracked sleep and substance use of 1133 adolescents from grade 7 through grade 12. ResultsThe adoption of a later school start time policy was initially associated with a 19-minute increase in sleep duration (95% CI, 5.52 to 32.04), driven by a delayed wake time and consistent bedtime. The policy was also associated with statistically significant reductions in monthly smoking and drinking frequencies. However, approximately a year after implementation, the observed increase in sleep duration shrank to 7 minutes (95% CI, −12.60 to 25.86) and became statistically nonsignificant. Similarly, the observed reduction in smoking and drinking was attenuated a year after. ConclusionsOur findings suggest that policies that increase sleep in adolescents may have positive effects on health behaviors, but additional efforts may be required to sustain positive impacts over time. Physicians and education and health policymakers should consider the long-term effects of later school start times on adolescent health and well-being.

Bedtime routines, development, and caregiver educational attainment in toddlerhood

BackgroundImplementing a consistent bedtime routine is an empirically supported intervention to improve sleep in toddlers, but little is known about its association with social-emotional outcomes, and among children living in lower socioeconomic status (SES) contexts.ObjectiveThis study examined the longitudinal associations between bedtime routines, social-emotional development, and caregiver educational attainment in toddlers presenting to primary care.MethodCaregivers of 40 toddlers (Mage = 12.85 months, 57.5% female, 62.5% Black/African American) completed questionnaires on sociodemographic factors and child bedtime routine consistency at their 12-month well visit. At the 15- and 24-month well visits, data were collected on child bedtime routine consistency and social-emotional development, including the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) for social-emotional problems and competency and the Ages and Stages Questionnaire (3rd edition; ASQ-3) to assess communication and personal-social skills.ResultsOverall, the majority of families engaged in a consistent bedtime routine (≥5 nights/week) at all time points (63% at 12 months, 75% at 15 months, and 86% at 24 months). Controlling for concurrent bedtime routine consistency, toddlers with a more consistent bedtime routine at 12 months exhibited less dysregulation at age 15 months. Toddlers without a consistent bedtime routine at 15 months exhibited more externalizing and internalizing problems and dysregulation at 24 months. Furthermore, there was a significant interaction between bedtime routine consistency at 15 months and caregiver education for internalizing problems at 24 months, such that toddlers of caregivers with a high school education or less who lacked a consistent bedtime routine showed the most internalizing problems.ConclusionClinicians should consider recommending that families with toddlers incorporate a nightly bedtime routine not only to improve overall sleep health, but also to potentially optimize toddlers' positive social-emotional and behavioral trajectories, especially in families with lower educational attainment.

0020 Associations between bedtime and waketime variability and sleep outcomes in autistic children

Abstract Introduction Up to 80% of autistic children experience sleep disturbances. Sleep hygiene guidelines advise patients to maintain consistent bedtimes and waketimes for the purpose of regulating one’s circadian rhythm. However, the relationship between bedtime and waketime variability and sleep outcomes in autistic children is unclear, and so the current study examines these associations. Methods One hundred thirty autistic children (Mage = 8.81 yrs, SD = 1.92 yrs, range = 6-12 yrs, 71% male) completed two weeks of daily sleep diaries with parental assistance and concurrently wore actigraphic wrist watches (Actiwatch-2, Respironics). Rest intervals in Actiware software were set using visual inspection while referencing self-reported bed/waketime. Boundaries of rest intervals were defined as the time when the child first attempted sleep to the time when the child vacated bed. Subjective and objective estimates of bedtime, waketime, total wake time during attempted sleep periods, and total sleep time were obtained. Bayesian multi-level models obtained individual estimates of average variability in bedtime and waketime. Multiple linear regressions were then used to examine associations between subjective and objective bedtime and waketime variability and total wake time and total sleep time, controlling for age and average levels of bed/waketime variability. Models were separated out by subjective/objective sleep outcomes (i.e., subjective waketime variability predicting subjective total sleep time). Results Greater objective waketime variability was associated with less objective total sleep time (B=-38.80, p&amp;lt;.001, partial eta-squared = .071). Greater subjective waketime variability was associated with longer subjective total wake time (B = 18.58, p=.02, partial eta-squared = .058) and shorter subjective total sleep time (B=-70.60, p&amp;lt;.001, partial eta-squared = 0.227). Conclusion While results do not possess causal implications, greater subjective and objective waketime variability are associated with poorer sleep outcomes in autistic children. Effect sizes ranged from approximately medium to large. Results suggest that bedtime variability may not be related to sleep outcomes in autistic children. Future studies should examine whether reductions in waketime variability mediate the effect of behavioral insomnia interventions on improved sleep in autistic children. Support (if any) MU Research Board Grant (McCrae, PI); Department of Defense Autism Research Program (McCrae, PI; W81XWH2010399); Thompson Center for Autism and Neurodevelopmental Disorders.

0924 Poor sleep regularity is widespread among first-year medical students

Abstract Introduction Poor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Sleep regularity is increasingly recognized as a key driver for sleep quality and health. This study sought to determine the prevalence of and the factors that contribute to irregular sleep among first-year medical students. Methods A one-time, 130-item survey was distributed to the first year medical school class three months into the first semester. Quantitative and open-text questions asked about various sleep health related topics, including sleep regularity across weekdays (WDs) and weekends (WEs) for the past two weeks. Likert scale responses were treated as continuous data and reported as mean ± standard deviation. Means for WD and WE times were compared using paired t-tests. Statistical significance was considered a p-value ≤0.05. Results Out of 209 medical students in the first-year class, 58% (n=121) completed the sleep irregularity items on the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. The differences between WD and WE times for getting into bed (1.03 hours ± 0.90 hours), falling asleep (0.92 ± 0.80 hours), waking up (1.62 ± 0.84 hours), and getting out of bed (1.89 ± 0.93 hours) were significant (p&amp;lt; 0.001). Furthermore, 49.3% of participants reported significant bedtime or wake time variability (&amp;gt;3 hours difference from one day to another) at least once per week during the past 3 months. This occurred despite respondents expressing a strong belief in the importance of sleep consistency (7.1 ± 2.25 on a 10-point Likert scale; 0=Strongly Disagree, 5=Neutral, 10=Strongly Agree). Conclusion Poor sleep regularity is widespread during the first year of medical school. While students are aware of the importance of consistent bedtimes and wake times, they rarely follow this knowledge suggesting that external factors encountered during medical school such as poorly balanced academic workloads or stress might be to blame. Future studies should seek to better understand the factors contributing to poor sleep regularity in medical school and develop interventions to help students address any barriers. Support (if any)

0124 The influence of the family environment on children’s sleep during the school year and summer

Abstract Introduction More than a third of US children do not receive adequate sleep. Earlier bedtimes, consistent bedtime routines, and good sleep hygiene help to support more adequate sleep. Our previous work has shown that during summer, 5-8-year-old children go to bed later and obtain less sleep compared to the school year. We hypothesized that school year-summer differences in the family environment would explain differences in children’s sleep timing during these periods. Methods During the school year and summer, 119 parents of 5–8-year-olds completed measures of child temperament, sleep hygiene, parenting practices, and parent stress and social support. Child sleep was measured for 8 days using wrist actigraphs. Sleep onset and offset were determined using the Sadeh algorithm and sleep diaries to determine sleep midpoint. Paired samples t-tests examined school year-summer differences in family environment variables and stepwise linear regression analyses were used to examine the effect of the family environment on sleep midpoint, controlling for age, gender, chronotype, and sleep duration. Results Compared to the school year, during summer parents reported less parent-child conflict before bed (t(117)=3.913, p&amp;lt;.001), less consistent bedtime routines (t(117)=4.808, p&amp;lt;.001), and average daily screen use (t(117)=-2.756, p=.007) and greater child surgency or impulsivity (t(108)=-2.960, p=.004. Overall, our model explained 48% of the variance in children’s sleep timing during the school year (p=&amp;lt;.001) and 45% during the summer (p=&amp;lt;.001). In the final model, greater caffeine intake (β=2.1, p=.033), later chronotype (β=0.4, p=&amp;lt;.001) and greater effortful control or self-regulatory skills (β=0.2, p=.047) predicted having a later sleep midpoint during the school year. During the summer, less consistent bedtime routines and later chronotype (β=0.3, p=.002) predicted having a later sleep midpoint (β=-0.2, p=.022). Conclusion The relaxed nature of the summer family environment likely contributes to decreased conflict over bedtime, increased child media use, and decreased bedtime routine consistency. However, only decreases in bedtime routine consistency contributed to later bedtimes during summer. Worryingly, 5-8-year-olds appear to be using caffeine during the school year contributing to later sleep timing. Addressing summer bedtime routines and children’s school-year caffeine intake are important targets for intervention to improve children’s sleep. Support (if any) Texas Children's Pediatric Pilot Award

0247 Developing and Implementing Sleep Health Education for Foster Care Personnel: A Qualitative Analysis

Abstract Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development, yet sleep health is a neglected part of training/education for foster parents and agency staff. This study examined foster care agency staff perceptions of child sleep problems encountered by foster caregivers in order to inform the development of a sleep health training program for foster care agency staff and caregivers. Methods N=36 staff members from public and private foster care agencies in Texas, New York, New Jersey, and Maryland were interviewed remotely. Questions included knowledge of sleep policies, concerns surrounding sleep, methods for addressing sleep concerns, and sleep training recommendations. Two members of the research team coded the interviews using the Atlas.ti program. Coders first independently reviewed and coded transcriptions for thematic key words without formal concepts before reviewing and refining themes/codes with the full research team for consensus. Results Eight interviews were coded for this preliminary analysis, focused on response to the question, “What kinds of questions/concerns/requests have you received from foster caregivers regarding children’s sleep?” Across the 8 transcripts, the code Fear/trauma associated with bed/sleeping (n = 22 occurrences) and Difficulty Sleeping (initiating, maintaining sleep) (n = 18 occurrences) were the most frequently reported concerns. Other codes included: Behavioral issues affecting issues fall asleep (n=11), Placement adjustment impacting sleep (n = 10); Lack of bedtime routine (n = 9); Concerns surrounding medication (n = 7); and Insufficient sleep impacting daytime functioning (n = 5). Conclusion Preliminary findings suggest that sleep training approaches and programs should focus on addressing fear and trauma associated with bedtime and sleeping, as well as establishing a healthy, consistent bedtime routine. Additionally, difficulties with the use of medications, placement adjustment, and behavioral issues manifesting around bedtime should be addressed. Support (if any) This research was funded by the AASMF grant: 266-CS-22.

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

0105 INSIGHT Study associations between sleep health and child behavior at age 6 years

Abstract Introduction Sub-optimal sleep duration, quality and timing are associated with the presence of disruptive behaviors in childhood. Previous studies have largely utilized parent-/teacher-report of children’s behaviors and focused on mean sleep duration and quality measures, ignoring sleep variability. This analysis uses actigraphy and standardized laboratory behavioral tasks to examine the associations of average levels and variability (SD) of sleep duration, timing, and quality with child behavior. Methods The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study randomized families with firstborn newborns to a responsive parenting intervention or a safety control shortly after delivery. At age 6 years, children wore a wrist actigraphy device (Spectrum Plus) for 7 days to measure sleep and completed frustration (Transparent Box) and parent-child interaction (Picture Frame) tasks. Tasks were recorded and coded using global behavioral coding schemes; inter-rater reliability was sufficient (Transparent Box ICCs=.83-.97; Picture Frame=.83-1). Children with data on sleep (≥3 valid days) and both behavioral tasks were included in this secondary data analysis (n=143). Separate linear regression models examined associations between 10 sleep variables (M/SD of onset, offset, and midpoint of sleep timing, sleep maintenance efficiency, and total sleep time) and 4 behavioral variables (Transparent Box: emotion regulation, impulsivity; Picture Frame: prosocial and antisocial behavior). Models controlled for child sex and age, household income, and study group. Results Children were aged 6.7 ± 0.3 years and predominantly White, non-Hispanic (95%). Sleep onset (timing) variability was positively associated with impulsivity (B=.85, p=.004) and negatively associated with emotion regulation (B=-.65, p=.01). Sleep midpoint (timing) variability was positively associated with impulsivity (B=.80, p=.03). Mean sleep timing, sleep duration, and sleep maintenance efficiency were not associated with any of the behavioral variables. Conclusion The regularity of sleep timing (onset and midpoint) at age 6 had a greater role in behavioral and emotional regulation than duration and quality of sleep. These findings support existing literature that highlight the importance of parents implementing consistent routines (e.g., consistent bedtime) and how such routines play a key role in socioemotional outcomes among children. Support (if any) R01DK088244

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&amp;lt;.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

Perspective: Teenagers and the sleep paradox.

Teenagers experience sleep deficits as they try to manage expectations with school, their social media presence, and increasingly competitive extracurriculars. Late-night screen time is a barrier to sleep hygiene. It is important to acknowledge and understand lifestyle challenges that can prevent teenagers from receiving adequate sleep every night. A teenager perspective on these issues and recommendations can incite better ways to outreach, educate, and support teenagers in maintaining good sleep. We describe what is known and not known about sleep health among teenagers and challenges to maintaining adequate sleep from the perspective of a third-year high school student. We also provide recommendations for outreach to promote early recognition of issues and tools that can support sleep hygiene to reinforce future mental and physical health. While teenagers enjoy good sleep, this is limited by heavy loads of homework along with increasingly competitive extracurriculars, keeping up with social and cultural demands, and early school starts. Also, teenagers may not understand what adequate sleep entails and the full impact of sleep on well-being. Social media provides a channel to extend outreach to teenagers to communicate the importance of consistent quality and quantity of sleep, increase awareness of sleep tracking tools, and highlight the impact of sleep on mental health. Additionally, better engagement is needed with schools and community to manage academic and extracurricular schedules that allow teenagers to schedule consistent bedtimes and wake times. Ramar S, Lloyd RM Perspective: teenagers and the sleep paradox. J Clin Sleep Med. 2023;19(8):1569-1571.

Sandman Send Me a Dream: Case of Non-24-Hour Sleep-Wake Disorder in a Sighted Pediatric Patient (P11-9.005)

<h3>Objective:</h3> Non-24-hour sleep-wake disorder (N24SWD) is a circadian rhythm disorder that leads to the inability to consistently sync the sleep wake (SW) pattern to the 24 hour day night cycle. Patients with N24SWD have progressively delayed SW patterns that occur in a cyclic fashion leading to significant interruptions to daily life. N24SWD is most commonly observed in non-sighted individuals impacting an estimated 50% of that population. It is exceedingly rare in patients with sight, with the first published case in 1971. Furthermore, this is even rarer, if ever, previously described in the pediatric population. <h3>Background:</h3> A 12-year-old male was referred for excessive daytime sleepiness and abnormal sleeping patterns. His bedtime is progressively more delayed each day. During periods of unrestricted sleep, sleep onset delays 2–3 hours each night, with a sleep latency of about 30 minutes and 8–10 hours of sleep duration. Return to a normal bedtime of 9:00pm occurs every 7–10 days. There was no other significant sleep history. He denies sleep paralysis, hypnogogic and hypnopompic hallucinations, and snoring. Melatonin had inconsistent success and adverse effects. The patient’s neurological examination was unremarkable. <h3>Design/Methods:</h3> NA <h3>Results:</h3> Actigraphy confirmed the diagnosis of N24SWD demonstrating cycling of SW when allowed a free sleep schedule. Brain MRI without contrast was unremarkable. The patient was initiated on tasimelteon which led to significant improvements in his ability to maintain a consistent bedtime. <h3>Conclusions:</h3> This case demonstrates that not only can N24SWD occur in sighted individuals, but it can certainly be present in the sighted pediatric population. If not identified, it can lead to long term effects on a child’s life, affecting their development and education. This case also demonstrated the benefits of selective melatonin agonists in the treatment of this condition. <b>Disclosure:</b> Dr. Hart has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Jazz Pharmaceuticals. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Avadel. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz Pharmaceuticals. Dr. Morse has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Jazz Pharmaceuticals. Dr. Morse has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Hayes solicitors. The institution of Dr. Morse has received research support from NIH.

Effect of weekend catch-up sleep on high-sensitivity C-reactive protein levels according to bedtime inconsistency: a population-based cross-sectional study

To investigate the associations of weekend catch-up sleep (WCS) and high-sensitivity C-reactive protein (hs-CRP) levels according to bedtime inconsistency in the Korean population. In this cross-sectional study using the Korea National Health and Nutrition Examination Survey (2016–2018) with 17,665 participants, four groups were defined: no-WCS (WCS within ± 1 h of weekday sleep time), moderate WCS (1 ≤ , < 3 h), severe WCS (≥ 3 h), and inverse WCS (≤ − 1 h). An inconsistent bedtime was defined as a > 2 h difference between weekend and weekday bedtimes. Outcomes were divided into quartiles based on the hs-CRP level: Lowest (< 0.34), Middle-low (≥ 0.34, < 0.55), Middle-high (≥ 0.55, < 1.10), Highest (≥ 1.10). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using multinomial logistic regression, controlling for relevant covariates. Moderate WCS was associated with a lower risk for the highest hs-CRP levels than no WCS (aOR = 0.87, 95% CI 0.78–0.97), and a similar association was observed only in participants with consistent bedtimes (aOR = 0.88, 95% CI 0.78–0.99). Significant interactions of those associations of WCS and hs-CRP levels with bedtime inconsistency were found. These findings provide evidence that people with inconsistent bedtimes would have limited protective effect of WCS on hs-CRP.

Adherence to 24-hour movement guidelines among rural Brazalian preschool children: associations with parenting practices

Background:Young children residing in rural areas of low-and-middle income countries (LMICs) such as Brazil are at greater risk of obesity and related chronic health conditions. Yet, the extent to which rural preschool children from Brazil aged 3- to 6-years meet the World Health Organisation (WHO) 24-hour movement guidelines is unknown. Parents play a central role in the development of children’s movement behaviors with logistic support, co-participation, modelling, and setting rules and limits recognized as influential parenting practices. However, the bulk of parenting research has been conducted in families from high income countries (HICs) and little is known about the relationship between parenting practices and children’s movement behaviors in LMIC communities. Therefore, the aims of this study were two-fold: (1) report the proportion of preschool children from low-income families in rural Brazil meeting the WHO 24-hour movement guidelines; and (2) determine associations with theory-based parenting practices related to physical activity, screen time, and sleep.Methods:A representative sample of 324 families from a rural district in north-eastern Brazil completed a validated, culturally adapted interviewer-administered survey assessing child physical activity, screen time and sleep, and associated parenting practices. The proportion of children meeting the physical activity, screen time, and sleep recommendations and all combinations of these recommendations was calculated. Forward selection logistic regression was used to determine which parenting practices were associated with meeting the individual recommendations and the 24-hour movement guidelines.Results:Less than half of the children (47.5%) met the physical activity recommendation, 22% met the screen time recommendation, 62% met the sleep recommendation, with just over 10% meeting all three recommendations in the 24-h movement guidelines. Having fewer rules and restrictions around indoor and outdoor play, limiting, or monitoring screen time, and maintaining a consistent bedtime routine were key parenting practices associated with children´s adherence to the 24-hour movement guidelines.Conclusion:Only 1 in 10 rural Brazilian preschool children meet the 24-hour movement guidelines. These findings underscore the need for family-based interventions targeting parenting practices to support healthful movement behaviors in young children from LMICs.

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.

Effects of a Sleep Health Education Program for Children and Parents on Child Sleep Duration and Difficulties

Preschool-aged children often lack sufficient sleep and experience sleep difficulties. A consistent bedtime routine, falling asleep alone, and other sleep practices reduce difficulties and increase sleep duration. To evaluate the effects of a preschool-based sleep health literacy program on children's sleep duration and difficulties and on parent sleep knowledge, attitudes, self-efficacy, and beliefs 9 and 12 months after the program. This stepped-wedge cluster randomized clinical trial was implemented across the 2018-2019 school year. Head Start preschool personnel delivered interventions and collected outcomes data at baseline and 4 follow-ups. Seven Head Start agencies across New York State were randomized to implement interventions in either fall 2018 or winter and spring 2019. Outcomes were ascertained at 9- and 12-month follow-up. From March 19 through September 28, 2018, Head Start staff recruited (a) English- or Spanish-speaking parents (b) of children 3 years of age on or about September 2018 (c) who planned to remain at the site through the school year. Altogether, 519 parent-child (aged 3 years) dyads completed baseline and (any) follow-up data. A 2-week classroom curriculum for children, a 1-hour parent workshop, and 1-on-1 parent discussions at home or school. Outcomes were the pre- vs postintervention differences measured at baseline and 9-month follow-up for parent-reported child school-night sleep duration per sleep logs, mild or moderate sleep difficulties per a validated questionnaire, and the total and domain scores for parent sleep knowledge, attitudes, self-efficacy, and beliefs. A modified intention-to-treat analysis excluding participants with only baseline data was used. The mean (SD) age at enrollment of 519 children was 2.7 (0.1) years, 264 (50.9%) were girls, 196 (37.8%) lived in Spanish-speaking households, and 5 (0.9%) identified as Alaskan Native or American Indian, 17 (3.2%) as Asian American or Pacific Islander, 57 (10.8%) as Black, 199 (37.8%) as White, and 63 (12.0%) as other. Mean sleep durations increased nonsignificantly from baseline by 5.6 minutes (95% CI, -2.3 to 13.6 minutes; P = .17) at 9-month follow-up and by 6.8 minutes (95% CI, 0.2-13.7 minutes; P = .06) at 12-month follow-up. There was a slight improvement in parental knowledge (1.13 unit increase from baseline; 95% CI, 0.13-2.12 units), but no significant outcomes for parent sleep attitudes (0.16 unit increase from baseline; 95% CI, -0.46 to 0.77 units), self-efficacy (-0.13 unit decrease from baseline; 95% CI, -1.02 to 0.76 units) and beliefs (-0.20 unit decrease from baseline; 95% CI, -0.56 to 0.16 units). Intervention effects for child sleep difficulties were not significant (odds ratio, 1.13; 95% CI, 0.62-2.09). Fewer than 1 in 4 parents accurately perceived their child's sleep difficulty at 12 months. The findings of this large pragmatic, stepped-wedge cluster randomized clinical trial, albeit largely negative, may have implications for the sustained impact, focus, and potential population-level effects of sleep education programs. Future research should evaluate the effects of more recurrent programming that emphasizes recognition of sleep problems and whether small increments of sleep across months and years in early childhood have meaningful effects. ClinicalTrials.gov Identifier: NCT03556462.

Insomnia Symptoms and Daytime Fatigue Co-Occurrence in Adolescent and Young Adult Childhood Cancer Patients in Follow-Up after Treatment: Prevalence and Associated Risk Factors.

Simple SummaryInsomnia symptoms and daytime fatigue significantly impact physical and psychosocial health. While these are common symptoms in pediatric oncology, relationships between these symptoms remain unclear. This study evaluated the prevalence of insomnia only, daytime fatigue only, the co-occurrence of insomnia and daytime fatigue symptoms, and associated risk factors in adolescent/young adult childhood cancer patients in follow-up after treatment. Results showed that around forty percent had insomnia and daytime fatigue symptoms, which often co-occurred. Risk factors that emerged were: female sex and co-morbidities (all), shorter time after treatment and bedtime gaming (insomnia only), young adulthood (insomnia–fatigue and fatigue only), needing someone else to fall asleep and inconsistent wake times (both insomnia groups), and lower educational level and consistent bedtimes (insomnia–fatigue). Overall, insomnia symptoms and daytime fatigue were common and often co-occurred in this patient population. While current fatigue guidelines do not include insomnia symptoms, healthcare providers should inquire about insomnia as this potentially provides additional options for treatment and prevention.Insomnia symptoms and daytime fatigue commonly occur in pediatric oncology, which significantly impact physical and psychosocial health. This study evaluated the prevalence of insomnia only, daytime fatigue only, the co-occurrence of insomnia–daytime fatigue symptoms, and associated risk factors. Childhood cancer patients (n = 565, 12–26 years old, ≥6 months after treatment) participated in a national, cross-sectional questionnaire study, measuring insomnia symptoms (ISI; Insomnia Severity Index) and daytime fatigue (single item). Prevalence rates of insomnia and/or daytime fatigue subgroups and ISI severity ranges were calculated. Multinomial regression models were applied to assess risk factors. Most patients reported no insomnia symptoms or daytime fatigue (61.8%). In the 38.2% of patients who had symptoms, 48.1% reported insomnia and daytime fatigue, 34.7% insomnia only, and 17.1% daytime fatigue only. Insomnia scores were higher in patients with insomnia–daytime fatigue compared to insomnia only (p < 0.001). Risk factors that emerged were: female sex and co-morbidities (all), shorter time after treatment and bedtime gaming (insomnia only), young adulthood (insomnia–fatigue/fatigue only), needing someone else to fall asleep and inconsistent wake times (both insomnia groups), lower educational level and consistent bedtimes (insomnia–fatigue). Insomnia symptoms and daytime fatigue are common and often co-occur. While current fatigue guidelines do not include insomnia symptoms, healthcare providers should inquire about insomnia as this potentially provides additional options for treatment and prevention.

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&amp;gt;.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