Delayed Sleep Onset Research Articles

Objective measures of sleep in adults and older adults with and without depression: A systematic review and meta-analysis

Sleep architecture is poorly defined in people with depression, especially in older adults. We investigated differences in sleep macro- and micro-architecture between adults and older adults (>50 years) with and without depression.A systematic review identified 2135 papers through PubMed, Scopus, Web of Science and Embase databases. Two reviewers excluded articles using PRISMA guidelines. Fifteen articles met inclusion criteria. A random effects model meta-analysis was performed. NICE case-control guidelines were used to assess risk of bias.In the fifteen articles, 838 participants underwent objective sleep measurement (406 depression and 432 control). All adults with depression had less total sleep time, delayed sleep onset latency, higher wake after sleep onset, shorter rapid eye movement latency (ROL) and greater rapid eye movement REM density than controls. Two of these studies examined sleep architecture in 62 older adults (31 depression, 31 control). Older adults with depression had more stage 1 sleep, less stage 2 sleep, shorter ROL than older controls with no between-group difference in sleep efficiency, REM sleep or REM density. Six studies had poor case-control selection, which when removed nullified the effects of REM density and REM latency in all adults. Sleep micro-architecture measures could not be meta-analysed due to the limited studies available.Adults with depression had moderately worse sleep initiation and continuity than controls. Alterations to REM sleep were observed in adults with depression, however these effects were not robust. Sleep macro-architecture differences were not consistent in younger adults and older adults with depression, compared to relative controls.

Effects of Ball Combination Exercise Combined with cTBS Intervention on Sleep Problems in Children with Autism.

Sleep problems significantly affect the quality of life of autism spectrum disorder (ASD) children. This study aimed to evaluate the effects of a 12-week ball combination exercise, continuous theta burst stimulation (cTBS) stimulation, and combined intervention on sleep problems in children with ASD. Forty-five ASD children were divided into three intervention groups (ball combination exercise(n = 12), cTBS stimulation(n = 10), combined (n = 12) and a control group (n = 11). The intervention groups underwent intervention, while the control group maintained daily activities. The effects were assessed using the Children's Sleep Habits Questionnaire (CSHQ) scale. The results revealed that after 12 weeks of intervention, three programs reduced sleep problems in children with ASD. The post-test scores of the cTBS group (p = 0.002) and the combined group (p < 0.001) were significantly lower than the baseline scores on the CSHQ scale. The exercise group (p = 0.002) and the combined group (p < 0.001) showed significant improvement in sleep anxiety, while there was no statistically significant difference in the effectiveness of the three interventions for sleep-onset delay. The combined group outperformed the single intervention groups in the CSHQ score and sleep anxiety sub-dimensions. The combined intervention group showed slightly superior performance in sleep onset latency, however, there was no significant difference. Three interventions alleviated sleep issues in ASD children, with the combined method proving more effective. This study validates non-pharmacologic and combined approaches for ASD sleep problems. Future research should delve deeper into the mechanisms of these interventions in ASD children's sleep improvement.

Childhood lead exposure and sleep problems in adolescents: a longitudinal cohort study.

Childhood lead exposure is linked to poorer neurobehavioral function in adolescence, but the relationship between lead and adolescent sleep health remains inconsistent. This study aimed to investigate concurrent and longitudinal associations between lead exposure and multiple sleep health domains in adolescents. A total of 972 adolescents from China Jintan Child Cohort were included in analyses. The Blood lead levels (BLLs) were assessed in two Waves, at ages 3-5years (mean 6.50 ± 2.76μg/dL) and 11-13years (mean 3.12 ± 1.17μg/dL). Sleep problems at age 11-13 were parent-reported via the Child Sleep Health Questionnaire (CSHQ) and self-reported by adolescents using the Pittsburgh Sleep Quality Index (PSQI). Both early and later BLLs were associated positively with parental reported sleep problems, including sleep onset delay, night waking, short duration, parasomnias, and disordered breathing. Sex-stratified analyzes showed that most adjusted associations between two-Wave BLLs and sleep outcomes (CSHQ and PSQI) remained statistically significant in males, with a minor increase in the magnitude of these associations. The association between Wave II BLLs and shorter self-reported sleep duration was only statistically significant in female adolescents. Compared to children with consistently low BLLs at both ages, those with persistently high BLLs at both ages had significantly shorter parental-reported sleep duration and worse sleep onset delay. Findings suggest that both early and later childhood lead exposures link to more adolescent sleep problems, with recent BLLs showing stronger associations with poor adolescent sleep health reported by their parents.

Screen Use at Bedtime and Sleep Duration and Quality Among Youths

Although questionnaire-based cross-sectional research suggests that screen time before bed correlates with poor sleep, self-reported data seem unlikely to capture the complexity of modern screen use, requiring objective night-by-night measures to advance this field. To examine whether evening screen time is associated with sleep duration and quality that night in youths. This repeated-measures cohort study was performed from March to December 2021 in participant homes in Dunedin, New Zealand. Participants included healthy youths aged 11 to 14.9 years. Data were analyzed from October to November 2023. Objectively measured screen time, captured using wearable or stationary video cameras from 2 hours before bedtime until the first time the youth attempted sleep (shut-eye time) over 4 nonconsecutive nights. Video data were coded using a reliable protocol (κ = 0.92) to quantify device (8 options [eg, smartphone]) and activity (10 options [eg, social media]) type. Sleep duration and quality were measured objectively via wrist-worn accelerometers. The association of screen use with sleep measures was analyzed on a night-by-night basis using mixed-effects regression models including participant as a random effect and adjusted for weekends. Of the 79 participants (47 [59.5%] male; mean [SD] age, 12.9 [1.1] years), all but 1 had screen time before bed. Screen use in the 2 hours before bed had no association with most measures of sleep health that night (eg, mean difference in total sleep time, 0 minutes [95% CI, -3 to 20 minutes] for every 10 minutes more total screen time). All types of screen time were associated with delayed sleep onset but particularly interactive screen use (mean difference, 10 minutes; 95% CI, 4 to 16 minutes for every additional 10 minutes of interactive screen time). Every 10 minutes of additional screen time in bed was associated with shorter total sleep time (mean difference, -3 minutes; 95% CI, -6 to -1 minute). The mean difference in total sleep time was -9 minutes (95% CI, -16 to -2 minutes) for every 10 minutes of interactive screen use and -4 minutes (95% CI, -7 to 0 minutes) for passive screen use. In particular, gaming (mean difference, -17 minutes; 95% CI, -28 to -7 minutes for every 10 minutes of gaming) and multitasking (mean difference, -35 minutes; 95% CI, -67 to -4 minutes on nights with vs without multitasking) were associated with less total sleep time. In this repeated-measures cohort study, use of an objective method showed that screen time once in bed was associated with impairment of sleep, especially when screen time was interactive or involved multitasking. These findings suggest that current sleep hygiene recommendations to restrict all screen time before bed seem neither achievable nor appropriate.

Sleep onset time as a mediator in the association between screen exposure and aging: a cross-sectional study.

Excessive screen exposure has become a significant health concern. This study investigates the impact of screen time on aging in middle-aged and elderly populations. Healthy working adults over 45years old in Shanghai, China, underwent general and ocular examinations. Questionnaires collected demographics, medical history, and screen exposure details. Aging was assessed using the retinal age gap, defined as the difference between the retinal age predicted by deep learning algorithms based on fundus images and chronological age. Pathway analysis tested the mediation effect of sleep duration and onset time on the relationship between screen usage and retinal age gap. The retinal age gap increased with longer screen exposure, from 0.49 ± 3.51years in the lowest tertile to 5.13 ± 4.96years in the highest tertile (Jonckheere-Terpstra test, p < 0.001). Each additional hour of screen exposure accelerated the retinal age gap by 0.087years (95% CI, 0.027, 0.148, p = 0.005) in the fully adjusted linear model. Sleep onset time mediated the impact of screen usage on the retinal age gap (indirect effect, β = 0.11; 95% CI 0.04-0.24). The impact of screen usage in a light-off environment on the retinal age gap was fully mediated by sleep onset time (indirect effect, β = 0.22; 95% CI 0.07-0.38), with the proportion being 100%. Our study identified a correlation between excessive screen time and a wider retinal age gap in middle-aged and elderly individuals, likely due to delayed sleep onset. To mitigate the adverse effects on the retina and aging, it is important to limit screen usage and avoid screens before bedtime.

Investigation of bi-directional relations between pre-sleep electronic media use and sleep: A seven-day dairy study

The current study aimed to examine the bi-directional relationships between pre-sleep electronic media use and sleep, and to assess the relative predictive strength of different types of electronic media use in the evening on subsequent sleep. Eighty-eight young adults (20.57 ± 0.99, 27 males) completed an online intake survey and received notifications to complete daily diaries for seven consecutive days. Results of dynamic structural equation models (DSEM) revealed that the total screen time, sleep onset time, sleep latency, sleep duration, and sleep quality showed significant positive autoregressive parameters. In contrast, the results revealed no statistically significant cross-lagged associations between the total screen time in the evening and sleep outcomes. Inspection of the predictive strength of various types of screen activities at the within-person level revealed that increased active social media use is linked to delayed sleep onset, while internet browsing is associated with shorter sleep latency. At the between-person level, screen time of T.V. watching, video streaming, social media use, and shopping correlated with delayed sleep onset. Shopping was also connected to longer sleep latency. Additionally, more time spent on T.V., video streaming, non-work internet browsing, and shopping was linked to reduced total sleep duration. These findings indicated a screen activity-dependent association between pre-sleep screen time and subsequent sleep. More objective assessments of electronic media use (e.g., app recording screen time) and sleep (e.g., actigraphy) and longitudinal monitoring over a relatively long period (i.e., several weeks or months) are warred to further elucidate (cross-lagged) relationships between electronic media use and sleep.

The Association Between Sleep Problems and Attentional Network Functions in Patients with Self-Limited Epilepsy with Centrotemporal Spikes.

To investigate sleep problems in children with self-limited epilepsy with central temporal spiking (SeLECTS) and to assess the relationship between sleep problems and attention network dysfunction. 107 children 6-14 years of age with SeLECTS and 90 age- and sex-matched healthy controls were recruited for this study. The sleep status of these participants was evaluated using the Children's Sleep Habits Questionnaire (CSHQ), while attentional network function was assessed with the attention network function test (ANT). Together, these analyses revealed that children with SeLECTS exhibited higher total CSHQ scores and sleep disorder incidence relative to healthy controls (P< 0.001). Children with SeLECTS had higher scores in delayed sleep onset, sleep duration, night awakenings, parasomnias, daytime sleepiness and sleep anxiety (P<0.01). Total CSHQ scores were negatively correlated with average ANT correct rates (ρ= -0.253, P<0.01), while they were positively correlated with total reaction time (ρ=0.367, P<0.01) and negatively correlated with the efficiency of the alerting and executive control networks (ρ=-0.344 P<0.01; ρ=-0.418 P<0.01). Children with SeLECTS face a higher risk of experiencing sleep disorders relative to age-matched healthy children, while also demonstrating that the magnitude of the impairment of attentional network function in these children is positively correlated with sleep disorder severity. Thus, the prognosis and quality of life of children with SeLECTS can be improved by interventions addressing sleep disorders.

Validity and reliability of the Swedish version of the Children’s Sleep Habits Questionnaire (CSHQ-SWE)

BackgroundTo translate and culturally adapt the Children’s Sleep Habits Questionnaire (CSHQ) to a Swedish version, CSHQ-SWE, and to assess its validity and reliability for use with children with attention deficit hyperactivity disorder (ADHD).MethodsA total of 84 children with ADHD (51 boys and 33 girls; 6–12 years) and parents (7 men and 77 women; 28–51 years) were included in the study. CSHQ was translated and culturally adapted to Swedish, and assessed for concurrent validity with sleep actigraphy (analyzed by Kendall’s Tau) and for reliability by internal consistency (analyzed by McDonald’s Omega H). Face and content validity was evaluated by parents (n = 4) and healthcare professionals (n = 6) qualitatively (comprehensiveness, relevance, and comprehensibility assessed by interviews and analyzed by thematic analysis) and quantitatively (analyzed by content validity ratio and content validity index for 33 items and four non-scored inquiries).ResultsParent-reported sleep problems (CSHQ-SWE total score) were moderately correlated with less “Sleep Efficiency” (Tau = −0.305; p < 0.001) measured by sleep actigraphy. Parent-reported problems with “Sleep Onset Delay” was moderately correlated with measured time for ”Sleep Onset Latency” (Tau = 0.433; p < 0.001). Parent-reported problems with “Night Wakings” were weakly correlated with measured time for “Wake After Sleep Onset” (Tau = 0.282; p < 0.001). Parents estimation of “Total daily sleep duration” was moderately correlated with measured “Total Sleep Time” (Tau = 0.386; p < 0.001). Five of the seven subscales reached an acceptable level for internal consistency (McDonald’s Omega H > 0.700). Comprehensiveness, relevance, and comprehensibility of CSHQ-SWE were satisfactory overall. Content validity ratio was 0.80 to 1.00 for six items, 0.00 to 0.60 for 22 items, and < 0.00 for nine items. Content validity index was 0.22.ConclusionsCSHQ-SWE demonstrated acceptable concurrent validity with objectively measured sleep and internal consistency, whereas the overall results of face and content validity assessment varied. The instrument needs to be further evaluated regarding construct validity, responsiveness, test-retest reliability, and its generalization to other populations.

A subclass of evening cells promotes the switch from arousal to sleep at dusk

Animals exhibit rhythmic patterns of behavior that are shaped by an internal circadian clock and the external environment. Although light intensity varies across the day, there are particularly robust differences at twilight (dawn/dusk). These periods are also associated with major changes in behavioral states, such as the transition from arousal to sleep. However, the neural mechanisms by which time and environmental conditions promote these behavioral transitions are poorly defined. Here, we show that the E1 subclass of Drosophila evening clock neurons promotes the transition from arousal to sleep at dusk. We first demonstrate that the cell-autonomous clocks of E2 neurons primarily drive and adjust the phase of evening anticipation, the canonical behavior associated with "evening" clock neurons. We next show that conditionally silencing E1 neurons causes a significant delay in sleep onset after dusk. However, rather than simply promoting sleep, activating E1 neurons produces time- and light-dependent effects on behavior. Activation of E1 neurons has no effect early in the day but then triggers arousal before dusk and induces sleep after dusk. Strikingly, these activation-induced phenotypes depend on the presence of light during the day. Despite their influence on behavior around dusk, invivo voltage imaging of E1 neurons reveals that their spiking rate and pattern do not significantly change throughout the day. Moreover, E1-specific clock ablation has no effect on arousal or sleep. Thus, we suggest that, rather than specifying "evening" time, E1 neurons act, in concert with other rhythmic neurons, to promote behavioral transitions at dusk.

Effects of Forest Activities on Sleep and Problematic Behaviors in Young Children

Background and objective: This study aims to determine the effects of forest activities, such as forest meditation and forest experience, on young children's sleep and problematic behaviors and to compare the changes that occur according to the type of forest activity.Methods: Fifty-nine five-year-old children from early childhood education institutions in Cheongju City, Korea, participated. The experiment took place over five weeks between May 3 and 31, 2022. Activities were conducted twice a week for a total of eight sessions. The forest meditation and forest experience groups carried out activities in the forest. The control group carried out thematic activities according to the Nuri curriculum followed by early childhood education institutions. The Korean version of the Children's Sleep Habits Questionnaire was used to assess the participants' sleep duration and sleep habits, and the Korean Child Behavior Checklist for Ages 1.5-5 was used to assess problematic behaviors.Results: We found a statistically significant increase in the average sleep duration of the children in the meditation group, as well as a statistically significant decrease in their total sleep habits score and the scores of the bedtime resistance, sleep onset delay, and sleep anxiety subdomains of sleep habits. A statistically significant decrease was observed in the forest experience group's scores for total problematic behaviors and internalizing problems. We also found a statistically significant positive correlation between sleep habits and problematic behaviors.Conclusion: These findings demonstrate that static activities, such as forest meditation activities, increase sleep duration and improve sleep habits, while dynamic activities, such as forest experience activities, improve problematic behaviors and internalizing problems. Providing specific programs that appropriately utilize static and dynamic forest activities can help improve sleep and problematic behaviors in young children.

Effects of GSM Phone Radiation on Sleep Quality

This study examines the correlation between exposure to GSM phone radiation and the quality of sleep in subjects. A varied group of 15 adults between the ages of 18 and 65 was selected, with demographic information gathered in addition to objective and subjective sleep measurements. Specialized equipment was used to monitor GSM phone radiation levels, while sleep quality was evaluated using polysomnography (PSG) devices and self-reported sleep diaries. Correlation analyses showed substantial links between GSM phone radiation exposure and different sleep metrics such as total sleep time, sleep onset delay, sleep efficiency, and subjective sleep quality ratings. Higher levels of GSM phone radiation were linked to longer total sleep lengths and longer sleep onset latencies, as well as worse sleep efficiency and poorer subjective sleep quality. The results emphasize the significance of examining how mobile phone use can affect sleep quality and emphasize the necessity for additional study to clarify the underlying mechanisms and determine causation.

Analyzing the Quality of Life in Individuals with Fragile X Syndrome in Relation to Sleep and Mental Health.

The purpose of this paper was to examine the physical, emotional, social and school functioning domains of quality of life of individuals with Fragile X Syndrome, in relation to mental health and sleep patterns to gain a better understanding of how these aspects are affected by the disorder. This study included 119 individuals with Fragile X Syndrome who were given different cognitive examinations by a neuropsychologist or by parent-proxy questionnaires. This study focused on the Pediatric Quality of Life Inventory (PedsQoL), the Anxiety, Depression and Mood Scale (ADAMS), the Children's Sleep Habits Questionnaire (CSHQ), but did include other cognitive tests (Vineland Adaptive Behaviour Scales, Nonverbal IQ, Autism Diagnostic Observation Schedule). We identified significant associations between decreases in emotional, social and school domains of PedsQoL and the ADAMS subtests of Generalized Anxiety, Manic/Hyperactivity and Obsessive/Compulsivity, with the subtest of Depressed Mood having associations with lower physical and emotional domains. We also identified a significant impact between CSHQ subtests of Sleep Anxiety, Night Wakings, Daytime Sleepiness, and Parasomnia with the emotional and school domains of PedsQoL. There were associations connecting school functioning with Bedtime Resistance, and additional associations connecting emotional functioning with Sleep Duration and Sleep Onset Delay. Physical functioning was also associated with Sleep Anxiety. Our study shows how mental health and sleep defects impact improper sleep patterns and mental health which leads to decreases in the quality of life for individuals with FXS, and how it is important to screen for these symptoms in order to alleviate issues.

Prevalence and factors of sleep problems among Japanese children: a population-based study.

High prevalence of sleep problems in not only children with neurodevelopmental disorders (NDS) but also non NDS has been established. However, there are few studies that have looked into population-based and age-specific prevalence of sleep problems of children. Moreover, there are even fewer studies that have investigated the correlation of demographic and lifestyle-related factors affecting sleep problems in children. Considering these, the purpose of this study is to assess the correlation of the prevalence of sleep problems and selected socio-demographic and lifestyle-related factors in 5-year-old Japanese children in population-based study. Study children (SC) were recruited from two cohorts of the Hirosaki City 5-Year-Old Child Developmental Health Checkup Study. The first cohort consisted of 281 (162 males, 119 females) children recruited from 2014 to 2015, and the second cohort consisted of 2055 (1,068 males, 987 females) children from 2018 to 2019. In total there were 2,336 SC participants (1,230 males and 1,106 females). To determine the prevalence of sleep problems the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) was utilized, and sleep problems are defined by a total score of ≥86. To determine socio-demographic and lifestyle-related factors affecting sleep, 10 factors (NDS diagnosis, birth month, childcare place, income, number of siblings, bedtime, waking time, sleeping hours, sleep onset delay, and screen time) were selected. Finally, to determine the correlation between prevalence of sleep problems and the selected demographic and lifestyle-related factors, data was analyzed using chi-square test. The prevalence rate of sleep problems in 5-year-olds was 18% (369/2,055). Further, the prevalence of sleep problems was high in participants with ASD (50.4%), ADHD (39.8%), <2 million yen of income (30.5%), no siblings (24.2%), >22:00 of bedtime (30.7%), >7:30 of waking time (30.7%), <9 h of sleeping hours (25.3%), >30 min of sleep onset delay (35.3%), and ≥2 h of screen time (21.1%). The findings report 18% prevalence rate of sleep problems in 5-year-old children. Further, the findings establish a significant correlation of sleep problems and NDS, specific socio-demographic, and lifestyle-related factors. In considering the identified modifiable lifestyle-related factors contributing to sleep problems among the participants (i.e., bed/waking times and screen times), sleep programs to address these concerns are suggested.

Mediating effects of sleep quality between clinical characteristics and quality of life in children with epilepsy: A cross-sectional study from Southwest China

BackgroundAlthough sleep quality (SQ) reportedly affects the health-related quality of life (QOL) of patients with epilepsy, little is known about the potential association between SQ and QOL, particularly in children with epilepsy (CWE). Our study aimed to investigate the mediating effect of SQ on the QOL of CWE to obtain more information for the prevention and treatment of epilepsy in children. MethodsWe collected general demographic and clinical data of 212 CWE and 79 controls (children who visited the Health Examination Department), and their guardians were instructed to answer the Children’s Sleep Habits Questionnaire (CSHQ) and the optimized Quality of Life in Childhood Epilepsy Questionnaire-16 (QOLCE-16). The t-test, analysis of variance, chi-square test, and Fisher’s exact test were used for between group comparisons. The Pearson correlation was used to analyze the correlation between variables. The direct, indirect, and total effects of predictors on the QOL of CWE were estimated based on an adjusted mediation model. ResultsCWE had significantly smaller long-term urban residence rates, less educated guardians, higher total CSHQ score, higher incidence of poor SQ, higher bedtime resistance, more sleep anxiety, worse sleep-disordered breathing, increased parasomnia, more daytime sleepiness, more frequent night waking, and greater sleep onset delay than controls (P < 0.05 for all). The univariable analysis showed significant differences in total CSHQ scores between CWE with different seizure frequency in the last month, whether or not drug-resistant epilepsy (DRE), and with different video electroencephalogram (VEEG) findings (P < 0.05 for all). Differences in QOLCE-16 scores between CWE with different guardian’s employment status, age at diagnosis, number of anti-seizure medication (ASM) types, seizure frequency in the last month, DRE status, seizure type, VEEG findings, neuropsychological evaluation findings, magnetic resonance imaging (MRI) findings, and etiology were statistically significant (P < 0.05 for all). The correlation study indicated that the total CSHQ score was negatively correlated with the QOLCE-16 score (P < 0.05). The mediation analysis showed that DRE and VEEG abnormalities had a standardized direct effect on the QOL. Seizure frequency in the last month, DRE, and VEEG abnormalities had an indirect effect on the QOL through SQ, and their mediating effect values of SQ were 31.61 %, 13.45 %, and 14.35 %, respectively. ConclusionOur findings uncovered the relationship of some clinical characteristics with SQ and QOL and characterized the nature of factors affecting the QOL of CWE. SQ could be a key factor in the prognosis of CWE experiencing epileptic seizures, and more attention should be paid on the management of SQ in interventions for epilepsy.

Substituting Book Reading for Screen Time Benefits Preschoolers' Sleep Health: Results from the Ulm SPATZ Health Study.

Healthy sleep is essential for the physical, cognitive, and social development of children. Several studies have reported the increase in digital media use in preschool children and its association with impaired sleep. However, there is relatively little evidence on the effects of book reading as a potentially safe alternative. The objective of this study, therefore, was to investigate whether sleep in children could benefit from book reading, and whether the negative effects of media use on sleep can be mitigated by substituting book reading for screen time. We used longitudinal data from three consecutive waves of the SPATZ Health study, including children at the ages of 4 (n=581), 5 (n=508), and 6 (n=426) years. All data were collected by self-administered questionnaires. Parent-reported child sleep was assessed by the Children's Sleep Habits Questionnaire. Across the three waves, screen-based media use increased and was associated with lower sleep quality. In contrast, the time spent with book reading decreased; however, book reading appeared to be beneficial for children's sleep. Substitution models revealed that the theoretical substitution of an equal amount of book reading for 50% of the time spent with screen-based media benefits several domains of preschoolers' sleep health, including parasomnias, sleep anxiety, daytime sleepiness, and sleep onset delay. Besides implications for population-wide and individual prevention, book reading may also be incorporated as a useful intervention to improve sleep quality in children who are already affected by sleep problems. Given that book reading is perceived as a safe alternative, the presented evidence may suffice to support recommendations in this direction.

Associations of light exposure patterns with sleep among Dutch children: The ABCD cohort study.

Light exposure affects the circadian system and consequently can affect sleep quality. Only few studies examined this relationship in children. We evaluated associations between light exposure patterns and sleep metrics in children. We measured the sleep parameters of 247 Dutch children, aged between 11 and 13 years and recruited from the ABCD cohort, using actigraphy and sleep records for 7 consecutive nights. Personal light exposures were measured with a light meter during the whole day and night. We applied generalized mixed-effects regression models, adjusted for possible confounders, to evaluate the associations of light exposure patterns on sleep duration, sleep efficiency and sleep-onset delay. In the models mutually adjusted for potential confounders, we found the amount of hours between the first time of bright light in the morning and going to sleep and the duration of bright light to be significantly associated with decreased sleep duration (in min; β: -2.02 [95% confidence interval: -3.84, -0.25], β: -8.39 [95% confidence interval: -16.70, -0.07], respectively) and with shorter sleep-onset delay (odds ratio: 0.88 [95% confidence interval: 0.80, 0.97], odds ratio: 0.40 [95% confidence interval: 0.19, 0.87], respectively). Increased light intensities at night were associated with decreased sleep duration (T2 β: -8.54 [95% confidence interval: -16.88, -0.20], T3 β: -14.83 [95% confidence interval: -28.04, -1.62]), while increased light intensities before going to bed were associated with prolonged sleep onset (odds ratio: 4.02 [95% confidence interval: 2.09, 7.73]). These findings further suggest that children may be able to influence their sleep quality by influencing the light exposure patterns during day and night.

A population-based study exploring association of parasomnia symptoms with sleep onset delay among school-aged children

ObjectiveParasomnia is potentially implicated in sleep pattern and sleep architecture, however, evidence is quite limited. This study aimed to investigate the association between parasomnia symptoms and sleep onset delay among children through a large epidemiological study. MethodsTwo rounds of cross-sectional studies were conducted among 21,704 children aged 3–11; one taking place in Shanghai and the other in Sanya, Hainan province. Children's sleep characteristics were evaluated using the Children's Sleep Habits Questionnaire (CSHQ). Propensity score matching was adopted to balance the difference of covariates, and the logistic regression models were implemented to examine the associations between parasomnia symptoms and sleep onset delay. ResultsA total of 38.2 % of children had sleep onset delay. Parasomnias, especially non rapid eye movement (NREM) and rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of sleep onset delay (Sleep Walking: OR = 1.55; Sleep Terror: OR = 1.34; Nightmare: OR = 1.37, all p˂0.001). The similar findings were observed in stratified analyses according to sleep duration, and the association was pronounced in sleep sufficiency group (Sleep Walking: OR = 1.62; Sleep Terror: OR = 1.35; Nightmare: OR = 1.35, all p˂0.001). Moreover, a dose-dependent pattern was observed, in which cumulative parasomnia symptoms were associated with increasing risk of sleep onset delay (2 symptoms: OR = 1.19; ≥3 symptoms: OR = 1.40; by comparison with ≤1 symptom). All these findings were also similarly observed in the propensity score matching sample. Moreover, the associations were generally established in both Shanghai and Sanya children. ConclusionsParasomnia symptoms were associated with a higher risk of sleep onset delay independently of sleep duration among children. More studies are needed to enrich the current evidence, thus further clarifying the association and interaction among different sleep parameters.

Unraveling the interplay: Exploring the relationship between children's obesity, sleep disorders, depressive symptoms, and age dynamics

&lt;b&gt;Objective: &lt;/b&gt;This study explores the relationships between sleep disorders, depressive symptoms, and obesity among children of different ages.&lt;br /&gt; &lt;b&gt;Material and methods: &lt;/b&gt;The data for this study were collected from 163 Turkish children aged 7 to 10 and 11 to 15 years (mean age=9.4, SD=1.9) who were attending well-child visits. Parents completed an online questionnaire on sociodemographic data, while children completed the Children Depression Inventory and The Children's Sleep Habits Questionnaire.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;The regression model for the 7-10 years group included sleep resistance, sleep onset delay, nighttime awakenings, and daytime sleepiness, and explained 33.8% of the variance in Children Depression Inventory scores (R&lt;sup&gt;2&lt;/sup&gt;=0.338, F=9.779, p&amp;lt;0.001). For the 11-15 age group, the regression model included obesity status, Children's Sleep Habits Questionnaire scores, sleep onset delay, sleep-related anxiety, and sleep-disordered breathing, and explained 80.3% of the variance in Children Depression Inventory scores (R&lt;sup&gt;2&lt;/sup&gt;=0.803, F=28.489, p&amp;lt;0.001).&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;Overall, the results of this study emphasize the significance of addressing sleep disorders, obesity, and depressive symptoms in children, particularly in adolescents, to promote better mental health outcomes.

O002 High strain evening exercise disrupts sleep: Insights from a real-world examination of ~7-million nights

Abstract Introduction Exercise is among the most effective daytime behaviors for promoting and maintaining sleep. However, late-night bouts of strenuous exercise that require high physiological demand (i.e., high strain) induce persistent increases in sympathetic arousal, which may disrupt sleep. We examined whether exercise strain moderates the relationship between evening exercise and objective sleep in free-living conditions. Methods A total of 19,977 individuals (26% female, M-age=37.9 years) wore a validated sleep and exercise biometric wearable device for 365 days between Sep 1, 2021 and Aug 31, 2022 (n=6,943,372 nights). Summated-heart-rate-zone-scores were used to categorize exercise strain into four groups: light, moderate, high, and all-out. Exercise timing was normalized to each individual’s habitual bedtime to account for individual differences in sleep/wake timing. Generalized additive mixed model analyses were used to model the non-linear relationship between exercise timing and sleep at different levels of exercise strain. Results Later exercise timing was associated with delayed sleep onset, reduced sleep quantity and quality, and increased sympathetic activity compared to no-exercise rest days (ps&amp;lt;.001). Importantly, a dose-response relationship was observed such that higher levels of exercise strain predicted worse sleep (ps&amp;lt;.001). Regardless of strain, exercise bouts ending at least 4 hours before habitual bedtime were not associated with changes in sleep. Discussion Evening exercise—particularly involving high exercise strain—can disrupt subsequent sleep (both duration and quality). It is recommended individuals stop exercising at least 4 hours before their habitual bedtime. However, when evening exercise is unavoidable, individuals could select lighter strain exercises to mitigate sleep disruption.

Circadian aspects in the aetiology and pathophysiology of insomnia.

Because the endogenous circadian pacemaker is a very strong determinant of alertness/sleep propensity across the 24 h period, its mistiming may contribute to symptoms of insomnia (e.g., difficulties initiating sleep and maintaining sleep) and to the development of insomnia disorder. Despite the separation of insomnia and circadian rhythm disorders in diagnostic nosology implying independent pathophysiology, there is considerable evidence of co-morbidity and interaction between them. Sleep onset insomnia is associated with later timed circadian rhythms and can be treated with morning bright light to shift rhythms to an earlier timing. It is also possible that the causal link may go in both directions and that having a delayed circadian rhythm can result in enough experiences of delayed sleep onset to lead to some conditioned insomnia or insomnia disorder further exacerbating a delayed circadian rhythm. Early morning awakening insomnia is associated with an advanced circadian phase (early timing) and can be treated with evening bright light resulting in a delay of rhythms and an improved ability to sleep later in the morning and to obtain more sleep. There is some evidence suggesting that sleep maintenance insomnia is associated with a blunted amplitude of circadian rhythm that may be treated with increased regularity of sleep and light exposure timing. However, this is an insomnia phenotype that requires considerably more circadian research as well as further insomnia clinical research with the other insomnia phenotypes incorporating circadian timing measures and treatments.