Sleep Guidelines Research Articles

Channel Contribution In Deep Learning Based Automatic Sleep Scoring - How Many Channels Do We Need?

Machine learning based sleep scoring methods aim to automate the process of annotating polysomnograms with sleep stages. Although sleep signals of multiple modalities and channels should contain more information according to sleep guidelines, most multi-channel multi-modal models in the literature showed only a little performance improvement compared to single-channel EEG models and sometimes even failed to outperform them. In this paper, we investigate whether the high performance of single-channel EEG models can be attributed to specific model features in their deep learning architectures and to which extent multi-channel multi-modal models take the information from different channels of modalities into account. First, we transfer the model features from single-channel EEG models, such as combinations of small and large filters in CNNs, to multi-channel multi-modal models and measure their impacts. Second, we employ two explainability methods, the layer-wise relevance propagation as post-hoc and the embedded channel attention network as intrinsic interpretability methods, to measure the contribution of different channels on predictive performance. We find that i) single-channel model features can improve the performance of multi-channel multi-modal models and ii) multi-channel multi-modal models focus on one important channel per modality and use the remaining channels to complement the information of the focused channels. Our results suggest that more advanced methods for aggregating channel information using complementary information from other channels may improve sleep scoring performance for multi-channel multi-modal models.

Perceptions and Use of Safe Sleep Baby Boxes at Hospital Discharge by New Mothers.

A large community hospital in South Texas began distributing safe sleep baby boxes to reduce sudden unexplained infant death (SUID) in 2017. To describe safe sleep practices among new mothers who received a safe sleep baby box at hospital discharge. An information sheet containing a link to an online survey was mailed to all women who received a safe sleep baby box prior to discharge from the hospital from January 2018 to January 2019. N = 84 women participated. Most reported using the safe sleep baby box only during nap time (n = 62, 88.6%). Only 70.2% of participants reported that baby always slept their back (n = 59). Most reported their baby did not use a pacifier (n = 62, 73.8%), and many reported they were not breastfeeding their baby (n = 38, 45.2%). Many women were not using the safe sleep baby box as intended and were not following many of the other safe sleep guidelines. Nurses should ask their patients about plans for infant safe sleep after discharge to provide individualized education or recommend specific resources to address the family's needs.

Prevalence and correlates of compliance with 24-h movement guidelines among children from urban and rural Kenya-The Kenya-LINX project.

Like many countries in sub-Saharan Africa, Kenya has experienced rapid urbanization in recent years. Despite the distinct socioeconomic and environmental differences, few studies have examined the adherence to movement guidelines in urban and rural areas. This cross-sectional study aimed at examining compliance to the 24-hour movement guidelines and their correlates among children from urban and rural Kenya. Children (n = 539) aged 11.1 ± 0.8 years (52% female) were recruited from 8 urban and 8 rural private and public schools in Kenya. Physical activity (PA) and sleep duration were estimated using 24-h raw data from wrist-worn accelerometers. Screen time (ST) and potential correlates were self- reported. Multi-level logistic regression was applied to identify correlates of adherence to combined and individual movement guidelines. Compliance with the combined movement guidelines was low overall (7%), and higher among rural (10%) than urban (5%) children. Seventy-six percent of rural children met the individual PA guidelines compared to 60% urban children while more rural children also met sleep guidelines (27% vs 14%). The odds of meeting the combined movement guidelines reduced with age (OR = 0.55, 95% CI = 0.35-0.87, p = 0.01), was greater among those who could swim (OR = 3.27, 95% CI = 1.09-9.83, p = 0.04), and among those who did not engage in ST before school (OR = 4.40, 95% CI = 1.81-10.68, p<0.01). The odds of meeting PA guidelines increased with the number of weekly physical education sessions provided at school (OR = 2.1, 95% CI = 1.36-3.21, p<0.01) and was greater among children who spent their lunch break walking (OR = 2.52, 95% CI = 1.15-5.55, p = 0.02) or running relative to those who spent it sitting (OR = 2.33, 95% CI = 1.27-4.27, p = 0.01). Prevalence of meeting movement guidelines among Kenyan children is low and of greatest concern in urban areas. Several correlates were identified, particularly influential were features of the school day, School is thus a significant setting to promote a healthy balance between sleep, sedentary time, and PA.

Movement guidelines for young children: Engaging stakeholders to design dissemination strategies in the Hong Kong early childhood education context.

Early childhood is a critical period during which patterns of movement behaviors are formed. The World Health Organization had endorsed guidelines for physical activity, sedentary behavior and sleep over a 24-h time period, which had been adopted by the Center for Health Protection of Hong Kong. This paper reports on stakeholder engagements that were conducted to inform the design of strategies to disseminate the guidelines in early childhood education (ECE) settings. Using a mixed-methods study design, we sought to (a) assess the stakeholders' levels of awareness and knowledge of the Hong Kong movement guidelines for young children and (b) identify the factors that influence the uptake of the said guidelines. We conducted an online survey of early childhood education teachers (N =314), twelve focus groups involving teachers (N = 18) and parents (N = 18), and individual interviews of key informants (N = 7) and domestic workers who provide care for preschool-aged children (N = 7). Descriptive statistics were used for the quantitative data, and thematic analysis was performed on the qualitative data using an inductive and semantic approach following a realist framework. Our findings show that teachers were aware of the movement guidelines for young children, but their knowledge of the specific guidelines was deficient; parents and domestic workers had limited awareness and knowledge of the guidelines. Uptake of the movement guidelines is enabled by parent engagement, activities in the ECE centers, home-school cooperation, and community activities for children. The challenges include the time poverty of parents, local curriculum requirements, limited physical spaces, social values, and pandemic-related restrictions. We recommend that dissemination strategies in the ECE context should deliver knowledge content and support stakeholders in mitigating the challenges associated with time, space, and social conditions.

Meeting guidelines for physical activity, muscle strength, and sleep lowers mortality risk: Commentary on: “Associations between aerobic and muscle-strengthening physical activity, sleep duration, and risk of all-cause mortality: A prospective cohort study of 282,473 U.S. adults”

Meeting guidelines for physical activity, muscle strength, and sleep lowers mortality risk: Commentary on: “Associations between aerobic and muscle-strengthening physical activity, sleep duration, and risk of all-cause mortality: A prospective cohort study of 282,473 U.S. adults”

Ensuring Safe Sleep in the Pediatric Intensive Care Unit: A Systematic Review of Informed Development of Clinical Guidelines for Implementation in Practice

Although general safe sleep guidelines have been established, their utility and implementation have yet to be examined systematically for inpatient populations for application to infants in the pediatric intensive care unit (PICU) setting. This study aimed to complete a systematic review of inpatient safe sleep practices studies to develop then safe sleep clinical guidelines for implementation in the care of medically complex infants in the PICU. This review was registered with PROSPERO and adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses systematic review guidelines. Nineteen articles met the inclusion criteria. A safe sleep guideline algorithm for medically complex infants in the PICU was created for implementation. Consistent and comprehensive safe sleep education and modeling by health care professionals in the inpatient setting is an effective technique to reduce the risk of harm and promote safe sleep behaviors in the home setting.

Integration of Time-Based Recommendations with CurrentPediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth.

Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep. Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.

Subject Matter Expert Nurses in Safe Sleep Program Implementation.

Pennsylvania sudden unexpected infant death rates rank among the highest nationally. A nursing team developed, implemented, evaluated, and disseminated an evidence-based quality improvement (QI) program at birthing hospitals in Pennsylvania to address this issue. To facilitate implementation, clinical nurses were educated as Subject Matter Experts (SMEs) to empower them to transform and sustain outcomes-driven QI for infant safe sleep nursing practice. This descriptive study examined outcomes from 268 nurses who received comprehensive education on infant safe sleep and the SME role. Likert-type scale surveys measured knowledge gained and progress made in practice following education. A programmatic dashboard tracked program implementation. Descriptive statistics were used to report findings. SME nurses ( N = 268) completed two interactive learning modules addressing safe sleep guidelines and teaching strategies and attended a workshop to acquire skills for program implementation. Key competencies included data collection and dissemination, policy development, and communication techniques. Immediate posteducation surveys completed by SMEs indicated that over 98% of respondents strongly agreed or agreed they were able to effectively demonstrate communication strategies, identify SME role components, provide environment surveillance, and demonstrate best practices in infant safe sleep. To allow time for assimilation of the of SME role, a survey was initiated at 6 months to capture progress made. Seventy-eight SMEs responded to the survey and reported exceptional or substantial progress in 10 areas for SME responsibilities. Use of the SME role for program implementation led to highly favorable SME-reported outcomes in leading a hospital-based QI program.

Longitudinal Shifts in Movement Behaviors during the COVID-19 Pandemic: Relations to Posttraumatic Stress Disorder among University Students.

This study examined the longitudinal changes of movement behaviors and their relationships with posttraumatic stress disorder (PTSD) among university students during the coronavirus disease 2019 in China. A total of 569 university students completed online surveys twice (Time 1: between December 2020 and January 2021; Time 2: between November and December 2021). Physical activity, sedentary behavior, sleep duration and quality, as well as PTSD were self-reported. According to Canadian 24-h movement guidelines, the longitudinal shifts in each movement behavior from Time 1 to Time 2 were divided into four categories (consistently meeting the guidelines, from meeting to not meeting the guidelines, from not meeting to meeting the guidelines, and consistently not meeting the guidelines). Generalized linear mixed models were conducted using 410 valid responses (20.2 ± 1.0 years old at Time 2, 41.2% males). From Time 1 to Time 2, 22.2%, 2.0%, and 45.6% of the students consistently met the physical activity, sedentary behavior, and sleep guidelines, respectively. Compared to those who consistently met the sedentary behavior guideline, students who consistently failed to meet or changed from meeting to not meeting the guidelines had higher levels of PTSD. Students who had poor sleep quality at both time points or changed from good to bad sleep quality had higher levels of PTSD than those who maintained good sleep quality over time. Compared to those who consistently failed to meet the guideline, students who consistently met the PA guideline had higher levels of PTSD. These findings highlight the needs to improve and maintain healthy behaviors for mental health.

Psychosocial factors related to sleep in adolescents and their willingness to participate in the development of a healthy sleep intervention: a focus group study

BackgroundOver the last decades, adolescents’ sleep has deteriorated, suggesting the need for effective healthy sleep interventions. To develop such interventions, it is important to first gather insight into the possible factors related to sleep. Moreover, previous research has indicated that chances of intervention effectivity could be increased by actively involving adolescents when developing such interventions. This study examined psychosocial factors related to sleep in adolescents and investigated adolescents’ willingness to participate in the development of a healthy sleep intervention.MethodsNine focus group interviews were conducted with seventy-two adolescents (63.9% girls, 14.8 (± 1.0) years) using a standardized interview guide. Interviews were audio-recorded and thematic content analysis was performed using Nvivo 11.ResultsAdolescents showed limited knowledge concerning sleep guidelines, sleep hygiene and the long-term consequences of sleep deficiency, but they demonstrated adequate knowledge of the short-term consequences. Positive attitudes towards sleep were outweighed by positive attitudes towards other behaviors such as screen time. In addition, adolescents reported leisure activities, the use of smartphones and television, high amounts of schoolwork, early school start time and excessive worrying as barriers for healthy sleep. Perceived behavioral control towards changing sleep was reported to be low and norms about sufficient sleep among peers were perceived as negative. Although some adolescents indicated that parental rules provoke feelings of frustration, others indicated these have a positive influence on their sleep. Finally, adolescents emphasized that it would be important to allow students to participate in the development process of healthy sleep interventions at school, although adult supervision would be necessary.ConclusionFuture interventions promoting healthy sleep in adolescents could focus on enhancing knowledge of sleep guidelines, sleep hygiene and the consequences of sleep deficiency, and on enhancing perceived behavioral control towards changing sleep. Interventions could also focus on prioritizing positive sleep attitudes over positive attitudes towards screen time, finding solutions for barriers towards healthy sleep and creating a positive perceived norm regarding healthy sleep. Involving adolescents in intervention development could lead to intervention components that match their specific needs and are more attractive for them.

Cross-sectional associations between 24-h movement guideline adherence and suicidal thoughts among Canadian post-secondary students

Suicide is one of the leading causes of death among post-secondary students. It is, therefore, imperative that we identify behavioral risk factors that can have protective effects in preventing against suicide. This study examined whether different combinations of adherence to the Canadian 24-Hour Movement Guidelines for Adults (i.e., physical activity, sedentary behavior, sleep) were associated with reduced odds of suicidal ideation and planning among emerging adults attending post-secondary education. This cross-sectional observational study used data from the first cycle of the Canadian Campus Wellbeing Survey, which included a total of 17,633 students (Mean age = 21.7 ± 2.92 years; 67.1% female, 31.5% male, 1.4% other) enrolled in 20 Canadian post-secondary institutions. Logistic regression models with covariate balanced propensity score weighting were computed. Suicidal ideation and suicidal planning were reported by 14.4% and 4.9% of students, respectively. Adherence to the sleep (OR = 0.71; 95% CI: 0.58–0.86), physical activity and sleep (OR = 0.74; 95% CI: 0.62–0.88), sedentary behavior and sleep guidelines (OR = 0.64; 95% CI: 0.45–0.90) as well as concurrent adherence to all three guidelines (OR = 0.58; 95% CI: 0.44–0.75) were associated with significantly reduced odds of suicidal ideation. Among students who reported suicidal ideation, only adherence to the physical activity and sleep guidelines (OR = 0.67; 95% CI: 0.48–0.96) was associated with suicidal planning. Collectively, findings suggest the promotion of healthy movement behavior patterns may be a promising avenue for broad suicide and mental health prevention efforts on campus, although the potency of these effects may not extend to more severe suicidal thoughts.

Healthy weight, health behaviours and quality of life among Aboriginal children living in regional Victoria

ObjectiveTo report the prevalence of healthy weight and related behaviours among Victorian Aboriginal and non‐Aboriginal children and explore associations between these factors and health‐related quality of life (HRQoL). MethodsAnalysis of cross‐sectional data from two cluster randomised controlled trials using logistic and linear mixed models. The sample included Aboriginal (n=303) and non‐Aboriginal (n=3,026) children aged 8–13 years. ResultsMore than two‐thirds of Aboriginal children met guidelines for fruit (75.9%), sweetened drinks (66.7%), sleep (73.1%), screen time (67.7%) and objectively measured physical activity (83.6%); and 79.1% reported consuming take‐away foods less than once per week. Aboriginal children were more likely to meet vegetable consumption guidelines (OR=1.42, 95%CI: 1.05, 1.93), but less likely to have a healthy weight (OR=0.66, 95%CI: 0.52, 0.85) than non‐Aboriginal children. Mean HRQoL scores were significantly higher among non‐Aboriginal children and both Aboriginal and non‐Aboriginal children meeting health guidelines. ConclusionsMost Aboriginal children in this study met guidelines for fruit, physical activity, screen time and sleep, and those meeting these guidelines had significantly higher HRQoL. Implications for public healthPromoting nutrition, physical activity and sleep is likely to benefit all children. Aboriginal community‐controlled organisations can use these data to design culturally‐specific programs that may improve disparities in healthy weight and HRQoL.

Examining Relationships among Chinese Preschool Children's Meeting 24-Hour Movement Guidelines and Fundamental Movement Skills.

Background: Few studies have investigated associations between meeting 24-Hour Movement Guidelines and preschool children’s fundamental movement skills (FMS). This study aimed to investigate the associations between Chinese preschoolers meeting various combinations of the Guidelines and FMS, as well as examining gender differences across those outcomes. Methods: A total of 322 preschool children (181 boys and 141 girls) aged 3–6 years old were recruited from five early-childhood education and care services in China. Children’s 7-day physical activity (PA) was assessed using accelerometry, and screen time (ST) and sleep duration were reported by their parents. FMS were assessed by Test of Gross Motor Development 3. Descriptive statistics and gender differences in children’s meeting the Guidelines and FMS were calculated using t-tests for continuous variables and Chi-square tests for categorical variables. Results: Most preschoolers met the sleep and ST guidelines, but only 22.3% met the PA guidelines; 4% of preschoolers did not meet any of the recommendations, while 9.3% met all three recommendations. Boys reported significantly higher compliance with all combined recommendations. There were positive associations between meeting the PA guidelines and both locomotor (β = 0.49; p < 0.001) and object control skills (β = 0.21; p < 0.001). A significantly positive relationship was identified between meeting PA + sleep guidelines and locomotor skills (β = −0.16; p = 0.02). A significantly negative association was observed between preschoolers’ meeting sleep + ST guidelines and locomotor skills (β = 0.31; p = 0.001). Conclusion: Few preschoolers met all three movement behavior guidelines. The findings suggest that PA levels, especially MVPA, are important for the promotion of FMS. Meanwhile, the impacts of ST and sleep on motor development cannot be neglected.

Sleep dimensions are associated with obesity, poor diet quality and eating behaviors in school-aged children.

ObjectivesThe aim of this cross-sectional study was to investigate the association between sleep dimensions (duration, patterns, and disturbances) with body mass index (BMI), diet quality, and eating behaviors in school-aged children. Additionally, we aimed to investigate whether obesogenic eating behaviors (higher food responsiveness, lower satiety responsiveness, and less slowness in eating) and poor diet quality could mediate the potential association between sleep and obesity in school-aged children.Materials and methodsFor all participants (n = 588 children, age 5–12 years; 51% girls) we evaluated: sleep dimensions, BMI, diet quality, eating behaviors (food responsiveness, satiety responsiveness and slowness in eating). Linear regression models were used to test associations between exposure and outcome variables. Additionally, path analysis was conducted to test whether eating behaviors mediated the relationship between sleep and obesity.ResultsShorter sleep duration (β = −0.722, p = 0.009) and greater sleep disturbances (β = 0.031, p = 0.012) were significantly associated with BMI. Additionally, we observed that diet quality was significantly associated with sleep duration (β = 0.430, p = 0.004), the midpoint of sleep (β = −0.927, p < 0.001), and sleep disturbances (β = −0.029, p < 0.001). Among other findings, greater sleep disturbances were associated with food responsiveness (β = 0.017, p < 0.001), satiety responsiveness (β = 0.015, p < 0.001), and slowness in eating (β = 0.012, p < 0.001). Importantly, food responsiveness was found as significant mediator of the relationship between sleep and BMI (R = 0.427, R2 = 0.182, p < 0.001).ConclusionsLate sleep patterns, short sleep duration, and greater sleep disturbances are significantly related with what and how school-aged children eat. Importantly, poor diet quality was significantly related to all three sleep dimensions, while eating behaviors had a significant relationship with greater sleep disturbances. These findings may be relevant to the development of behavioral targets to prevent childhood obesity, including sleep hygiene guidelines as a strategy to improve children's eating habits, as well as their BMI.

The influence of sleep and movement on mental health and life satisfaction during the transition to parenthood

ObjectivesThis study assessed whether sleep and physical activity impact mental health and life satisfaction across the transition to parenthood. This study assessed the impact of parenthood on mental health of new parents and parents expecting their second child, and whether change in mental health occurred dyadically across couples. DesignLongitudinal 12-month study. ParticipantsOne hundred and fifty-seven couples (N = 314) between the ages of 25 and 40, who were not expecting to have a child (n = 102), expecting their first child (n = 136), or expecting their second child (n = 76) were recruited. MeasurementsParticipants completed measures at baseline, 6 months, and 12 months. Sleep was assessed with how often participants met sleep guidelines (7-9 hours). Physical activity was measured objectively via accelerometers. Mental health was measured using 6 items from the short form-12 Quality of Life Survey. Life satisfaction was assessed with the Satisfaction with Life Scale (5 items). ResultsMental health was not predicted by physical activity but was predicted by sleep. Sleep at 6 months was positively related to mental health at 6 months (β = 0.156, p < .001), and sleep at 12 months was positively related to mental health at 12 months (β = 0.170, p < .001). The change in mental health did not occur dyadically: mental health increased for women but not for men across groups. Mental health was positively related to life satisfaction at 6 months (β = 0.338, p < .001) and 12-months (β = 0.277, p < .001). ConclusionsFor new and established parents, getting sufficient sleep plays an important role in mental health and, in turn, life satisfaction

Associations between Parent Attitudes and on- and off-Screen Behaviours of Preschool Children in Singapore.

The research aims were to examine the relationships between parent and child digital media use and to describe the characteristics of the top and bottom quartiles of child digital media use in meeting the 24 h integrated guidelines for sleep, physical activity, and sedentary behaviour. Parent-reported on- and off-screen habits and quality of life of children were collected from 1481 parents of preschool children aged 2–5 years in 2019. Significant relationships were detected between parent and child digital media use (weekday, r = 0.274; weekend, r = 0.421, p < 0.05) with no sex difference in daily child digital media use (p > 0.05). Age of first exposure to fixed screens, daily digital media use, and physical play durations were significantly different between heavy (child-TQ) and light (child-BQ) child users of digital media (p < 0.05). Parental perceived importance of child digital media use and parental awareness and practice of guidelines for child digital media use differed significantly between parents of child-TQs and parents of child-BQs (p < 0.05). The number of 24 h movement guidelines met between child-TQs and child-BQs differed (p < 0.05). Parents voiced serious concerns for child digital media use, including addiction (75–76%), poor eyesight (73%), access to inappropriate content (73–74%), a lack of parent–child interaction (65%), poor sleep (49–55%), and a lack of physical activity (55–59%), but these findings did not translate to parental enforcement of the guidelines. Parent education on how to get the best digital media use outcomes for preschool children is recommended.

Impact of Virtual vs. In-Person School on Children Meeting the 24-h Movement Guidelines during the COVID-19 Pandemic.

The pandemic mitigation strategy of closing schools, while necessary, may have unintentionally impacted children’s moderate-to-vigorous physical activity (MVPA), sleep, and time spent watching screens. In some locations, schools used hybrid attendance models, with some days during the week requiring in-person and others virtual attendance. This scenario offers an opportunity to evaluate the impact of attending in-person school on meeting the 24-h movement guidelines. Children (N = 690, 50% girls, K–5th) wore wrist-placed accelerometers for 14 days during October/November 2020. Parents completed daily reports on child time spent on screens and time spent on screens for school. The schools’ schedule was learning for 2 days/week in-person and 3 days/week virtually. Using only weekdays (M–F), the 24-h movement behaviors were classified, and the probability of meeting all three was compared between in-person vs. virtual learning and across grades. Data for 4956 weekdays (avg. 7 d/child) were collected. In-person school was associated with a greater proportion (OR = 1.70, 95% CI: 1.33–2.18) of days that children were meeting the 24-h movement guidelines compared to virtual school across all grades. Students were more likely to meet the screen time (OR = 9.14, 95% CI: 7.05–11.83) and MVPA (OR = 1.50, 95% CI: 1.25–1.80) guidelines and less likely to meet the sleep (OR = 0.73, 95% CI: 0.62–0.86) guidelines on the in-person compared to the virtual school days. Structured environments, such as school, have a protective effect on children’s movement behaviors, especially physical activity and screen time.

O68 - Addressing Caregiver Challenges with Inconsistent and Unrealistic Safe Sleep Messaging: a Safer Sleep Guideline informed by Risk Minimisation

Safe sleep messaging varies considerably in clinical practice and guidelines within and between Australian states and territories. Risk elimination approaches which attempt to enforce idealistic expectations of where and how a baby sleeps have been demonstrated to alienate parents. Risk minimisation approaches which support ‘safer sleep’ offer flexibility and practical strategies that are more likely to engage families in risk reduction and infant health promoting behaviours. This analysis aims to share safe sleep messages that parents identified as most challenging to implement and introduce the Safer Infant Sleep clinical guideline designed to address common barriers encountered. A cross-sectional survey of 3341 Queensland families with infants aged approximately 3-months, birthed April-May 2017. Data included family characteristics, infant care practices used and engagement with safe sleep recommendations. Qualitative free-text items explored challenges with current safe sleep recommendations. Of caregivers, 1033 (31%) reported difficulty with at least one recommendation. Infant sleep position and avoiding a shared-sleep surface presented the greatest challenges. Families experiencing challenges were significantly less likely to employ advice compared to those not reporting difficulty (sleep position: 198/473, 42% vs 2548/2837, 90%[p<0.0001]; own sleep space: (269/344, 78% vs 1331/2884, 46%[ p <0.0001]). Parenting strategies believed to be unsupported weren’t disclosed, reducing opportunities between family and health professionals to share information and inform safer strategies. A tiered approach to tailor interventions for priority families based on identified vulnerabilities has been designed to develop safer sleep plans for every sleep. Structured support such as the Pēpi-Pod® Program is included. Many families encounter difficulties in implementing safe sleep advice; these challenges negatively impact infant care practices. The Safer Sleep guideline provides families a voice for collaborative and informed decision-making and provides professionals a tiered approach to manage risk whilst recognising their clinical judgement and reasoning to meet the needs of families.

Associations between aerobic and muscle-strengthening physical activity, sleep duration, and risk of all-cause mortality: A prospective cohort study of 282,473 U.S. adults

PurposeTo examine the joint associations between meeting guidelines for physical activity (PA) and sleep duration and all-cause mortality risk among adults. MethodsParticipants were adults (n = 282,473) aged 18–84 years who participated in the 2004–2014 U.S. National Health Interview Survey. Mortality status was ascertained using the National Death Index through December 2015. Self-reported PA (Active: meeting both aerobic (AER) and muscle-strengthening (MSA) guidelines, AER only (AER), MSA only (MSA), or not meeting either AER or MSA (Inactive)) and sleep duration (Short, recommended (Rec), or Long) were classified according to guidelines, and 12 PA–sleep categories were derived. Adjusted hazard ratios and 95% confidence intervals (95%CIs) for all-cause mortality risk were estimated using Cox proportional hazards regression models. ResultsA total of 282,473 participants (55% females) were included; 18,793 deaths (6.7%) occurred over an average follow-up of 5.4 years. Relative to the Active-Rec group, all other PA-sleep groups were associated with increased mortality risk except for the Active-Short group (hazard ratio = 1.08; 95%CI: 0.92–1.26). The combination of long sleep with either MSA or Inactive appeared to be synergistic. For a given sleep duration, mortality risk progressively increased among participants classified as AER, MSA, and Inactive. Within each activity level, the mortality risk was greatest among adults with long sleep. ConclusionRelative to adults meeting guidelines for both PA and sleep duration, adults who failed to meet guidelines for both AER and muscle strengthening PA and who also failed to meet sleep duration guidelines had elevated all-cause mortality risks. These results support interventions targeting both PA and sleep duration to reduce mortality risk.

Weight status and meeting the physical activity, sleep, and screen-time guidelines among Texas children: results from a population based, cross-sectional analysis

BackgroundEvidence suggests that the interactive effects of physical activity, screen-time and sleep are stronger than independent effects of these behaviors on pediatric obesity. However, this hypothesis has not been fully examined among samples of young school-aged children. The aim of this study is to determine the association of weight status with meeting the physical activity, screen-time, and sleep guidelines, independently and concurrently, among 2nd grade children.MethodsThe Texas School Physical Activity and Nutrition Project collected parent-reported physical activity, screen-time, and sleep, and measured body height and weight on a statewide representative weighted sample (n = 320,005) of children. Weighted multivariable logistic regressions were used to assess associations of weight status (classified using age- and sex-specific body weight [kg]/height [m]2, based on International Obesity Task Force cutoffs) with meeting the physical activity, screen-time, and sleep guidelines, while controlling for relevant covariates (age, sex, race/ethnicity, comorbidities etc.).ResultsA greater proportion of healthy weight children (9.9%) met the physical activity, screen-time, and sleep guidelines concurrently compared to children who are thin (3.3%), or children with overweight (5.7%), obese (3.5%), and morbid obesity (1.0%). Children who were thin (adjusted odds ratio [aOR]:0.40, 95% confidence interval [CI]: 0.10, 1.50), overweight (aOR = 0.75, CI: 0.33, 1.70), obese (aOR = 0.53, CI: 0.15, 1.81), and morbidly obese (aOR = 0.10, CI: 0.02, 0.28) had lower odds of concurrently meeting the guidelines compared to children with healthy weight.ConclusionsAmong this representative sample of Texas children, weight status was associated with meeting physical activity, screen-time, and sleep guidelines. Future studies should aim to evaluate causal relations between these behaviors and weight status.