Sleep In School-aged Children Research Articles

Child routines moderate a brief behavioral intervention to enhance sleep in school-aged children.

To examine whether child routines (the consistency or variation in children's daily routines, household responsibilities, discipline routines, and homework routines) moderated the effectiveness of a brief behavioral intervention to enhance sleep in school-aged children. Secondary analysis was conducted with a subset of 66 families with short sleeping (≤9.5 hr/day) children, 8-11 years old (female = 68%; mean age = 9.76, SD = 1.02) who completed the Child Routines Inventory at baseline and were then randomized to receive a behavioral sleep intervention (n = 32) or to control (n = 34). Sleep period was objectively measured using wrist actigraphy at baseline and 2 months post-randomization. Moderation analysis was performed using ordinary least squares regression using the PROCESS macro for SPSS. Controlling for sleep period at baseline, treatment condition was significantly related to the sleep period at 2 months post-randomization, with the intervention group achieving a longer sleep period compared to the usual sleep period group (control) (b = 46.30, p < .01). Intervention response was moderated by child routines (b = 1.43, p < .05). Specifically, the intervention produced the greatest change in sleep period for children who engaged in greater routine behaviors at baseline than those who engaged in fewer routine behaviors. Families that engage in routine behaviors may be better equipped to adopt the behavioral modifications required to get a good night's sleep. The findings highlight the importance of working with families to establish routine behaviors to improve responses to behavioral sleep interventions.

Mild Traumatic Brain Injury and Behavior and Sleep Among 9- and 10-Year Old Children: Initial Findings From the Adolescent Brain Cognitive Development (ABCD) Study.

There has been concern about the potential sequelae of mild traumatic brain injury (mTBI) in children. This study used data from the Adolescent Brain Cognitive DevelopmentSM (ABCD) study to investigate associations between mTBI and behavior and sleep in school-aged children. Generalized additive mixed models were run to examine the association between TBI and parent-reported Child Behavior Checklist and Sleep Disturbance Scale for Children scores. mTBI with or without loss of consciousness (LOC) in 9- and 10-year old children was associated with 1) higher internalizing, externalizing and total problems and 2) greater sleep disturbance scores on the CBCL. The study also demonstrated a higher incidence of mTBI with and without LOC in boys compared to girls. This study shows a statistically significant but modest association between mTBI and behavioral and sleep changes, suggesting that in a non-clinical, sociodemographically diverse community sample of school-aged children mTBI does not result in clinically significant behavioral or psychological sequelae.

Parental Perceptions of the Impact of the COVID-19 Pandemic on the Sleep of Children With Neurodevelopmental Disorders

Little is known about the impact of the COVID-19 pandemic on sleep in school-aged children with neurodevelopmental disorders (NDDs). The present study aimed to: 1) determine and describe the impact of the COVID-19 pandemic, and 2) identify and describe contributing factors. Parents of children with NDDs and insomnia symptoms (n = 100) were surveyed to determine if their child's sleep had changed because of the COVID-19 pandemic. Parents who reported changes were asked to describe how the pandemic influenced their child's sleep. Most parents (66%) reported the pandemic did not worsen their child's sleep; 30% stated their child's sleep had worsened and 4% reported an improvement. Stress and anxiety about the pandemic, disrupted routines, and increased screen time were common parent-identified contributing factors. Healthcare providers should explore strategies to mitigate contributing factors, such as anxiety about the pandemic, disrupted routines, and increased screen time.

0513 Sleep in Children in Need of a Bed and Living in Poverty

Abstract Introduction Healthy sleep is important for child development, with youth living in poverty and especially those who do not have a bed at greater risk for sleep issues. This study assessed sleep in school-aged children identified by social services as needing a bed and living in poverty. Methods Fifty-two families (100% living ≤ 100% of the US poverty line) of children ages 8-12 years (M= 9.65; 55.8% girls; 61.5% non-Latinx Black) referred to a non-profit bed provision program completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of child sleep disturbances, sleep-related impairment, and sleep practices prior to bed provision. Comparisons were made to normative data for each measure based on converted T-scores/means. Results T-scores (M = 50; SD = 10) for caregiver and child reported child sleep disturbances (M= 46.81 and 47.22, respectively) and sleep-related impairment (M= 56.82 and 53.33, respectively) fell within the normal range. Although few caregiver-child dyads reported clinically significant (&amp;gt; 1 SD above the mean) child sleep disturbances (7.7% and 10.8%, respectively), 30.7% of caregivers and 27.4% of children reported clinically significant child sleep impairment scores compared to an expected rate of 15.9% from normative data. Regarding sleep practices, few caregiver (11.5%) and child (9.8%) reports of problematic sleep timing and caregiver-rated child bedtime routine inconsistency (13.5%) were &amp;gt; 1 SD above the normative mean. However, 25.5% of youth reported inconsistent bedtime routine scores &amp;gt; 1 SD above the normative mean, while 25.0% of caregivers and 31.4% of youth reported scores &amp;gt; 1 SD above the normative mean for child difficulty falling asleep without caregiver presence at bedtime. The prevalence of these elevated scores were greater than the expected prevalence of 15.9% in normative data. Conclusion Overall, children living in poverty and without an individual bed score similar to normative samples on sleep measures. However, a greater proportion of youth in this sample showed clinically significant sleep impairments and poor sleep practices compared to normative data. Future studies are needed to understand and promote healthy sleep among youth living in poverty. Support (If Any) American Academy of Sleep Medicine Foundation

The association between school-age children duration and quality of sleep and their psychoemotional status: a retrospective-prospective study

Summary. Getting enough sleep is essential for the physical and mental health of children and adolescents, therefore, the study of the impact of stress factors in this direction is relevant. The aim of the study was to study the characteristics of sleep in school-age children with various psycho-emotional statuses during the introduction of strict quarantine measures and after a lockdown compared to the period before the pandemic. Materials and methods. The analysis of sleep characteristics and mental health status in 2592 school-age children (1407 boys, 1185 girls) was carried out. The retrospective study was based on the results of the assessment using the DON questionnaire and during a pandemic was the RCADS-P-25 questionnaire. SPSS Statistics v.26.0 was used for statistical performance. Results. The proportion of school-age children with depressive manifestations during the pandemic increased by 13.3% (p &lt;0.001) compared to the period before the pandemic and it is 21.5 ± 2.0% in 2021. The proportion of children with anxiety disorders is 6.9 ± 1.3% that corresponds to the period before the pandemic. It was determined an increase in the school-age children duration of sleep during the lockdown compared with other periods of the study by 30-40 minutes/day (p &lt;0.001). It was found that during the lockdown period in 2021, the sleep duration of school-age children decreased by 5.5% compared to the data in 2020 (p &lt;0.01). In the group without anxiety-depressive disorders after the lockdown, the sleep duration significantly decreased, and in the group with mental health disorders, the sleep duration did not statistically differ from the level established during the strict quarantine restrictions. Sleep quality disorders during the lockdown were detected in 29.8 ± 2.6% of children in the surveyed cohort, and in the period after the lockdown - in 31.5 ± 4.0%. In the group of children with anxiety-depressive disorders, a decrease in the duration of sleep was found in all periods of the study. Conclusions. A decrease in the duration of sleep with an increase in the proportion of children with depressive disorders in the second year of the pandemic indicates negative trends in the mental health of school-age children and requires improved preventive measures.

The role of prior sleep for divergent thinking in infants.

Higher-order cognitive functions seem particularly vulnerable to disruptions in prior sleep in school-aged children and adult populations. This study tested whether divergent thinking in infants varied as a function of prior sleep. Forty-three infants aged 13-16months participated in a behavioural assessment of divergent thinking. Length of wakefulness since last sleep was experimentally manipulated. In addition, potential relations between divergent thinking and sleep quantity and quality during the night immediately before the assessment, as well as during three consecutive nights preceding the assessment, were examined using actigraphy recordings in combination with parent diaries. Divergent thinking was not impaired by lack of sleep within the previous 4h. Divergent thinking was consistently related to night-time sleep quality and quantity prior to the assessment. These results suggest that timing of prior naturally occurring daytime sleep is less relevant for emergent divergent thinking capacity than quality and quantity of preceding night-time sleep.

152 Prospective associations between pre-sleep electronics use and same-night sleep in healthy school-aged children

Abstract Introduction Electronic media devices are ubiquitous in modern society and believed to adversely affect nighttime sleep. Cross-sectional research provides evidence of robust associations but prospective findings are limited and mixed. In this study, we examined the impact of specific types of electronics devices and overall use on objective and subjective sleep parameters the same night across one week. Methods The sample consisted of school-aged children (N=55) between the ages of 7 to 11 years. Hierarchical linear modeling was used to assess the impact of pre-bedtime electronics use on sleep the same night across 5 weekday nights. A sleep diary was used to record pre-bed electronic devices used and subjective sleep parameters. Objective sleep variables were assessed concurrently via actigraphy. Results The usage of different types of electronic media varied significantly between and within children across the five days. However, neither total electronics usage nor any individual type of device was found to significantly predict self-reported or objective sleep parameters the same night. Conclusion The extent to which the use of electronic media specifically within an hour of bedtime impacts sleep in school-aged children remains unclear. Future research should investigate these relationships using more robust methodology, including prospective designs and examination of relevant contextual and environmental factors. Support (if any) This study was funded by the National Institute of Mental Health [grant number #R21 MH099351] awarded to the last author.

Persistent Short Sleep from Childhood to Adolescence: Child, Parent and Peer Predictors.

PurposeMany children have periods when they sleep too little, with widely recognized detrimental effects. Less is known about persistent short sleep during childhood. Therefore, the present study aimed to investigate the prevalence of persistent short sleep in school-aged children and identify a set of child, parent, and peer predictors thereof.Participants and MethodsObjectively measured sleep duration (hip-held accelerometer) was biennially assessed in a community sample followed from 6 to 14 years (n=801). A latent profile analysis was applied to assess whether a subgroup of children slept consistently short across time and predictors of persistent short sleep were determined through regression analysis.ResultsA subgroup of children (n=160; 20.2%) was identified as having persistent short sleep across time. Temperamental negative affectivity (β=0.08; 95% CI=0.01, 0.15; p=0.03) and low observer-assessed parental emotional availability (β=−.09; 95% CI=−.18, −.01; p=0.04) predicted membership to that group. Teacher ratings of victimization from bullying were not associated with persistent short sleep (β=0.01; 95% CI: −.10, 11; p=0.88).ConclusionHigh child temperamental negative affectivity and low parental emotional availability may be involved in the development of persistent short sleep through childhood.

Comparing measures of free-living sleep in school-aged children

Objective/BackgroundRecent technological advances and emerging commercially-available consumer-friendly sleep assessment products affords researchers with a host of tools to consider for capturing free-living sleep in children. The purpose of this study was to compare free-living sleep characteristics (duration and bed/wake times) across different measures in children. MethodsElementary school-aged children (N = 30, mean age 7.2 years, 63% boys, 87% non-Hispanic white) wore an ActiGraph GT9X Link© and Fitbit Charge HR© on the non-dominant wrist, with a Beddit 3 Sleep Monitor© affixed to their mattress for two consecutive weekend nights of free-living sleep. Parents completed a sleep log of bed and wake times. Absolute differences in bed and wake times were examined and Bland Altman plots assessed the level of agreement across sleep measures. ResultsAcross the four sleep measures, total sleep time (TST) ranged from 458 min/night (ActiGraph GT9X Link©) to 613 min/night (Parent report). Mean bed and wake times ranged from 8:46PM to 9:03PM, and 6:52AM to 7:16AM, respectively. Pearson correlation coefficients were moderate between all four sleep measures (range r = 0.30–0.71). Bland–Altman plots indicated the highest level of agreement for TST was between Beddit 3 Sleep Monitor© and Fitbit Charge HR© (mean difference −11.7, limits of agreement: 119.0, −142.4 min). ConclusionsThe findings from this study show a high level of agreement of when a child goes to sleep and wakes up across a variety of sleep measures; however, more work is needed to classify TST once the sleep period has commenced.

0776 A Behavioral Intervention to Enhance Sleep in School-Aged Children: Moderation by Child Routines

0776 A Behavioral Intervention to Enhance Sleep in School-Aged Children: Moderation by Child Routines

Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis.

Sleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents. In a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy. After intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (-9.31 minutes, P = .007) and actigraphy (-19.48 minutes, P < .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries -15.85 minutes (P = .01) and actigraphy -23.67 minutes (P < .0001). At follow-up, the effects on wake after sleep onset from ratings (-14.41 minutes, P = .001) and actigraphy (-7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated. Cognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed.

Assessment of behavior and sleep in school-age children with generalized epilepsy

Background Epilepsy affects 1% of the human population. Sleep disorders frequently coexist in patients with epilepsy. Whether sleep affects epilepsy or epilepsy modifies sleep has been extensively evaluated, but very little literature exists on the mutual interaction of epilepsy and sleep problems. Objective and aims To assess the sleep pattern and behavior in school age children with generalized epilepsy. Methods The current study was comparative case control study was carried on 60 school aged children 30 of them had generalized epilepsy on carbamazepine presented to neuropsychiatry department in suez canal university hospital and other 30 healthy children had no chronic illness, The Children's Sleep Habits Questionnaire and Vanderbilt assessment scale were applied on both groups. Results the current study showed that epileptic children have a statistically significant difference in breathing problem like snoring ( P =0.001), epileptic children had more common daytime sleepiness problem ( P =0.002). Behavioral problems were more common in epileptic children like ADHD ( P -value=0.001), anxiety and depression were highly frequent in epileptic children than normal children ( P -value=0.001) and schoolastic achievement was more problematic in epileptic children. Conclusions Epileptic children are more vulnerable to sleep problems, behavioral problems and poor schoolastic achievement is more common in epileptic children. Controlled fits and monotherapy decreased the effect of epilepsy in all aspects.

Leg movement activity during sleep in school-age children and adolescents: a detailed study in normal controls and participants with restless legs syndrome and narcolepsy type 1.

To evaluate leg movement activity during sleep (LMS) in normal school-age children and adolescents, to eventually establish age-specific periodic LMS (PLMS) index thresholds that support the diagnosis of restless legs syndrome (RLS), and to evaluate the utility of other LMS indices. Polysomnographic recordings from 61 controls, 46 children with RLS, and 44 children with narcolepsy type 1 (NT1) were analyzed for total leg movements (LMS), PLMS, and isolated leg movements (ISOLMS) duration and indices, separately for school-age children and adolescents. Moreover, intermovement interval (IMI) graphs and time-of-night distribution of LMS were analyzed, and cut-off thresholds for PLMS index and total LMS index were assessed for the separation of RLS from controls. All indices tended to decrease from school-age children to adolescents in normal controls and in NT1, whereas in RLS, only PLMS index increased. All school-age children had a similar IMI distribution with a single peak at IMI 2-4 s followed by gradual decline. In adolescents with RLS, a second peak at IMI 10-50 s was seen. Time-of-night distribution of most indices decreased in RLS, whereas most tended to increase in NT1. A PLMS index cutoff of 2 per hour best differentiated RLS from controls in school-age children (accuracy 70.0%) and in adolescents (accuracy 70.8%); however, most participants with NT1 also showed PLMS indices higher than this threshold. PLMS index alone does not reliably predict the diagnosis of RLS in children and adolescents. However, analyses of IMI distribution and time-of-night distribution provide additional elements to support a diagnosis of RLS.

Interventions that stimulate healthy sleep in school-aged children: a systematic literature review

Healthy sleep among children has social, physical and mental health benefits. As most of today’s children do not meet the healthy sleep recommendations, effective interventions are urgently needed. This systematic review summarizes the characteristics and effectiveness of interventions aiming to stimulate healthy sleeping in a general population of school-aged children. The search engines PubMed, Embase, Web of Science, PsycInfo and the Cochrane Database Library were systematically searched up to March 2016. We included all studies evaluating interventions targeting healthy sleep duration and/or bedtime routines of children aged 4–12 years. All steps in this systematic review, i.e. search, study selection, quality assessment and data extraction, were performed following CRD Guidelines and reported according to the PRISMA Statement. Eleven studies were included, of which only two were of strong quality. The interventions varied in terms of targeted determinants and intervention setting. Overall, no evidence was found favoring a particular intervention strategy. One intervention that delayed school start time and two multi-behavioral interventions that targeted both the school and home setting showed promising effects in terms of increasing sleep duration. Due to few high quality studies, evidence for the effectiveness of any particular intervention strategy to stimulate healthy sleep in children is still inconclusive. However, the more effective interventions in stimulating healthy sleep duration and adherence to regular bedtimes were mostly multi-behavioral interventions that included creating daily healthy routines and combined intervention settings (e.g. home and school). In conclusion, high-quality studies evaluating systematically developed interventions are needed to move this field forward.

The Association Between Anxiety Symptoms and Sleep in School-Aged Children: A Combined Insight From the Children’s Sleep Habits Questionnaire and Actigraphy

The current study assessed the association between anxiety symptoms and sleep in 90 school-aged children, aged 6–12 years (Mage = 108 months, 52.2% male). The Children’s Sleep Habits Questionnaire (CSHQ) and 14 nights of actigraphy were used to assess sleep. Anxiety was assessed using the Spence Children’s Anxiety Scale (SCAS). A significant association was found between parent-reported anxiety symptoms and current sleep problems (i.e., CSHQ total scores ≥ 41). An examination of SCAS subscales identified a specific association between generalized anxiety disorder (GAD) symptoms and increased parental sleep concerns, including sleep onset delay, sleep duration, and daytime sleepiness. Regarding actigraphy, whilst anxiety was not associated with average sleep variables, a relationship was identified between anxiety and the night-to-night variability of actigraphy-derived sleep schedules.

Association between Information and Communication Technology Usage and the Quality of Sleep among School-Aged Children during a School Week

Objective. To determine the association between intensity of information and communication technology (ICT) usage and quality of sleep in school-aged children during a school week. Methods. In all 61 subjects, 10–14 years of age, a quasiexperimental laboratory study where criterions for inclusion were absence of prior medical condition and duration of ICT use. A portable device (Holter monitor) was used to measure heart rate variability (HRV) over a 24-hour period, while activity diary was used to record in 15-minute intervals ICT use and sleep and wake up time. Low and high ICT user groups were formed according to their intensity of ICT use. Statistical analysis was done with two independent samples tests and factorial ANCOVA. Results. The higher ICT users showed a lower sleep time standard deviation of normal to normal interval (SDNN) measures in comparison to the low ICT users. Conclusion. The intensive ICT use was associated with poorer quality of sleep indicated by physiological measures among children and adolescents. Knowing the crucial role of healthy sleep in this age, the results are reason for concern.

The Relation Among Sleep Duration, Homework Burden, and Sleep Hygiene in Chinese School-Aged Children

Insufficient sleep in school-aged children is common in modern society, with homework burden being a potential risk factor. The aim of this article is to explore the effect of sleep hygiene on the association between homework and sleep duration. Children filled out the Chinese version of the Adolescent Sleep Hygiene Scale, and parents filled out a sociodemographic questionnaire. The final sample included 363 boys and 371 girls with a mean age of 10.82 ± 0.38 years. Children with more homework went to bed later and slept less. Better sleep hygiene was associated with earlier bedtimes and longer sleep duration. Findings suggest that homework burden had a larger effect on sleep duration than sleep hygiene. Fifth-grade children in Shanghai have an excessive homework burden, which overwrites the benefit of sleep hygiene on sleep duration.

Effects of stay at gymnasium on sleep in school aged children

Effects of stay at gymnasium on sleep in school aged children

High prevalence of irritable bowel syndrome with poor sleep quality in children and adolescents in Shanghai

This study explored the prevalence of irritable bowel syndrome (IBS) and investigated the relation-ship between IBS and disturbed sleep in school-age children in Shanghai, China. Primary, middle and high school students (n = 1542) were recruited from schools in Shanghai. Students completed two questionnaires: the questionnaire for IBS in children and adolescents and the Pittsburgh Sleep Quality Index (PSQI). The overall prevalence of IBS adjusted for cluster effects among students was 18.81%, and prevalence increased with age. Relative to non-IBS students, more IBS students tended to have poor sleep, including quality and duration. IBS is common among children and adolescents in Shanghai, China, and its prevalence increases with age. A tendency toward poor sleep also increases with age. The causal relationship between sleep and IBS needs to be further studied.

Inconsistent sleep schedules and daytime behavioral difficulties in school-aged children

Current recommendations for healthy sleep in school-aged children are predominantly focused on optimal sleep duration (9-11h). However, given the importance of routine for circadian health, the stability of sleep/wake schedules may also be important, especially for daytime behavioral functioning. We examined the relationship between short sleep duration, sleep schedule instability and behavioral difficulties in a community sample of Australian children. Children, aged 5-10 years (N=1622), without chronic health or psychological conditions, were recruited from primary schools in Adelaide, South Australia. A parent-report questionnaire was used to assess sleep/wake behavior. Behavioral functioning was assessed using the Strengths and Difficulties Questionnaire. Most children met sleep duration recommendations with approximately 5% reporting <9h and 3% >12h. Weekly variability of bed and rise times >1h were reported in up to 50% of children. Multinomial regression analysis revealed sleep duration <10h, bedtime latency >60 min, and bed and rise time variability >60 min significantly increased the risk of scoring in the 95th percentile for behavioral sub-scales. Inconsistent sleep schedules were common and, similar to short sleep duration, were associated with behavioral difficulties. Considering the lack of study in this area, further research is needed for the development of new recommendations, education and sleep health messages.