Sleep Routines Research Articles

Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain.

Children and adolescents are not indifferent to the dramatic impact of the COVID-19 pandemic, and the need to be forced to live in confinement. The change in life to which they have been abruptly subjected forces us to understand the state of their mental health in order to adequately address both their present and future needs. The present study was carried out with the intention of studying the consequences of confinement on anxiety, sleep routines and executive functioning of 1,028 children and adolescents, aged from 6 to 18 years, residing in Spain to; assess if there are differences regarding these consequences in terms of sex and age; how anxiety affects executive functioning in males and females; and to examine the possible correlations between the measured variables. For this purpose, an online questionnaire containing five sections was designed: the first section gathers information on sociodemographic and health data, while the following sections gather information from different standardized scales which measure anxiety, sleep and executive functions, whose items were adapted in order to be completed by parents, and/or legal guardians. The statistical analyzes carried out highlights significant differences in executive functioning between males and females. In turn, in regards to age, greater difficulties were detected in anxiety in the 9 to 12 age group and greater sleep disturbances between 13 and 18 year olds. On the other hand, significant differences were found in intra-sexual executive functioning depending on whether they presented greater or lesser anxiety, with executive functioning being more tendentiously maladjusted in males than in females, revealing a significantly relevant effect size (p = 0.001; ω2 = 0.27 BRIEF-2; ω2 = 0.19 BDEFS-CA; 95%). Positive correlations are obtained between state anxiety and sleep and executive functioning alterations. Finally, through Path Analysis, it is verified that state anxiety is the variable with the greatest weight within the model that would explain the alteration in the executive functioning of the present sample.

Sleep Habits and Routines of Individuals Diagnosed with Mental and/or Substance-Use Disorders

The purpose of this study was to explore sleep habits and routines in individuals (N = 52) with mental and/or substance-use disorders attending community wellness centers. Outcome measures included Pittsburgh Sleep Quality Index (PSQI), a researcher developed survey to analyze habits and routines and its effect on sleep, and semi-structured interviews. Results showed 78.6% of participants had poor sleep as per PSQI. Facilitators of sleep included turning off lights, listening to music, and taking a bath/shower, while barriers included taking a nap, smoking, and using the phone. The findings can guide assessment and intervention for sleep preparation and participation.

Effects of COVID-19 pandemic and lockdown on lifestyle and mental health of students: A retrospective study from Karachi, Pakistan

IntroductionDue to the COVID-19 pandemic, many countries imposed lockdowns on their citizens in an attempt to contain the disease. Pakistan is one of these countries. A government mandated lockdown can have mitigating psychological effects on young adults, out of which a large fraction is made up of students. This study aims to investigate the correlations between changes in sleep pattern, perception of time, and digital media usage. Furthermore, it explores the impact of these changes on the mental health of students of different educational levels. MethodsThis cross-sectional study was conducted via a web-based questionnaire, from March 24 to April 26, 2020. The survey was targeted at students and 251 responses were obtained. It was a 5-section long questionnaire. The first section inquired about demographics of participants. Each of the other 4 sections was devoted to changes in sleep pattern, perception of time flow, digital media usage and mental health status of students. Close-ended questions with multiple choice responses, dichotomous, interval and 4-point Likert scales were used in the construction of the survey questionnaire. Chi2 T-tests multinomial and binary logistic regression were used as primary statistical tests. All data were analysed using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). ResultsOut of 251 adolescents that participated in our study, the majority (70.2%) were females. The mean age of the participants was 19.40±1.62 years. Two-thirds of the respondents did not have much trouble falling asleep (66.5%). The analysis found no significant association between longer sleep periods and procrastination level (P=0.054). Nearly three-fourths (72.9%) of our participants felt that getting through quarantine would have been more difficult if they did not have any electronic gadgets. Of these, a majority (85.8%) had a general feeling of tiredness and lacked motivation (P=0.023). Additionally, a large number of students (69.7%) had reported that time is seemingly moving faster. A significant relationship between increased usage of electronic items and longer sleep periods was also noted (P=0.005). With respect to the level of education, statistically significant values were noted for alarm use both before and after quarantine began (P=0.021 and P=0.004, respectively). Further analysis showed that there was a significant difference in the median difference of time spent on social media before the outbreak (3.0±32.46) and time spent on social media after the outbreak (6.0±3.52) in a single day (P=0.000). ConclusionsOur research has revealed that due to the lockdown imposed by the government in response to COVID-19, the sleeping patterns of the students was affected the most. Our findings show that the increase in use of social media applications led to a widespread increase in the length of sleep, worsening of sleep habits (people sleeping at much later hours than usual), and a general feeling of tiredness. A general lack of recollection regarding what day of the week it was, as well as a change in the perceived flow of time were also notable. All these findings indicate the decline in mental health of students due to the lockdown. Promoting better sleep routines, minimising the use of digital media, and encouragement of students to take up more hobbies could collectively improve the health and mood of students in self-quarantine.

Associations between health-related family environment and objective child sleep quality.

This study aimed to assess the relationship between the family environment and behaviours with objective child sleep quality. Twenty-four children (aged 2-5 years) and their parents participated. Child sleep was assessed by accelerometer. Health of the family environment was quantified using the Family Nutrition and Physical Activity Screening Tool (FNPA). Exact Wilcoxon rank sum tests and linear regression were used to determine associations between FNPA scores and child sleep. Healthier Total FNPA, Physical Activity FNPA, and Sleep Routine scores were associated with earlier bedtime. Healthier Sleep Routine score was associated with more total minutes of sleep per night. Healthier screen time-related FNPA construct scores were associated with earlier bedtime. A composite score of family environment and behaviours, including physical activity- and nutrition-related constructs, was related to child sleep quality. Focus should be placed on the obesogenic family environment and healthy sleep routines to promote overall health among pre-school-aged populations.

Patient experiences of sleep in dialysis: systematic review of qualitative studies

Rationale and objectiveSleep problems affect more than half of patients receiving dialysis and are associated with increased risk of mortality, cardiovascular events, depression and impaired functioning and quality of life. Symptoms such as fatigue and exhaustion may be attributed to sleep problems or sleep disorders, as well as the burden of kidney disease and treatment. This study aims to describe the patient perspectives on the reasons, impact and management of sleep problems in dialysis. Study designSystematic review and thematic synthesis of qualitative studies that report patient experience and perspectives on sleep in dialysis. Setting and populationPatients receiving dialysis. Search strategy and sourcesMEDLINE, Embase, PsycINFO, CINAHL, reference lists and PhD dissertations were searched from inception to August 2019. Data extractionAll text from the results/conclusion of the primary studies. Analytical approachThematic synthesis. ResultsWe included 48 studies involving 1156 participants from 16 countries. We identified six themes: dominating demands of treatment (with subthemes of: demanding and relentless schedule, regret for wasted time); scheduling and control (managing sleep routines, napping and nocturnal sleep disruption, meditative aids); disruptions due to dialysis (unsettled sleep, hypervigilance and worry); symptoms depriving sleep (difficulty falling asleep, constant waking); overwhelmed and without choice (futility of sleep, uncontrollable exhaustion, restlessness is irrepressible); and as a coping mechanism (avoiding anxiety, alleviating symptoms, combating boredom). LimitationsMost studies were conducted in high-income, English-speaking countries. ConclusionThe treatment and symptom burden of dialysis disrupts and deprives patients of sleep, which leads to overwhelming and uncontrollable exhaustion. Better management of symptoms and effective strategies to manage sleep routines may improve sleep quality for better overall health in patients receiving dialysis.

Teachers’ Sleep, Religious Tasks, and Suicidal Thoughts: A Preliminary Assessment

Because of the unexpected and debilitating effect of the current pandemic, the impact of the pandemic on teachers is detrimental. This paper investigated the public-school teachers' sleep, religious tasks, and suicidal thoughts. The study used a descriptive correlational design with the online survey as the primary data gathering tool. 198 public school teachers from a school's division in Central Luzon, Philippines participated in the online survey. The researchers created the online instrument with validation done by experts. After the data gathering, the study used the following statistical tools to calculate the frequency count, percentage, rank, t-test, and Analysis of Variance with the help of SPSS 22. Results show that teachers go to sleep between 10:00-11:00 PM and wake up between 5:00-6:00 AM. This comprises 7-9 hours of sleep. Teachers also go to church or other religious meetings once a week and also, they pray, meditate, or study the Bible more than once a week. Also, most of the responses of teachers in the suicidal thoughts were either "no" or "never". Furthermore, the study also found significant differences in the teachers' sleep, religious tasks, and suicidal thoughts when grouped according to their profile. The study concluded that teachers have established sleep and religious tasks routines. On the other hand, suicidal thoughts are out of the options for the teachers’ business.

A study on impact of Corona Virus Disease 2019 Pandemic on activities of daily living, play, and sensory behaviors of children with autism spectrum disorder: A cross-sectional survey study

Background: New Corona Virus Disease 2019 (COVID-19) pandemic has a greater influence on all of us and has changed many of our everyday routines. Adjusting to a new routine is stressful for everyone, but especially for children with Autism who have difficulty with change, it is more stressful. As, insistence on sameness, inflexible adherence to routines, and ritualistic patterns are the core features of autism, environmental changes, home confinement, disrupted daily routines, restricted access to schools, therapy centers during this pandemic will have a unique impact on children with Autism and their families. Objectives: The objective of this study was to systematically assess the impact of the COVID-19 pandemic on activities of daily living (ADL), play, and sensory behaviors of children with autism spectrum disorder (ASD). Study Design: Cross-sectional survey study was conducted. Methods: Convenient sampling method was used. The study sample consisted of 100 parents/primary caregivers of children with Autism. A structured ADL, play, sensory behavior questionnaire (45 items) was designed, validated, and administered through face to face and telephonic interviews. The duration of the study was 1 month. Results: Substantial proportion of the parents (69%) reported inconsistent daily routines and inconsistent sleep routines (67%) since the COVID-19 pandemic. Eighty-three percent of ASD children spend more time on mobile phones and televisions than interactive play. Home confinement during this pandemic resulted in lower physical activity was mentioned by 69% of ASD parents and 70% mentioned the increased social withdrawal of ASD. Many parents reported increased intensity of vestibular-proprioceptive seeking (75%), other sensory behaviors during this COVID-19 pandemic. Conclusion: The study analysis suggests that COVID-19 pandemic has a major impact on children with ASD on their ADL, play, and sensory behaviors. Ninety nine percent of our study respondents were not able to access therapy centers, and other intervention facilities during this pandemic. Lack of access to these structured environments during this pandemic could have contributed to the worsening of ASD children's behaviors. So, this study stress, access to the health care services that serve ASD children, especially occupational therapy, needs to be considered essential and remain available during these kinds of pandemics with universal precautions and/or via alternative modes of delivery, i.e. tele-consultation.

Are Differences in Bedtimes Bad for Relationships? Associations With Attachment and Conflict in Middle-Aged Couples

A robust body of literature has found birdirectional associations between sleep quality and marital quality in couple relationships (Hasler & Troxel, 2010; Pearlin, 2010). Additionally, dyadic research shows that differences in couples’ bed time routines and habits is associated with mental health outcomes (Chen, 2018), however the literature has not connected them with other marital processes that are mutable and clinically relevant. Attachment theory provides a clinically relevant framework that captures both interpersonal marital processes such as relationship conflict as well intrapersonal processes of individual emotional safety—essentially individuals’ personal strategies to balance closeness and distance in a relationship (Feeney, 2002; Rhodes et al., 2001). The two main attachment styles related to sleep processes are attachment avoidance and attachment anxiety (Collins et al., 2002; Gun, 2015; Troxel, 2007). Utilizing data from 234 couple dyads, we investigated if differences in partners’ bed times is associated with conflict frequency and attachment avoidance using a structural equation modeling approach. We controlled for a number of important factors and tested our hypothesized model against two plausible alternative models. Results revealed that greater difference in partners’ bed times was associated with higher conflict frequency for both husbands and wives through higher men’s attachment avoidance. Our findings highlight previous research on matched vs. unmatched couples on sleep routines, habits, and chronotypes (both morning or night vs. different; Larson et al., 1991) but highlight mutable and clinically relevant constructs for intervention. Implications for health promotion and marital therapy will be discussed.

Can children's oral hygiene and sleep routines be compromised during the COVID-19 pandemic?

BackgroundDuring COVID‐19 pandemic, children are confined at home, with changes in family routines.AimEvaluate sleep disorders among Brazilian and Portuguese children during social distancing, and its association with parental perception of child's oral hygiene.DesignIn this cross‐sectional study, Portuguese and Brazilian parents/caregivers of 3‐ to 15‐year‐old children, practicing social distancing due to COVID‐19 pandemic, answered an online questionnaire, from April 24‐26, 2020, evaluating sociodemographic characteristics, child's school activities online, child's sleep quality during social distancing. Two questions from the questionnaire, developed based on previous studies, evaluated the parental perception of child's oral hygiene quality and routine changes during social distancing. Parents/caregivers answered five domains of the Portuguese‐language version of the Sleep Disturbances Scale for Children, evaluating sleep‐breathing disorders, disorders of arousal, sleep‐wake transition disorders, disorders of excessive somnolence and sleep hyperhidrosis. Descriptive, Linear‐by‐linear association, Kruskal‐Wallis and post hoc analysis were performed (P ≤ .05).ResultsParticipated in the study 253 parents/caregivers, 50.2% from Brazil. Most parents (72.2%) reported changes in child's routine during social distancing. Sleep breathing disorders (P = .019), sleep‐wake transition disorders (P = .022), and disorders of excessive somnolence (P < .001) were associated with poor oral hygiene during social distancing.ConclusionSleep disorders are associated with poor oral hygiene during social distancing.

The 2020 Coronavirus Pandemic as a Change-Event in Sport Performers' Careers: Conceptual and Applied Practice Considerations.

The Coronavirus experience (CE) presents a highly challenging period for sport performers (e.g., athletes, coaches, referees), with potential effects on their lives and career trajectories. In this article, we initially conceptualize the CE using the scheme of change for sport psychology practice (Samuel and Tenenbaum, 2011a). Within this framework, the CE is understood as a longitudinal, multifaceted, unpredicted, non-controlled change-event, with four distinct stages: (a) a pre-Coronavirus stage with unique career contextual conditions (i.e., stable engagement or a transitional period), (b) Coronavirus stage-A accompanied by instability and confusion, emotional response, and cognitive appraisal, (c) Coronavirus stage-B characterized by active coping or regression, and (d) Coronavirus stage-C; instability endures or decreases, depending on career trajectory. The CE presents sport performers with modifications in various dimensions, including physical and physiological, motor skills, psycho-social and self-identity, relationships, performance and achievement, motivation and aspirations, organizational-occupational, and micro– and macro–cultural issues. Sport performers can exhibit several emotional responses (i.e., positive, negative, neutral), and consequential coping endeavors. The development of the change process is underlined by key decisions, manifested in sport performers’ attempts to implement responsive change in these dimensions (e.g., adapt their diets, sleep routines, and exercise regimen). The second part of the article discusses applied practice considerations, presenting various techniques and methodologies which practitioners can apply while consulting from a change-based perspective. Ethical issues pertaining to the formation of effective therapeutic relationships during this period are also assessed. The conclusions offer future avenues for researchers and practitioners when attempting to evaluate and cope with this global phenomenon.

Parenting and social-ecological correlates with children's health behaviours: A latent profile analysis.

Paediatric obesity poses dangers to children's short and long-term health. Multi-level ecological models posit how children's health behaviours are influenced by interpersonal relationships. To identify profiles of individual and interpersonal health behaviours and parenting skills among caregivers and their children with elevated BMI. Participants were 240 children (63.7% Latino) ages 5 to 12 years with body mass index ≥85th percentile and their caregivers in a paediatric weight management intervention trial. A latent profile analysis was used to identify profiles among caregiver report of parenting skills; child physical activity, eating behaviours, and food and beverage choices; family mealtime, media and sleep routines; and parent health behaviours, and associations with food and housing insecurity. A three-class model was chosen based on conceptual interpretation and model fit. Profiles were differentiated by parenting skills, child food choices, child physical activity habits, family mealtime, media, and sleep routines, and parent health behaviours. Food and housing insecurity were associated with class membership while child and caregiver anthropometrics were not. Distinct profiles existed among this low-income, racially/ethnically diverse sample of children with elevated BMI. Such findings emphasize the importance of assessing individual and interpersonal influences and contextual factors on childhood obesity.

Links between sleep problems in early childhood and borderline personality disorder/psychosis in adolescence

Some behavioral sleep problems in childhood are associated with onset of psychosis and borderline personality disorder (BPD) in early adolescence, researchers have found. In addition, the association with psychosis may be mediated by depression at 10 years of age. The study, published in JAMA Psychiatry, used the Avon Longitudinal Study of Parents and Children birth cohort and included 13,488 participants who were born in 1991–92 and focused on parent‐reported nighttime sleep duration, night awakening frequency, bedtime, and regulatory of sleep routines in children assessed at 6 months, 18 months, and 30 months of age, and at 3.5, 4.8, and 5.8 years of age. While it is known that persistent childhood nightmares are associated with psychosis and BPD in adolescence, little was known about the association with general behavioral sleep problems, as well as the potential mechanisms.

Association of Parent-Reported Sleep Problems in Early Childhood With Psychotic and Borderline Personality Disorder Symptoms in Adolescence

Persistent nightmares in childhood have been prospectively associated with psychosis and borderline personality disorder (BPD) in adolescence. However, the extent to which this association is also true for behavioral sleep problems is still unknown, and the potential mechanisms are unexplored. To examine the prospective associations between several parent-reported sleep problems in early childhood and psychotic and BPD symptoms at 11 to 13 years of age and the potential mediation of the associations by depression at 10 years of age. This cohort study assessed 13 488 participants in the Avon Longitudinal Study of Parents and Children birth cohort who were followed up for more than 13 years. Pregnant women from Avon, United Kingdom, with expected dates of delivery from April 1, 1991, to December 31, 1992, were invited to take part in the study. Data analysis was conducted from May 1 to December 31, 2019. Psychotic experiences at 12 to 13 years of age were assessed using the Psychosis-Like Symptom Interview, and BPD symptoms at 11 to 12 years of age were tested using the UK Childhood Interview for DSM-IV Borderline Personality Disorder. Parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines were assessed when the child was 6, 18, and 30 months and 3.5, 4.8, and 5.8 years of age. Data were available on 7155 participants (3718 girls [52%]) who reported on BPD symptoms and 6333 (3280 boys [52%]) who reported on BPD symptoms. Higher night awakening frequency at 18 months of age (odds ratio [OR], 1.13; 95% CI, 1.01-1.26) and less regular sleep routines at 6 months (OR, 0.68; 95% CI, 0.50-0.93), 30 months (OR, 0.64; 95% CI, 0.44-0.95), and 5.8 years (OR, 0.32; 95% CI, 0.19-0.53) of age were significantly associated with psychotic experiences in adolescence, whereas shorter nighttime sleep duration (OR, 0.78; 95% CI, 0.66-0.92) and later bedtime at 3.5 years of age (OR, 1.32; 95% CI, 1.09-1.60) were significantly associated with BPD symptoms. Results of mediation analysis were consistent with all these associations, except for later bedtime at 3.5 years and BPD in adolescence, which had no association. Depression at 10 years of age mediated the associations between frequent night awakenings at 18 months of age (bias-corrected estimate, -0.005; 95% CI, -0.008 to -0.002; P = .002) and irregular sleep routines at 5.8 years of age (bias-corrected estimate, -0.006; 95% CI, -0.010 to -0.003; P = .003) with psychosis. The findings suggest that some behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and BPD in adolescence, following different pathways. Furthermore, depression at 10 years of age may mediate only the association with psychosis. These findings contribute to the design of more personalized interventions in psychosis and BPD.

The impact of sleep problems on functional and cognitive outcomes in children with Down syndrome: a review of the literature.

The aim of this review was to summarize the existing literature on the association between sleep problems and cognition, function, and behavior in children with Down syndrome. Embase, PubMed, CINAHL, and PsychINFO databases were searched to retrieve all studies published between 1990 and 2018 that evaluated the relationship between sleep and cognition, function, or behavior in children with Down syndrome. Fifteen articles were included, which were mostly of a cohort or case-controlled design. Five articles addressed sleep and cognition only, 6 reported on sleep and behavior, and only 1 reported on sleep and functional ability. Three papers evaluated sleep and both cognition and behavior. Findings varied across studies with methodological differences, making it difficult to directly compare results. The association between sleep and behavior or cognition in children with Down syndrome remains uncertain, but a large study in 110 children provides strong evidence of a negative impact of sleep disorders on the accomplishment of daily life habits. The impact of coexisting sleep disorders in children with Down syndrome has not been widely studied, with only 15 relevant studies found through an extensive literature review. Large well-designed studies are required to fully understand this relationship further. This is important as sleep-disordered breathing and difficulties with sleep patterns and routines are highly prevalent in children with Down syndrome. Sleep may be one of the few treatable factors that can assist in improving long-term outcomes in this population.

Implementation of a Sleep Hygiene Program in 4 - 6 Year Old Portuguese Children: the “It is Time to Sleep” Project First Results

Abstract Introduction Sleep, as one of the most determining and present factors in our life, is fundamental for humans, and especially during childhood: it is indispensable for good cognitive, physical and emotional development. Objectives Designed in the scope of the Portuguese National School Health Program, the objectives of this project were to promote adequate sleep routines, raise awareness of children’s sleep deprivation and to the consequences of an abusive contact with technologies. At the end of this activity, children should be able to recognize the importance of these dimensions. Methodology The formative activity, performed by 2 school nurses, was applied to 104 children (from 3 different schools from a northern city of Portugal), with 4 (41.3 %), 5 (44.2 %) and 6 years old (14.4 %), and lasted 45 minutes. The project comprises 4 stages: the first one relates to nurses and project theme presentation; the second one is the implementation of a theatre where major issues of the project are presented, namely the importance of sleep and nap, sleep hygiene rules, consequences of sleep deprivation and the influence of technologies on sleep; the third one is the discussion of the main ideas using the song "Sleep Hour"; at the end, a questionnaire was applied to assess children knowledge about sleep hygiene habits divided into six questions with two images each, in which one corresponds to a healthy practice and the other does not. Results The percentage of correct answers ranged between 96.6 to 98.3 %, suggesting that the formative activity had a positive impact on children’s knowledge about healthy sleep hygiene habits. The 2 questions on which the rate of incorrect answers was higher relate to the fact that sleeping with parents is better than sleeping alone (6.3 %) and that watching TV before going to sleep is a better option than reading a story (4.4 %). Conclusion This intervention has given children important knowledge about healthy sleep hygiene habits, resulting in its understanding through an approach tailored to their age.

0981 Sleep Practices In Pediatric Cancer—Does Sleep Hygiene Matter For Reducing Cancer Symptom Burden?

Abstract Introduction Sleep disturbances are common during pediatric cancer treatment and recent evidence suggests a correlation between sleep and symptom burden. Improving nighttime sleep may impact patients’ ability to cope with symptoms. The current study tests the interaction between sleep hygiene and sleep disturbances in predicting cancer-related symptoms to determine if the relationship between sleep and symptoms is different for patients with better sleep hygiene. Methods 102 caregivers of children with cancer (ages 5-17, M=10.12, SD=4.02; 58% female) completed parent-proxy Pediatric Sleep Practices Questionnaire (yielding routine consistency and sleep opportunity scores) and measures of cancer-related symptoms (PROMIS Sleep Disturbance, Fatigue, and Pain Interference; PedsQL—Cancer Module-Nausea subscale). The interaction between sleep disturbances and sleep hygiene (consistency, opportunity) on each symptom (pain, nausea, fatigue) were tested using PROCESS moderation. Results 81% of caregivers report that their child receives sufficient sleep but only 12% reported regular consistent sleep patterns/routines. Sleep opportunity was not related to sleep disturbances or cancer-related symptoms, but more routine consistency was related to fewer sleep disturbances (r=.30, p=.003). The interaction between sleep disturbances and routine consistency significantly predicted pain interference [R2=.16, F(3, 98)=6.37, p&amp;lt;.001; Bint =-0.17, p=.028] and nausea [R2=.16, F(3, 98)=6.47, p&amp;lt;.001; Bint=0.46, p=.004]. The interaction between sleep disturbances and sleep opportunity significantly predicted nausea [R2=.15, F(3, 98)=5.76, p=.001; Bint =0.68, p=.016] but not pain interference. Both interaction models predicting fatigue were not significant. Conclusion The sleep/pain and sleep/nausea relationships are stronger in patients with more consistent sleep routines and the sleep/nausea relationship is also stronger in patients with sufficient/well-timed sleep opportunities. Sleep and fatigue were moderately related across all levels of both sleep hygiene components. Clinical interventions that target sleep hygiene together with sleep disturbances such as nighttime awakenings and poor sleep quality may be more effective in addressing cancer-related symptoms such as pain and nausea. Support This work was supported in part by funding from the Patient-Centered Outcomes Research Institute (PCORI-D-17-00187; PI Christopher Forrest).

Variability of Sleep and Relations to Body Weight Among First-Year College Students.

Existing research suggests that greater sleep variability may increase risk for weight gain. College often marks a transition to a less consistent daily schedule, which may adversely impact sleep routines and further increase risk for weight gain. The current study is among the first to explore relations between nighttime sleep variability and daytime sleep (napping) and body weight among first-year college students. Using daily diary methods, first-year college students (N = 307; 84.7% female) self-reported their sleep for seven days. Several indices were created to capture sleep variability for reported bedtime, wake time, and sleep duration, including weekday versus weekend differences (WvW), day to day differences (D2D), and overall standard deviation (SD). Napping was also assessed. Based on body mass index (BMI), individuals were categorized as underweight, healthy weight, overweight, and obese. Across indices, students' sleep varied over an hour on average across the week. Hierarchical regressions revealed that greater differences in wake time D2D, wake time SD, and sleep duration WvW were all associated with higher BMI, after accounting for gender, depressive symptoms, and sleep duration. Longer napping was also associated with higher BMI, using the same covariates. Finally, greater sleep variability was reported by overweight and obese than healthy weight individuals. These findings suggest that sleep variability, particularly wake times and napping may be important modifiable sleep behaviors to investigate in future studies. More longitudinal research is needed to explore relations between multiple facets of sleep variability and weight gain, including possible mechanisms.

Sleep Deprivation in the Intensive Care Patient.

Sleep deprivation in the intensive care unit setting. The Society of Critical Care Medicine has identified sleep deprivation as a significant contributor to the development of delirium in adult patients in the intensive care unit. Thus, preventing and managing sleep deprivation is important in reducing the incidence of delirium in this patient population. A multifaceted and multidisciplinary approach to promoting sleep in the intensive care unit setting that includes sleep hygiene routines, nursing care plans, and appropriate medication regimens may improve patient outcomes, including reducing delirium. To review the current literature on sleep deprivation in the intensive care unit setting and present care guidelines in a concise format. This information may be helpful in the development of clinical tools and may guide future quality improvement projects aimed at reducing delirium through sleep promotion in critical care patients. A review of current literature and national organization recommendations revealed consistent themes in addressing the problem of sleep deprivation in the intensive care unit. Modifiable and nonmodifiable risk factors included frequent care interactions, light, noise, medication effects, and preexisting sleep problems.

Behavioral and social routines and biological rhythms in prevention and treatment of pediatric obesity.

A growing body of research supports the potential importance of behavioral and social routines for children's health promotion and obesity risk reduction. Evidence in support of this comes from multiple lines of research, which suggest that specific behavioral routines, namely, eating and sleep routines, may be protective against excessive weight gain and development of pediatric obesity. Emerging work also supports the potential importance of the timing of these behavioral routines. From a circadian perspective, alignment of behavioral and social routines with underlying circadian rhythms may be particularly important for enhancing children's weight regulation. Specifically, engaging in appropriately timed behavioral routines may serve to entrain circadian rhythms that affect metabolism and weight regulation. Thus, in addition to promoting healthier eating, activity, and sleep behaviors for prevention and treatment of pediatric obesity, it may also be important to consider promotion of consistency in, and optimal timing of, these behaviors in an effort to enhance extant prevention and treatment approaches. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Development and Validation of the Pediatric Sleep Practices Questionnaire: A Self-Report Measure for Youth Ages 8–17 Years

ABSTRACT Objective: To develop and evaluate the validity of a self-report measure of sleep practices for youth 8–17 years. Methods: Following recommended guidelines for the development of patient reported outcomes (PROs), sleep practice concepts were identified through expert (n = 8) and child (n = 28) concept elicitation interviews and a systematic literature review. Items were developed based on these concepts and tested in cognitive interviews with children (n = 32). Psychometric analyses were applied to item response data collected from a diverse sample of youth 8–17 years (n = 307). Construct validity was evaluated through tests of associations between sleep practices and sleep disturbance and sleep-related impairment. Finally, clinical validity of the tool was assessed by comparing scores of youth with and without a parent-identified sleep problem. Results: The final Pediatric Sleep Practices Questionnaire (PSPQ) included 15 items that were used to identify 5 sleep practices: sleep timing, sleep routines and consistency, technology use before bedtime, sleep environment, and the need for parental presence to fall asleep. A confirmatory factor analysis supported the hypothesized structure (all factor loadings ≥ 0.72) and PSPQ indices were significantly associated with self-reported sleep disturbances and sleep-related impairment. Finally, children with parent-reported sleep problems had shorter sleep opportunity, later bedtimes, greater need for parental presence, poorer bedtime routines, and more technology use than children without parent-reported sleep problems. Conclusions: The PSPQ was developed using best-practice PRO development methodology. The PSPQ can be used in clinical settings and for research assessment to capture modifiable sleep practices that may promote or interfere with healthy sleep.