First name
Jodi
Middle name
A
Last name
Mindell

Title

Correlates of a caregiver-reported child sleep problem and variation by community disadvantage.

Year of Publication

2022

Number of Pages

83-90

Date Published

2022 Jan 13

ISSN Number

1878-5506

Abstract

<p><strong>BACKGROUND: </strong>Previous studies of sleep patterns and perceived problems in early childhood indicate variation by family socioeconomic status. The purpose of this study was to examine variation in correlates of a caregiver-perceived child sleep problem across and within levels of community disadvantage in a large US sample.</p>

<p><strong>METHODS: </strong>Caregivers of 14,980 young children (ages 0-35.9 months) in the US completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R) on the freely and publicly available Johnson's® Bedtime® Baby Sleep App. Zip code was used to identify a Distressed Communities Index (DCI) score, which represents community disadvantage based on neighborhood indicators.</p>

<p><strong>RESULTS: </strong>Across all levels of community disadvantage, caregivers who reported greater impact of child sleep on their own sleep, bedtime difficulty, more frequent and longer night wakings, and increased total nighttime sleep were more likely to endorse a child sleep problem. These associations varied by level of community disadvantage. For caregivers living in more disadvantaged communities, impact of child sleep on their own sleep and night wakings were the strongest correlates of endorsing a child sleep problem, whereas for those in more advantaged communities the impact of child sleep on their own sleep and night wakings as well as additional aspects of sleep health, such as short sleep duration, were associated with endorsement of a child sleep problem.</p>

<p><strong>CONCLUSIONS: </strong>Findings suggest that families living in more distressed communities are most likely to identify the impact of child sleep on their own sleep and night wakings in reporting a child sleep problem, whereas those from more prosperous communities consider these factors as well as other sleep parameters, including sleep duration. Clinicians should consider expanding screening questions for child sleep problems to include the perceived impact on caregiver sleep.</p>

DOI

10.1016/j.sleep.2022.01.009

Alternate Title

Sleep Med

PMID

35123150

Title

Sleep Well! An adapted behavioral sleep intervention implemented in urban primary care.

Year of Publication

2021

Date Published

2021 Dec 16

ISSN Number

1550-9397

Abstract

<p><strong>STUDY OBJECTIVES: </strong>To describe the adaptation, feasibility, and initial outcomes of <em>Sleep Well!</em>, an intervention for early childhood insomnia and insufficient sleep, designed for families from lower-socioeconomic status (SES) backgrounds presenting to large metropolitan primary care sites.</p>

<p><strong>METHODS: </strong>Fifteen caregiver-child dyads (caregivers: 92.3% mothers; 80.0% Black; 53.3% ≤125% US poverty level; children: 73.3% female; 86.7% Black; age = 3.0 years) participated this multi-method, single-arm trial. A family advisory board of caregivers (N = 4) and a clinician advisory board of sleep experts, primary care clinicians, and psychologists (N = 13) provided intervention feedback throughout the pilot. Most adaptations were related to intervention delivery methods, with some related to sleep strategies. At post-intervention, caregivers completed surveys on intervention acceptability and cultural humility (primary outcomes) and completed semi-structured interviews. Caregivers also reported on child sleep pre- and post-intervention.</p>

<p><strong>RESULTS: </strong>Thirteen (86.6%) families completed <em>Sleep Well!&nbsp;</em>and 12 (80.0%) completed pre- and post-intervention measures. Caregivers reported strong intervention acceptability and cultural humility. There were pre-to-post reductions in child sleep problems, bedroom electronics, sleep onset latency, and night awakening frequency and duration. Nighttime sleep duration and overall insufficient sleep also improved. Qualitative data also showed strong intervention acceptability and perceived flexibility, with few participation barriers.</p>

<p><strong>CONCLUSIONS: </strong>A brief, early childhood behavioral sleep intervention delivered in primary care with families from primarily lower-SES and/or racially minoritized backgrounds is feasible to implement, with strong retention rates, acceptability, and perceptions of cultural humility. Child sleep improvements are positive, and warrant replication in a randomized controlled trial.</p>

DOI

10.5664/jcsm.9822

Alternate Title

J Clin Sleep Med

PMID

34910624

Title

Sleep Problems, Cumulative Risks, and Psychological Functioning in Early Childhood.

Year of Publication

2021

Date Published

2021 Mar 19

ISSN Number

1465-735X

Abstract

<p><strong>BACKGROUND: </strong>Sleep problems and cumulative risk factors (e.g., caregiver depression, socioeconomic disadvantage) have independently been linked to adverse child development, but few studies have examined the interplay of these factors. We examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes.</p>

<p><strong>METHODS: </strong>205 caregiver-child dyads (child Mage = 3.3 years; 53.7% girls; 62.9% Black, 22.4% non-Latinx White, and 4.4% Latinx; 85.4% maternal caregiver reporter) completed child sleep, family sociodemographic, and child psychological functioning (internalizing, externalizing, and executive functioning) questionnaires. Indexes of cumulative risk exposure, insomnia symptoms, and poor sleep health were created.</p>

<p><strong>RESULTS: </strong>Ninety percent of children had ≥1 cumulative risks, 62.9% had ≥1 insomnia symptom, and 84.5% had ≥1 poor sleep health behavior. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Cumulative risk exposure was not associated with outcomes but moderated the association between insomnia symptoms and all psychological outcomes, such that children with higher cumulative risk exposure and insomnia symptoms had the greatest impairments. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns.</p>

<p><strong>CONCLUSIONS: </strong>Insomnia symptoms in particular are associated with poor child outcomes, which are exacerbated when accompanied by greater cumulative risk exposure. Clinicians should assess sleep when treating early psychological concerns, especially within the context of increased cumulative risks.</p>

DOI

10.1093/jpepsy/jsab022

Alternate Title

J Pediatr Psychol

PMID

33738501

Title

Socioeconomic disadvantage and sleep in early childhood: Real-world data from a mobile health application.

Year of Publication

2021

Date Published

2021 Mar 04

ISSN Number

2352-7226

Abstract

<p><strong>OBJECTIVES: </strong>To examine whether increased socioeconomic disadvantage, indexed using a measure of community distress, was associated with variation in caregiver-reported early childhood sleep patterns and problems in a large US sample using a mobile health application (app).</p>

<p><strong>DESIGN: </strong>Cross-sectional.</p>

<p><strong>SETTING: </strong>Data were collected using the free, publicly available Johnson's Bedtime© baby sleep app.</p>

<p><strong>PARTICIPANTS: </strong>A total of 14,980 caregivers (85.1% mothers) of children ages 6-35.9 months (M&nbsp;=&nbsp;13.88 months; 52.6% boys) participated in this study.</p>

<p><strong>MEASURES: </strong>Caregivers reported on child sleep using the Brief Infant Sleep Questionnaire-Revised. Socioeconomic disadvantage was indexed by zip code using the Distressed Communities Index (DCI), which combines seven US census indicators of socioeconomic disadvantage. DCI scores range from prosperous (lowest quintile) to distressed (highest quintile).</p>

<p><strong>RESULTS: </strong>Socioeconomic disadvantage was significantly associated with later bedtimes, longer sleep onset latency, and shorter nighttime and 24-hour (total) sleep duration, with children living in distressed communities showing the poorest sleep. However, caregivers living in distressed communities reported a significantly lower prevalence of overall child sleep problems (43% vs 58% in prosperous communities), and more confidence in managing child sleep (42% vs 34% in prosperous communities).</p>

<p><strong>CONCLUSIONS: </strong>Children living in the most distressed communities have the poorest reported sleep patterns and bedtime behaviors; however, their caregivers are less likely to report problematic child sleep. These findings highlight the need for community-level sleep health promotion interventions, as well as further investigation of caregiver perceptions about child sleep and sleep health promotion among families living in socioeconomically disadvantaged contexts.</p>

DOI

10.1016/j.sleh.2021.01.002

Alternate Title

Sleep Health

PMID

33678602

Title

Pediatric sleep health: It matters, and so does how we define it.

Year of Publication

2021

Number of Pages

101425

Date Published

2021 Jan 19

ISSN Number

1532-2955

Abstract

<p>In 2014, Buysse published a novel definition of sleep health, raising awareness for the importance of this construct for individuals, populations, clinical care, and research. However, the original definition focused on adults, with the recommendation that it should be adapted for children and adolescents. As children live within a complex and dynamic system, and may not always have control over their own sleep, this theoretical review will examine and apply Buysse's five dimensions of sleep health within the context of pediatrics. In addition, using examples from the pediatric sleep literature we introduce a modified definition that takes into consideration the influence of the socio-ecological system within which children live, and the sleep-related behaviors that are critical in supporting or hindering sleep health. Finally, we discuss how the proposed theoretical framework, Peds B-SATED, can be applied to clinical practice, research, and training in the field of pediatric sleep.</p>

DOI

10.1016/j.smrv.2021.101425

Alternate Title

Sleep Med Rev

PMID

33601324

Title

Longitudinal sleep problem trajectories are associated with multiple impairments in child well-being.

Year of Publication

2020

Date Published

2020 Jul 26

ISSN Number

1469-7610

Abstract

<p><strong>BACKGROUND: </strong>This study examined whether distinct sleep problem trajectories from infancy through middle childhood were associated with multiple aspects of child well-being at ages 10-11&nbsp;years.</p>

<p><strong>METHODS: </strong>Data were from the first six waves of the Longitudinal Study of Australian Children - Birth Cohort (5,107 children recruited at birth). Caregivers reported on child sleep problems at each time point. A combination of caregiver-reported, teacher-reported and child-completed tasks were used to index child well-being outcomes at ages 10-11&nbsp;years including emotional/behavioural functioning (internalizing and externalizing symptoms; self-control), health-related quality of life, cognitive skills and academic achievement.</p>

<p><strong>RESULTS: </strong>Latent class analysis identified five distinct sleep problem trajectories over time: persistent sleep problems through middle childhood (7.7% of the sample), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%) and no sleep problems (51.9%). Compared to those with no sleep problems, children with persistent sleep problems had the greatest impairments across all outcomes except cognitive skills (perceptual reasoning), with moderate to large effect sizes. Children with increased middle childhood sleep problems similarly experienced greater internalizing and externalizing symptoms and worse quality of life, but few academic impairments. Both the limited infant/preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver-reported quality of life, although effects were smaller than the other sleep trajectories.</p>

<p><strong>CONCLUSIONS: </strong>The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well-being.</p>

DOI

10.1111/jcpp.13303

Alternate Title

J Child Psychol Psychiatry

PMID

32713013

Title

Effectiveness of an mHealth Intervention for Infant Sleep Disturbances.

Year of Publication

2020

Number of Pages

548-558

Date Published

2020 Jul

ISSN Number

1878-1888

Abstract

<p>Bedtime problems and night wakings are highly prevalent in infants. This study assessed the real-world effectiveness of an mHealth behavioral sleep intervention (Customized Sleep Profile; CSP). Caregivers (83.9% mothers) of 404 infants (age 6 to 11.9 m, M = 8.32 m, 51.2% male) used the CSP (free and publicly available behavioral sleep intervention delivered via smartphone application, Johnson's® Bedtime® Baby Sleep App). Caregivers completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R) at baseline and again 4 to 28 days later. Changes in sleep patterns were analyzed, based on sleep problem status (problem versus no problem sleepers; PS; NPS). Sleep onset latency improved in both groups. Earlier bedtimes, longer continuous stretches of sleep, as well as decreased number and duration of night wakings, were evident in the PS group only. The BISQ-R Total score, total nighttime sleep, and total 24-hour sleep time improved for both groups, with a greater change for the PS group. Further, caregivers of infants in the PS group decreased feeding (bedtime and overnight) and picking up overnight, and perceived better sleep. Bedtime routine regularity, bedtime difficulty, sleep onset difficulty, and caregiver confidence improved for both groups, with the PS group showing a greater magnitude of change. Thus, a real-world, publicly available, mHealth behavioral sleep intervention was associated with improved outcomes for older infants. Intervention recommendations resulted in changes in caregivers' behavior and improvements in caregiver-reported sleep outcomes in infants, in as few as 4 days.</p>

DOI

10.1016/j.beth.2019.12.011

Alternate Title

Behav Ther

PMID

32586429

Title

Early Childhood Sleep Intervention in Urban Primary Care: Clinician and Caregiver Perspectives.

Year of Publication

2020

Date Published

2020 May 20

ISSN Number

1465-735X

Abstract

<p><strong>BACKGROUND: </strong>Despite significant income-related disparities in pediatric sleep, few early childhood sleep interventions have been tailored for or tested with families of lower socio-economic status (SES). This qualitative study assessed caregiver and clinician perspectives to inform adaptation and implementation of evidence-based behavioral sleep interventions in urban primary care with families who are predominantly of lower SES.</p>

<p><strong>METHODS: </strong>Semi-structured interviews were conducted with (a) 23 caregivers (96% mothers; 83% Black; 65% ≤125% U.S. poverty level) of toddlers and preschoolers with insomnia or insufficient sleep and (b) 22 urban primary care clinicians (physicians, nurse practitioners, social workers, and psychologists; 87% female; 73% White). Guided by the Consolidated Framework for Implementation Research, the interview guide assessed multilevel factors across five domains related to intervention implementation. Qualitative data were analyzed using an integrated approach to identify thematic patterns across participants and domains.</p>

<p><strong>RESULTS: </strong>Patterns of convergence and divergence in stakeholder perspectives emerged across themes. Participants agreed upon the importance of child sleep and intervention barriers (family work schedules; household and neighborhood factors). Perspectives aligned on intervention (flexibility; collaborative and empowering care) and implementation (caregiver-to-caregiver support and use of technology) facilitators. Clinicians identified many family barriers to treatment engagement, but caregivers perceived few barriers. Clinicians also raised healthcare setting factors that could support (integrated care) or hinder (space and resources) implementation.</p>

<p><strong>CONCLUSIONS: </strong>Findings point to adaptations to evidence-based early childhood sleep intervention that may be necessary for effective implementation in urban primary care. Such adaptations could potentially reduce significant pediatric sleep-related health disparities.</p>

DOI

10.1093/jpepsy/jsaa024

Alternate Title

J Pediatr Psychol

PMID

32430496

Title

Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers.

Year of Publication

2017

Number of Pages

1281-1288

Date Published

2017 Nov 15

ISSN Number

1550-9397

Abstract

<p><strong>STUDY OBJECTIVES: </strong>Community-based research indicates that Black preschoolers tend to have more bedtime difficulties and are at higher risk for obstructive sleep apnea (OSA) compared to White preschoolers. This study examined differences in sleep patterns and problems by race among a clinical sample of Black and White preschoolers at an outpatient sleep clinic.</p>

<p><strong>METHODS: </strong>Data were collected from electronic medical records for 125 children ages 2-5 years (mean = 3.37 years, 64.0% White, 36.0% Black; 59.2% male) presenting at a pediatric sleep clinic in an academic medical center. Neighborhood income data were based on ZIP codes entered into the United States Census Bureau's American Fact Finder.</p>

<p><strong>RESULTS: </strong>Black patients (51.1%) were significantly more likely than White patients (20.0%) to bed-share with a caregiver (χ = 12.99, ≤ .001). There were no other significant differences in presenting sleep patterns (bed/wake times, sleep onset latency, naps, night awakenings, or sleep opportunity). Logistic regressions showed that White patients were more likely to present with difficulty falling/staying asleep and receive an insomnia diagnosis, and Black patients were more likely to present with OSA-related concerns and receive a diagnosis of suspected OSA, even when controlling for relevant sociodemographic covariates.</p>

<p><strong>CONCLUSIONS: </strong>In contrast to community-based research, Black and White children showed similar sleep patterns. However, there were differences by race in referral questions and diagnoses. Findings suggest the need to consider caregiver perceptions and other sociocultural factors that may contribute to differential rates of presentation for sleep services, as well as potential health disparities in this regard.</p>

DOI

10.5664/jcsm.6798

Alternate Title

J Clin Sleep Med

PMID

28992828

Title

Benefits of a bedtime routine in young children: Sleep, development, and beyond.

Year of Publication

2018

Number of Pages

93-108

Date Published

2018 08

ISSN Number

1532-2955

Abstract

<p>This paper presents a conceptual model and reviews the empirical evidence to support a nightly bedtime routine as a key factor in the promotion of not only healthy sleep, but also of broad development and wellbeing in early childhood. A bedtime routine embodies the characteristics of nurturing care and early child stimulation, which are deemed to be essential for positive outcomes, especially for at-risk children. Furthermore, common, adaptive components of a bedtime routine can contribute to an array of positive developmental outcomes beyond improved sleep, inclusive of language development, literacy, child emotional and behavioral regulation, parent-child attachment, and family functioning, among other outcomes. These bedtime routine components include activities in the broad domains of nutrition (e.g., feeding, healthy snack), hygiene (e.g., bathing, oral care), communication (e.g., reading, singing/lullabies) and physical contact (e.g., massage, cuddling/rocking). A bedtime routine can provide multiple benefits to child and family functioning at a time of day that many parents are present with their children. Although additional research on hypothesized routine-related child outcomes and mechanisms of action are needed, promoting a bedtime routine may be a feasible and cost-effective method to promote positive early childhood development worldwide, particularly for socioeconomically disadvantaged and other at-risk young children.</p>

DOI

10.1016/j.smrv.2017.10.007

Alternate Title

Sleep Med Rev

PMID

29195725

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