Associations of actigraphy measures of sleep duration and continuity with executive function, vigilance, and fine motor control in children with snoring and mild sleep-disordered breathing.

2023

04/2023

1550-9397

STUDY OBJECTIVES: Children with snoring and mild sleep-disordered breathing may be at increased risk for neurocognitive deficits despite few obstructive events. We hypothesized that actigraphy-based sleep duration and continuity associate with neurobehavioral functioning and explored whether these associations vary by demographic and socioeconomic factors.

METHODS: 298 children enrolled in the Pediatric Adenotonsillectomy Trial, aged 3 to 12 years, 47.3% from racial or ethnic minority groups, with habitual snoring and an apnea-hypopnea index <3 were studied with actigraphy (mean 7.5 ± 1.4 days) and completed a computerized vigilance test (Go-No-Go) and a test of fine motor control (9-Hole Pegboard). Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF). Regression analyses evaluated associations between sleep exposures (24-hour and nocturnal sleep duration, sleep fragmentation index, sleep efficiency) with the BRIEF Global Executive Composite index, pegboard completion time (fine motor control), and vigilance (d prime on the Go-No-Go), adjusting for demographic factors and study design measures.

RESULTS: Longer sleep duration, higher sleep efficiency and lower sleep fragmentation were associated with better executive function; each additional hour of sleep over 24 hours associated with more than a 3-point improvement in executive function (p=0.002). Longer nocturnal sleep (p=0.02) and less sleep fragmentation (p=0.001) were associated with better fine motor control. Stronger associations were observed for boys and children less than six years old.

CONCLUSIONS: Sleep quantity and continuity are associated with neurocognitive functioning in children with mild sleep-disordered breathing, supporting efforts to target these sleep health parameters as part of interventions for reducing neurobehavioral morbidity.

CLINICAL TRIAL: Pediatric Adenotonsillectomy for Snoring (PATS), clinicaltrials.gov.: NCT02562040.

10.5664/jcsm.10620

J Clin Sleep Med

37185231

A multi-method evaluation of bed provision and sleep education for young children and their families living in poverty.

2023

04/2023

1550-9397

STUDY OBJECTIVES: To evaluate the impact of bed provision and sleep education through the Beds for Kids (BfK) program on early childhood sleep and behavior, and maternal mood and sleep.

METHODS: Twenty-seven mother-child dyads (child= 2-5 yrs, 85.2% Black) living in poverty and without an individual child bed were randomly assigned (multi-method randomized waitlist control trial design) to BfK intervention ~1-week post-baseline (initial intervention) or ~2 weeks post-baseline (waitlist control), with follow-up at one-month. BfK intervention (home bed delivery and written sleep health education) was provided to all families. Children wore actigraphs and mothers completed daily diaries to assess child and maternal sleep, child behavior, and maternal mood for the initial one-week comparison period. Maternal-reported child sleep and behavior (internalizing and externalizing problems) were collected at one-month post BfK-participation for all families; n=11 completed a qualitative interview at one-month assessment.

RESULTS: At one-week post-BfK, mothers' sleep duration increased by 1 hour compared to waitlist controls. No changes were found in child sleep, child behavior, or maternal mood. However, at one-month post-BfK intervention, improvements were found in mother-reported child night awakenings, sleep quality and sleep problems, and behavior. Mothers qualitatively reported significant BfK benefits for child sleep and family wellbeing, although noted challenges to transitioning young children to sleeping independently.

CONCLUSIONS: Bed provision and sleep education for families living in poverty has a more immediate impact on maternal sleep and reported wellbeing. Child sleep and behavioral improvements are seen by one month, with children experiencing an initial adjustment period to sleeping independently.

CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Impact of Beds for Kids Program on Child Sleep; Identifier: NCT03392844; URL: https://www.clinicaltrials.gov/ct2/show/NCT03392844.

10.5664/jcsm.10614

J Clin Sleep Med

37086055

Maternal Perceptions of Evidence-Based Early Childhood Sleep Health Promotion Recommendations: An Explanatory Sequential Study.

2023

1-13

04/2023

1540-2010

OBJECTIVES: The purpose of this explanatory sequential design study was to better understand caregivers' perceptions about and interest in evidence-based early childhood sleep health promotion recommendations.

METHOD: A purposeful sample of mothers of 20 1-5-year-old children (10 children exhibiting optimal sleep and 10 children exhibiting insufficient/fragmented sleep) attending a preschool serving a low socio-economic (SES) status metropolitan community were invited to participate in qualitative interviews. Data were coded according to a grounded theory approach and themes were identified within the optimal and suboptimal sleeper groups.

RESULTS: Mothers reported different approaches to managing electronics by optimal/suboptimal sleeper group, with mothers of optimal sleepers limiting access to electronics more than mothers in the suboptimal sleep group. Other themes of sleep health practices did not differ meaningfully between groups.

CONCLUSIONS: Maternal perspectives about early childhood sleep health were similar across optimal and suboptimal sleepers on most elements of child sleep health. Managing child sleep was contextually influenced and these results highlight the complexities of how families living in lower SES environments perceive common sleep recommendations. Thus, sleep health education efforts should be tailored to the needs and values of specific families and communities.

10.1080/15402002.2023.2189723

Behav Sleep Med

37042454

Pediatric Sleep: Current Knowledge, Gaps, and Opportunities for the Future.

2023

03/2023

1550-9109

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g., autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps in our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e., actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

10.1093/sleep/zsad060

Sleep

36881684

Nighttime sleep duration and variability in children with obstructive sleep apnea syndrome: Sociodemographic disparities and neurobehavioral outcomes.

2023

165-172

02/2023

1878-5506

OBJECTIVES: This study examined differences in sleep patterns by race, ethnicity, and socioeconomic status (SES) among children with Obstructive Sleep Apnea Syndrome (OSAS), and linkages between sleep patterns and neurobehavioral functioning.

METHOD: We used baseline data from the Childhood Adenotonsillectomy Study (CHAT), a multicenter, single-blind, randomized controlled trial designed to evaluate the efficacy of early adenotonsillectomy versus watchful waiting with supportive care for children with OSAS. Participants included children with OSAS (ages 5.0-9.9 years). SES indicators were obtained via questionnaire and geocoding (ArcGIS version 10.1). Caregivers and teachers reported on child inattention/impulsivity and executive functioning. Nighttime sleep duration and variability were measured using five-night sleep diaries.

RESULTS: Black children experienced shorter nighttime sleep duration than White children, by about 25 min, as well as greater sleep duration variability, while sleep duration was more variable in children of "other" racial and ethnic backgrounds versus White children. Of the socioeconomic correlates, only lower family income was associated with sleep duration variability. A short and more variable nighttime sleep duration were each associated with caregiver-rated child inattention and impulsivity. Greater sleep duration variability was linked to greater teacher-rated, but not caregiver-rated, executive functioning impairments.

CONCLUSIONS: Compared to White children with OSAS, Black children with OSAS experience a shorter and more variable nighttime sleep duration. Having a short and/or variable sleep duration may increase risk for neurobehavioral impairments in youth with OSAS, underscoring the potential benefits of sleep health promotion in the context of OSAS care.

10.1016/j.sleep.2023.01.003

Sleep Med

36682144

Discrepancies Between Caregiver Reported Early Childhood Sleep Problems and Clinician Documentation and Referral.

2023

02/2023

1876-2867

OBJECTIVES: The American Academy of Pediatrics (AAP) recommends routine sleep problem screenings during child well-visits. However, studies suggest a discrepancy between caregiver- and clinician-reported child sleep problems. The present study examines whether caregiver-reported child sleep problems (i.e., habitual snoring, insomnia symptoms, poor sleep health) and clinician-documented child sleep problems and management are congruent.

METHODS: The sample included 170 caregiver-child dyads (child M = 3.3 years, range=2-5 years; 56.5% girls; 64.1% Black, 20.0% non-Latinx White, and 4.1% Latinx; 86.5% maternal caregiver reporter). Caregivers' questionnaire-based reports of habitual snoring, insomnia symptoms, and sleep health behaviors (nighttime electronics, caffeine intake, insufficient sleep) were compared with clinician documentation in the electronic health record.

RESULTS: 92.3% of children had at least one caregiver-reported sleep problem (66% insomnia symptoms, 64% electronics, 38% insufficient sleep, 21% caffeine, 17% snoring). In contrast, a substantially lower percent of children had a clinician documented sleep problem (20% overall; 10% insomnia symptoms, 7% electronics, 0% insufficient sleep, 3% caffeine, 4% snoring), sleep-related referral (1% overall; 0.6% Otolaryngology, 0.6% polysomnogram, 0% sleep clinic), or recommendation (12% overall; 8% insomnia symptoms, 4% electronics, 0% insufficient sleep, 1% caffeine).

CONCLUSIONS: There is a vast discrepancy between caregiver-reported child sleep problems and clinician-documented sleep problems and management, with a higher proportion of caregiver reports. To benefit overall child health and well-being, future research and quality improvement initiatives should focus on enhancing screening tools and educational opportunities to improve clinician documentation and enhance family conversations about early childhood sleep problems.

10.1016/j.acap.2023.02.001

Acad Pediatr

36764578

Discrepancies Between Caregiver Reported Early Childhood Sleep Problems and Clinician Documentation and Referral.

2023

02/2023

1876-2867

OBJECTIVES: The American Academy of Pediatrics (AAP) recommends routine sleep problem screenings during child well-visits. However, studies suggest a discrepancy between caregiver- and clinician-reported child sleep problems. The present study examines whether caregiver-reported child sleep problems (i.e., habitual snoring, insomnia symptoms, poor sleep health) and clinician-documented child sleep problems and management are congruent.

METHODS: The sample included 170 caregiver-child dyads (child M = 3.3 years, range=2-5 years; 56.5% girls; 64.1% Black, 20.0% non-Latinx White, and 4.1% Latinx; 86.5% maternal caregiver reporter). Caregivers' questionnaire-based reports of habitual snoring, insomnia symptoms, and sleep health behaviors (nighttime electronics, caffeine intake, insufficient sleep) were compared with clinician documentation in the electronic health record.

RESULTS: 92.3% of children had at least one caregiver-reported sleep problem (66% insomnia symptoms, 64% electronics, 38% insufficient sleep, 21% caffeine, 17% snoring). In contrast, a substantially lower percent of children had a clinician documented sleep problem (20% overall; 10% insomnia symptoms, 7% electronics, 0% insufficient sleep, 3% caffeine, 4% snoring), sleep-related referral (1% overall; 0.6% Otolaryngology, 0.6% polysomnogram, 0% sleep clinic), or recommendation (12% overall; 8% insomnia symptoms, 4% electronics, 0% insufficient sleep, 1% caffeine).

CONCLUSIONS: There is a vast discrepancy between caregiver-reported child sleep problems and clinician-documented sleep problems and management, with a higher proportion of caregiver reports. To benefit overall child health and well-being, future research and quality improvement initiatives should focus on enhancing screening tools and educational opportunities to improve clinician documentation and enhance family conversations about early childhood sleep problems.

10.1016/j.acap.2023.02.001

Acad Pediatr

36764578

Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions.

2023

02/2023

1550-9397

STUDY OBJECTIVES: This review synthesizes the pediatric behavioral sleep intervention (BSI) evidence base, summarizes challenges in translating BSIs from research to practice, and provides recommendations for integrating Implementation Science (Imp Sci) methods to advance pediatric BSI research.

METHODS: We briefly review the common behavioral sleep disturbances among youth, discuss the pediatric BSIs with well-established evidence, and identify gaps in pediatric BSI research. We then identify contributors to the dearth of research evaluating pediatric BSIs in accessible settings and present a model for applying Imp Sci strategies to address identified gaps across the continuum of translational research.

RESULTS: Relatively few BSI trials include older children and adolescents. Similarly, there is limited research evaluating BSIs among racially and ethnically minoritized children and families and/or those of lower socioeconomic status backgrounds. Access to scalable and easily disseminable tools to treat pediatric sleep disturbances early in their development is crucial for promoting positive child outcomes. To address these gaps, researchers should apply Imp Sci theories, models, and frameworks to design new interventions for implementation, adapt existing interventions with end-users and settings in mind, conduct hybrid effectiveness-implementation trials, and test implementation strategies.

CONCLUSIONS: Given the prevalence and consequences of poor sleep across developmental periods, pediatric BSIs must be effective as well as adaptable, scalable, and easily disseminable. Imp Sci theories, models, and frameworks can enhance access to, engagement in, and the implementation and dissemination of scalable BSIs across diverse pediatric care settings and heterogeneous populations.

10.5664/jcsm.10476

J Clin Sleep Med

36722616

Promoting Sleep Duration in the Pediatric Setting Using a Mobile Health Platform: A Randomized Optimization Trial.

2023

01/2023

OBJECTIVE: Determine the optimal combination of digital health intervention component settings that increase average sleep duration by ≥30 minutes per weeknight.

METHODS: Optimization trial using a 2 factorial design. The trial included 2 week run-in, 7 week intervention, and 2 week follow-up periods. Typically developing children aged 9-12y, with weeknight sleep duration <8.5 hours were enrolled (N=97). All received sleep monitoring and performance feedback. The five candidate intervention components ( ) were: 1) sleep goal ( ); 2) screen time reduction messaging ( ); 3) daily routine establishing messaging ( ); 4) child-directed loss-framed financial incentive ( ); and 5) caregiver-directed loss-framed financial incentive ( ). The primary outcome was weeknight sleep duration (hours per night). The optimization criterion was: ≥30 minutes average increase in sleep duration on weeknights.

RESULTS: Average baseline sleep duration was 7.7 hours per night. The highest ranked combination included the core intervention plus the following intervention components: sleep goal (either setting was effective), caregiver-directed loss-framed incentive, messaging to reduce screen time, and messaging to establish daily routines. This combination increased weeknight sleep duration by an average of 39.6 (95% CI: 36.0, 43.1) minutes during the intervention period and by 33.2 (95% CI: 28.9, 37.4) minutes during the follow-up period.

CONCLUSIONS: Optimal combinations of digital health intervention component settings were identified that effectively increased weeknight sleep duration. This could be a valuable remote patient monitoring approach to treat insufficient sleep in the pediatric setting.

10.1101/2023.01.04.23284151

medRxiv

36711634

A protocol for applying health equity-informed implementation science models and frameworks to adapt a sleep intervention for adolescents at risk for suicidal thoughts and behaviors.

2022

971754

12/2022

2296-2565

Background: Effective and equitable strategies to prevent youth suicidal thoughts and behaviors (STB) are an urgent public health priority. Adolescent sleep disturbances are robustly linked to STB but are rarely addressed in preventive interventions or among Black and/or Hispanic/Latinx youth for whom STB risk is increasing disproportionately. This paper describes an application of health equity-informed implementation science models and frameworks to adapt and evaluate the evidence-based Transdiagnostic Sleep and Circadian (TSC) intervention for primary care implementation with adolescents of minoritized backgrounds with depression and STB risk.

Methods: This multiphase study protocol uses the Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, Testing (ADAPT-ITT) model to adapt and evaluate TSC for primary care implementation with adolescents who are depressed, at risk for STB, and of primarily Black and/or Hispanic/Latinx backgrounds. We integrate the Consolidated Framework for Implementation Research (CFIR) in an initial qualitative inquiry of adolescent, caregiver, and clinician perceptions of TSC. Subsequent ADAPT-ITT phases include systematically and iteratively testing adaptations based on the qualitative inquiry, with ongoing key informant input, and then evaluating the adapted TSC for feasibility, acceptability, and efficacy in a pilot randomized trial.

Anticipated results: Based on youth depression and sleep health disparities research, we expect that TSC adaptations will be needed to enhance intervention content for adolescents with depression, STB risk, and primarily Black and/or Hispanic/Latinx backgrounds. We also anticipate adaptations will be needed to align TSC delivery methods with primary care implementation.

Conclusions: Adapting evidence-based interventions with end-users and contexts in mind can help ensure that intervention strategies and delivery methods are acceptable to, and feasible with, health disparate populations. Although TSC has shown effectiveness for adolescents with sleep disturbances, we expect that additional multiphase research is necessary to optimize TSC for primary care delivery with Black and/or Hispanic/Latinx adolescents with depression and STB risk.

10.3389/fpubh.2022.971754

Front Public Health

36311565