Associations of bedroom PM, CO, temperature, humidity, and noise with sleep: An observational actigraphy study.

2023

04/2023

2352-7226

OBJECTIVE: Climate change and urbanization increasingly cause extreme conditions hazardous to health. The bedroom environment plays a key role for high-quality sleep. Studies objectively assessing multiple descriptors of the bedroom environment as well as sleep are scarce.

METHODS: Particulate matter with a particle size <2.5 µm (PM), temperature, humidity, carbon dioxide (CO), barometric pressure, and noise levels were continuously measured for 14 consecutive days in the bedroom of 62 participants (62.9% female, mean ± SD age: 47.7 ± 13.2 years) who wore a wrist actigraph and completed daily morning surveys and sleep logs.

RESULTS: In a hierarchical mixed effect model that included all environmental variables and adjusted for elapsed sleep time and multiple demographic and behavioral variables, sleep efficiency calculated for consecutive 1-hour periods decreased in a dose-dependent manner with increasing levels of PM, temperature, CO, and noise. Sleep efficiency in the highest exposure quintiles was 3.2% (PM, p < .05), 3.4% (temperature, p < .05), 4.0% (CO, p < .01), and 4.7% (noise, p < .0001) lower compared to the lowest exposure quintiles (all p-values adjusted for multiple testing). Barometric pressure and humidity were not associated with sleep efficiency. Bedroom humidity was associated with subjectively assessed sleepiness and poor sleep quality (both p < .05), but otherwise environmental variables were not statistically significantly associated with actigraphically assessed total sleep time and wake after sleep onset or with subjectively assessed sleep onset latency, sleep quality, and sleepiness. Assessments of bedroom comfort suggest subjective habituation irrespective of exposure levels.

CONCLUSIONS: These findings add to a growing body of evidence highlighting the importance of the bedroom environment-beyond the mattress-for high-quality sleep.

10.1016/j.sleh.2023.02.010

Sleep Health

37076419

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

Associations of the residential built environment with adolescent sleep outcomes.

2021

2021 Jan 28

1550-9109

<p><strong>STUDY OBJECTIVES: </strong>Over 75% of US high school students obtain insufficient sleep, placing them at risk for adverse health outcomes. Identification of modifiable determinants of adolescent sleep is needed to inform prevention strategies, yet little is known about the influence of the built environment on adolescent sleep.</p>

<p><strong>METHODS: </strong>In this prospective study, actigraphy was used to assess sleep outcomes among 110 adolescents for 14 days each in eighth and ninth grades: duration (hours/night), onset and offset, and sleeping ≥8 hours. Home addresses were linked to built environment exposures: sound levels, tree canopy cover, street density, intersection density, population density, and housing density. Mixed-effects regression estimated associations of built environment measures with sleep outcomes, adjusting for sex, race, parent education, household income, household size, grade, weeknight status, and neighborhood poverty.</p>

<p><strong>RESULTS: </strong>A 1-standard deviation (SD) increase in neighborhood sound was associated with 16 minutes later sleep onset (β = 0.28; 95% confidence interval (CI): 0.06, 0.49) and 25% lower odds of sleeping for ≥8 hours (odds ratio (OR) = 0.75, 95% CI: 0.59, 0.96). A 1-SD increase in neighborhood tree canopy was associated with 18 minutes earlier sleep onset (β = -0.31, 95% CI: -0.49, -0.13) and 10 minutes earlier sleep offset (β= -0.17, 95% CI: -0.28, -0.05). No associations were observed for density-based exposures.</p>

<p><strong>CONCLUSIONS: </strong>Higher neighborhood sound level was associated with lower odds of sufficient sleep, while higher tree canopy cover was associated with more favorable sleep timing. Neighborhood sound levels and tree canopy cover are potential targets for policies and interventions to support healthier sleep among adolescents.</p>

10.1093/sleep/zsaa276

Sleep

33507268

Engineering a Mobile Platform to Promote Sleep in the Pediatric Primary Care Setting.

2020

2020 Nov 07

<p><strong>BACKGROUND: </strong>Pediatricians lack tools to support families at home for the promotion of childhood sleep. We are using the Multiphase Optimization Strategy (MOST) framework to guide the development of a mobile health platform for childhood sleep promotion.</p>

<p><strong>PURPOSE: </strong>Under the preparation phase of the MOST framework, to demonstrate feasibility of a mobile health platform towards treating children with insufficient sleep.</p>

<p><strong>METHODS: </strong>Children aged 10-12y were enrolled (Study #1: N=30; Study #2: N=43). Participants wore a sleep tracker to measure sleep duration. Data were retrieved by a mobile health platform, programmed to send introductory messages during run-in (2 weeks) and goal achievement messages during intervention (7 weeks) periods. In study #1, participants were randomized to control, gain-framed incentive or loss-framed incentive arms. In study #2, participants were randomized to control, loss-framed incentive, normative feedback or loss-framed incentive plus normative feedback arms.</p>

<p><strong>RESULTS: </strong>In study #1, 1,514 nights of data were captured (69%) and sleep duration during the intervention was higher by an average of 21 (95% CI: -8, 51) and 34 (95% CI: 7, 61) minutes per night for the gain-framed and loss-framed arms, respectively, compared to controls. In study #2, 2,689 nights of data were captured (81%), with no major differences in average sleep duration between the control and the loss-framed or normative feedback arms.</p>

<p><strong>CONCLUSION: </strong>We have developed and deployed a mobile health platform that can capture sleep data and remotely communicate with families. Promising candidate intervention components will be further investigated under the optimization phase of the MOST framework.</p>

10.1101/2020.11.06.20223719

medRxiv

33173886

Engineering a mobile platform to promote sleep in the pediatric primary care setting.

2021

zpab006

2021

2632-5012

<p><strong>Study Objectives: </strong>Pediatricians lack tools to support families at home for the promotion of childhood sleep. We are using the Multiphase Optimization Strategy (MOST) framework to guide the development of a mobile health platform for childhood sleep promotion. The objective of this study is to demonstrate feasibility of a mobile health platform towards treating children with insufficient sleep.</p>

<p><strong>Methods: </strong>Children aged 10-12 years were enrolled (Study #1: = 30; Study #2: = 43). Participants wore a sleep tracker to measure sleep duration. Data were retrieved by a mobile health platform, programmed to send introductory messages during run-in (2 weeks) and goal achievement messages during intervention (7 weeks) periods. In study #1, participants were randomized to control, gain-framed incentive or loss-framed incentive arms. In study #2, participants were randomized to control, loss-framed incentive, normative feedback or loss-framed incentive plus normative feedback arms.</p>

<p><strong>Results: </strong>In study #1, 1514 nights of data were captured (69%) and sleep duration during the intervention was higher by an average of 21 (95% CI: -8, 51) and 34 (95% CI: 7, 61) minutes per night for the gain-framed and loss-framed arms, respectively, compared to controls. In study #2, 2,689 nights of data were captured (81%), with no major differences in average sleep duration between the control and the loss-framed or normative feedback arms.</p>

<p><strong>Conclusions: </strong>We have developed and deployed a mobile health platform that can capture sleep data and remotely communicate with families. Promising candidate intervention components will be further investigated under the of the MOST framework.</p>

<p><strong>Clinical Trials: </strong>Both studies included in this manuscript were registered at clinicaltrials.gov:-Study #1: NCT03263338-Study #2: NCT03426644.</p>

10.1093/sleepadvances/zpab006

Sleep Adv

33173886

Changes in Sleep Duration and Timing During the Middle-to-High School Transition.

2020

2020 Jun 20

1879-1972

<p><strong>PURPOSE: </strong>The purpose of the study was to quantify changes in sleep during the middle-to-high school transition and determine if changes in sleep differ by sociodemographic characteristics.</p>

<p><strong>METHODS: </strong>Adolescents were enrolled in eighth grade and followed into ninth grade (N&nbsp;= 110; 2,470 nights observed). The outcomes were actigraphy-estimated sleep duration, sleep onset, sleep offset, and sleep sufficiency (≥8&nbsp;hours of sleep). The exposures were school grade (eighth or ninth), school night status (school or nonschool), sex (female or male), and race (white, black, or other).</p>

<p><strong>RESULTS: </strong>On school nights, sleep duration declined by 25.8&nbsp;minutes per night (p &lt; .001) from eighth to ninth grade. There was no change in sleep duration on nonschool nights. Timing of sleep onset was 22.2&nbsp;minutes later on school nights (p &lt; .001) and 17.4&nbsp;minutes later on nonschool nights (p&nbsp;&lt;&nbsp;.001) in ninth grade. Timing of sleep offset did not change on school mornings but was 22.2&nbsp;minutes later on nonschool mornings (p &lt; .001) in ninth grade. The proportion of school nights (and nonschool nights) with sleep duration ≥8&nbsp;hours was 9.4% (38.3%) in eighth grade and 5.7% (35.9%) in ninth grade. The odds of sleeping ≥8&nbsp;hours per night was 42% lower in ninth grade, compared toeighth grade (odds ratio&nbsp;= .58; 95% confidence interval: .37, .91). Males were 59% less likely to sleep ≥8&nbsp;hours per night. Black adolescents were 51% less likely to sleep ≥8&nbsp;hours per night.</p>

<p><strong>CONCLUSIONS: </strong>Insufficient sleep is highly prevalent, especially on school nights and among male and black adolescents, and this problem worsens with the transition to high school.</p>

10.1016/j.jadohealth.2020.04.024

J Adolesc Health

32576483