Risk factors associated with short sleep duration among Chinese school-aged children

ObjectivesTo examine risk factors regarding short sleep duration among Chinese school-aged children.MethodsA random sample of 20,778 children aged around 5–11 years participated in a cross-sectional survey, which was conducted in eight cities of China in 2005. A parent-administered questionnaire was used to collect information on children’s sleep duration and possible related factors from eight domains. Short sleep duration was defined as total sleep duration <9 h per day.ResultsIn all, 28.3% of the sampled children slept <9 h per day. The multivariate logistic regression identified, after adjusting for demographic and socioeconomic variables, factors associated with short sleep duration: more television viewing during weekdays (OR = 1.21, p = 0.004), more frequent computer/internet using (OR = 1.17, p = 0.006), earlier school starting time (OR = 1.10, p = 0.020), more time on homework during weekdays (OR = 1.66, p < 0.001) and weekends (OR = 1.14, p = 0.001), poor bedtime hygiene (e.g., having drinks with caffeine after 6:00PM [OR = 1.22, p < 0.001], doing exciting activities during bedtime [OR = 1.16, p < 0.001], and irregular bedtime [OR = 1.55, p < 0.001]), and shorter sleep duration of parents (mother: OR = 1.31, p < 0.001 for sleep duration <6 h and OR = 1.24, p = 0.006 for 6–8 h; father: OR = 1.52, p < 0.001 for <6 h and OR = 1.19, p < 0.001 for 6–8 h).ConclusionsFactors associated with sleep duration covered multidimensional domains among school-aged children. Compared to sleep environments and chronic health problems, school schedules, lifestyle patterns, and parents’ sleep habits had greater impact on children’s sleep duration, indicating the existing chronic sleep loss in school children could be, at least partly, intervened by reducing the use of visual technologies, by changing the school schedules, by improving the sleep hygiene routine, and by regulating parents’ sleep habits.     

Sleep patterns and sleep disturbances across pregnancy

ObjectiveThis study sought to characterize sleep patterns and sleep problems in a large sample of women across all months of pregnancy.MethodsA total of 2427 women completed an Internet-based survey that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, vitality scale of the Short Form 36 Health Survey (SF-36), Insomnia Severity Index (ISI), Berlin questionnaire, International Restless Legs Syndrome (IRLS) question set, and a short version of the Pregnancy Symptoms Inventory (PSI).ResultsAcross all months of pregnancy, women experienced poor sleep quality (76%), insufficient nighttime sleep (38%), and significant daytime sleepiness (49%). All women reported frequent nighttime awakenings (100%), and most women took daytime naps (78%). Symptoms of insomnia (57%), sleep-disordered breathing (19%), and restless legs syndrome (24%) were commonly endorsed, with no difference across the month of pregnancy for insomnia, sleep-disorder breathing, daytime sleepiness, or fatigue. In addition, high rates of pregnancy-related symptoms were found to disturb sleep, especially frequent urination (83%) and difficulty finding a comfortable sleep position (79%).ConclusionsWomen experience significant sleep disruption, inadequate sleep, and high rates of symptoms of sleep disorder throughout pregnancy. These results suggest that all women should be screened and treated for sleep disturbances throughout pregnancy, especially given the impact of inadequate sleep and sleep disorders on fetal, pregnancy, and postpartum outcomes.     

Sleep disturbances among Chinese residents during the Coronavirus Disease 2019 outbreak and associated factors

ObjectivesSleep status can affect the body's immune status and mental health. This study aims to investigate the sleep status of Chinese residents during the outbreak of Coronavirus Disease 2019 (COVID-19) and to evaluate its related risk factors.MethodsThis research carried out a cross-sectional survey in February 2020 (during the COVID-19 outbreak) to investigate the sleep status of residents nationwide in the form of an online questionnaire. Of the 8151 respondents, 6437 were eventually included in the analysis. Logistic regression is applied to analyze the associated factors affecting residents' sleep quality.ResultsDuring the COVID-19 outbreak, the incidence of sleep disturbances in residents was 17.65%. Increased risk of sleep disturbances was found to be associated with older age, female gender, and poor self-reported health status. Moreover, the odds ratios (ORs) were 1.42 (95% CI: 1.1–2.64), 1.35 (95% CI: 1.16–1.59), 5.59 (95% CI: 4.32–7.23), respectively. Those residents who believed COVID-19 had caused a high number of deaths or who thought COVID-19 was not easy to cure were more likely to experience sleep disorders, and the ORs were 1.73 (95% CI: 1.43–2.09), 1.57 (95% CI: 1.29–1.91), respectively. Regular exercise was a protective factor for sleep disturbances, OR = 0.77 (95% CI: 0.63–0.93).ConclusionsDuring the outbreak of COVID-19, nearly one-fifth of participants had sleep disorders. It is necessary to pay more attention to people at high risk for sleep disturbances during the outbreak, adopt effective risk communication methods, enhance residents' rational understanding of COVID-19, and develop practical indoor exercise programs for general public to improve sleep quality.     

Prevalence of and risk factors associated with sleep disturbances among HPCD exposed to COVID-19 in China

ObjectiveTo assess sleep disturbances and associated factors among front-line healthcare providers who have been called upon for, dispatched (HPCD) and exposed to COVID-19 in China.MethodsThis cross-sectional, survey-based, isolation area-stratified study collected demographic data, sleep status and emotional measurements from 1036 HPCD in nine medical institutions from March 5 to 9, 2020 in Wuhan, China, which was the epicenter of the epidemic. HPCD who worked in isolation areas with COVID-19 were eligible for inclusion. The severity of symptoms of sleep disorders, insomnia and emotional self-efficacy were assessed by the Chinese versions of the 10-item Self-rating sleeping situation scale, the seven-item Insomnia Severity Index and the 12-item Regulatory emotional self-efficacy questionnaire, respectively. Univariate analysis was performed to identify factors associated with sleep disturbances. A structural equation model (SEM) was constructed via AMOS to explore the relationship among the four components.ResultsA total of 1036 out of 1075 contacted individuals completed the survey, with a participation rate of 96.4%. A total of 925 (89.3%) were aged 20–39 years, and 755 (72.9%) were women. Among all participants, 874 (84.4%) were nurses, and 162 (15.6%) were physicians; 538 (51.9%) worked in intensive care isolation units; 843 (81.4%) worked in isolation areas for 4 h straight, and 395 (38.1%) perceived COVID-19 peer exposure. A considerable proportion of participants reported symptoms of sleep disorders (543, 52.4%). Exposure status and length of work were the main factors affecting sleep status, which had indirect effects on sleep status by mediating regulatory emotional self-efficacy.ConclusionsIn this survey of HPCD for patients with COVID-19 in China, participants reported experiencing sleep disturbance burdens, especially those having exposure experience and working long shifts. Regulatory emotional self-efficacy (RESE) is an important resource for alleviating sleep disturbances and improving sleep quality. These findings emphasize the importance of being prepared to support HPCD through psychological interventions.     

Sleep disturbances and associated factors among 2-6-year-old male children with autism in Bhubaneswar,India

BackgroundSleep disturbances are considered one of the significant comorbidities of autism; they negatively impact the quality of life of children with autism as well as their parents or caregivers. This study aimed to determine the prevalence of sleep disturbances in Indian male children diagnosed with autism and examine the association of lifestyle behaviors and socio-demographic characteristics with sleep problems.MethodsThe present cross-sectional study was conducted in Bhubaneswar city in the year 2018, involving mothers of 100 male children with autism aged 2–6 years. We used a children's sleep habits questionnaire (CSHQ) to evaluate the sleep problems in children with autism and a semi-structured schedule for gathering information regarding lifestyle behaviors and socio-demographic characteristics.ResultsThe overall prevalence of parent-reported sleep problems was 93%; the most prevalent CSHQ subscales were: bedtime resistance (95%), sleep anxiety (85%), and sleep duration (81%). The mean ISAA score of the study sample was 133.89 ± 19.59, where 12%, 71%, and 17% of the children had mild, moderate, and severe autism, respectively. Multiple linear regression analysis revealed that variables such as autism severity, screen time, caffeine intake, physical activity, maternal age, child's age, and birth weight were significantly associated with the CSHQ subscales.ConclusionThe prevalence of parent-reported sleep problems is very high among the male children with autism in Bhubaneswar, India, and there is an urgent need for interventional measures for appropriate management of this problem among these children.     

Prevalence and associated factors of poor sleep quality among Chinese returning workers during the COVID-19 pandemic

ObjectivesThe 2019 novel coronavirus (COVID-19) pandemic is a severe global crisis which has resulted in many public health problems. This study aimed to investigate the prevalence of poor sleep quality and its related factors among employees who returned to work during the COVID-19 pandemic.MethodsOur online cross-sectional study included 2,410 participants aged ≥17 years in Deqing and Taizhou, Zhejiang Province, China from 5th to 14th March 2020. The questionnaire covered information on demographic characteristics, health status, workplace, lifestyle, attitude towards COVID-19, assessment of anxiety, depression and sleep quality. The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) was administered to measure the poor sleep quality. Poor sleep quality was defined as a global PSQI score>5. Factors associated with sleep quality were analyzed by logistic regression models.ResultsIn sum near half (49.2%) of 2,410 returning workers were females and the average year of subjects was 36.3 ± 9.1 years. The overall prevalence of poor sleep quality was 14.9% (95%CI: 13.5%–16.3%). The average score of PSQI was 3.0 ± 2.5 and average sleep duration was 7.6 ± 1.2 h. Independent related factors of poor sleep quality included age older than 24 years, higher education level, negative attitude towards COVID-19 control measures, anxiety and depression.ConclusionsPoor sleep quality was common and there was a shorter sleep duration among returning workers during the COVID-19 pandemic. Possible risk factors identified from this study may be of great importance in developing proper intervention for the targeted population to improve the sleep health during the COVID-19 public health emergency.     

Sleep quality and sleep disturbances among volunteer and professional French firefighters: FIRESLEEP study

BackgroundAlthough insufficient sleep among firefighters reduces work efficiency and increases the risk of injury, little is known about the sleep quality of French firefighters in the Loire department. The aim of the FIRESLEEP study was to evaluate sleep quality and sleep disturbances among professional and voluntary French firefighters.MethodsA cross-sectional observational study was conducted between November 2018 and May 2019. Firefighters were invited to complete a questionnaire on a secure platform including clinical questions and validated questionnaires (Pittsburgh Sleep Quality Index [PSQI], Epworth sleepiness scale [ESS], Insomnia Severity Index [ISI] and the STOP-Bang score) during their periodic medical examination.Results193 firefighters were included in this study, of which 29% were of professional status and 71% were volunteer firefighters. Among them, 26.9% had poor sleep quality, 27.7% showed excessive daytime sleepiness (EDS), 18.8% reported moderate-to-severe symptoms of insomnia, and 1.6% had moderate-to-high risk of obstructive sleep apnea. Subgroup analysis revealed that professional firefighters had poorer sleep quality and higher sleep disturbances than volunteer firefighters. The independent risk factors associated with poor sleep quality were known sleep disorder, treated anxiety/depression, night calls, and insomnia symptoms. Moreover, the independent risk factors associated with EDS were short sleep duration, taking a nap, and insomnia symptoms; while older age was a protective factor for EDS.ConclusionsPoor sleep quality and sleep disturbances are highly frequent in French firefighters and underdiagnosed. Prevention through education and systematic screening could limit the impact of sleep disturbances on firefighters' global health.     

Prevalence and patterns of problematic sleep among older adolescents

OBJECTIVE: Despite many constraints on time schedules among teenagers, epidemiological data on sleep complaints in adolescence remain limited and are nonexistent for sleep disorders. This study provides additional data on sleep habits and DSM-IV sleep disorders in late adolescence. METHOD: A representative sample of 1,125 adolescents aged 15 to 18 years was interviewed by telephone using the Sleep-EVAL system. These adolescents came from 4 European countries: France, Great Britain, Germany, and Italy. Information was collected about sociodemographic characteristics, sleep/wake schedule, sleep habits, and sleep disorders and was compared with information from 2,169 young adults (19-24 years of age). RESULTS: Compared with young adults, adolescents presented with a distinct sleep/wake schedule: they went to sleep earlier, they woke up later, and they slept longer than young adults did. On weekends and days off, they also slept more than young adults did. However, the prevalence rates of sleep symptoms and sleep disorders were comparable in both groups. Approximately 25% reported insomnia symptoms and approximately 4% had a DSM-IV insomnia disorder. Fewer than 0.5% had a circadian rhythm disorder. CONCLUSIONS: Prevalence of insomnia disorders is lower in the adolescent population than in middle-aged or elderly adults. However, a rate of 4% in this young population is important given their young age and the consequences for daytime functioning.     

Gender,socioeconomic, and ethnic differences in sleep patterns in school-aged children

ObjectivesAge-related changes in sleep behavior are well described in children, yet the effect of gender, socioeconomic status (SES), and ethnicity is less clear. These factors are important when developing culturally and socially appropriate guidelines for healthy sleep. The objective of our study was to examine the effects of age, gender, SES, and ethnicity on sleep patterns in school-aged children.MethodsA cross-sectional survey was conducted through primary schools in Adelaide, South Australia. Parents reported demographic information and sleep patterns for school and non-school days for 1845 children aged 5 to 10 years.Results48% of the cohort were boys (mean age, 7.7 ± 1.7 y), 85% were Caucasian, and there was an equal distribution across defined SES bands. Sleep duration reduced with age and was shorter on non-school than school nights as a result of later bedtimes. Boys, children from low SES areas, and non-Caucasian children reported shorter sleep times than girls, children from high SES areas, and Caucasian children, respectively. Non-Caucasian children from low SES areas reported the shortest sleep opportunity.ConclusionsThe results from our study suggest that in addition to biological mechanisms, sleep behaviors are culturally and socially driven and should be considered when developing recommendations for healthy sleep in children.     

Bed- and room-sharing in Chinese school-aged children: prevalence and association with sleep behaviors

OBJECTIVE: To survey the prevalence of bed- and room-sharing and assess associations with sleep/wake patterns, duration of sleep, and sleep problems among urban school-aged children in China. METHODS: Students representing eight Chinese cities were studied during November and December, 2005. A total of 19,299 elementary-school children (49.7% boys and 50.3% girls with a mean age of 9.00 years) participated in the survey. A parent-administered questionnaire and the Chinese version of the Children's Sleep Habits Questionnaire were completed to quantify children's sleep arrangements and to characterize sleep behaviors. RESULTS: Co-sleeping was a common practice, with a prevalence of 37.6% (routine bed-sharing: 23.0%; room-sharing: 14.6%) in Chinese school-aged children. Bed- and room-sharing did not show significant gender difference but gradually decreased with increasing age. Compared to room-sharing and sleeping alone, bed-sharing was correlated with later bedtimes, later awakening times, and a shorter duration of sleep. However, the small difference was unlikely to have clinical significance. Bed- and room-sharing tended to be associated with the increased probability of six types of sleep problems: bedtime resistance, sleep anxiety, night waking, parasomnia, sleep-disordered breathing, and daytime sleepiness. Compared to bed-sharing, room-sharing had a lower odds ratio. Among six sleep problems, bedtime resistance and sleep anxiety had the strongest association with bed-sharing. CONCLUSIONS: Sleep problems were common in Chinese school-aged children. Co-sleeping was highly prevalent and may be potentially associated with negative effects on sleep hygiene and sleep quality, although the context of the co-sleeping must be taken into consideration.     

Sleep patterns among rural Chinese twin adolescents

ObjectiveTo examine sleep patterns and influencing factors (age, gender, Tanner Stage, weekday vs. weekend, and pre-sleep activity) among rural Chinese adolescents.MethodsThis is a prospective study among 621 adolescents aged 11–20 years (341 males) using both a questionnaire and sleep diary to obtain bedtime, wake-up time, sleep latency, and total sleep time (TST).ResultsThe median TST was 8.6 h on weekdays and 9.4 h on weekends. Despite absence of late night social pressure and computers, a U-shaped TST pattern was observed across age and Tanner Stage, with a nadir around age 15–16 years or Tanner IV. Bedtimes became progressively later with age and Tanner Stage, while wake-up time was considerably earlier for school students or up to Tanner IV. Later wake-up times and longer TST on weekends were seen in school students, but not in non-school adolescents (>17 years). Pre-sleep activity, like reading or studying, was related to later bedtime, earlier wake-up time, and shorter TST in both genders.ConclusionsAge, Tanner Stage, and pre-sleep activity affected sleep patterns in this sample of rural Chinese adolescents. Later bedtime coupled with earlier wake-up time associated with academic demand appear to be important contributors to sleep loss among school students.     

Tobacco smoke exposure and inadequate sleep among U.S. school-aged children

Objective/backgroundInadequate sleep and tobacco smoke exposure (TSE) have been separately linked to adverse childhood health consequences. Our objective was to assess the association between home TSE status and inadequate sleep among U.S. school-aged children.MethodsWe analyzed 2018–2019 National Survey of Children's Health data, and included 17,851 children ages 6–11 years. Children were classified into three parent-report TSE groups: (1) did not live with a smoker (no TSE at home); (2) lived with a smoker who did not smoke inside the home (thirdhand smoke (THS) exposure only); and (3) lived with a smoker who smoked inside the home (secondhand smoke (SHS) and THS exposure). Parent-report of inadequate sleep on most weeknights was defined as <9 h, following age-specific national guidelines. We fitted a weighted multivariable logistic model to assess the association between TSE groups and inadequate sleep, adjusting for child covariates (sociodemographics, overweight status, health status, physical activity, and screen time).ResultsAbout 13% and 1% of school-aged children were exposed to home THS only and home SHS and THS, respectively; approximately 36% overall had inadequate sleep. Compared to children with no TSE at home, children who were exposed to home THS only had higher odds of inadequate sleep (AOR = 1.44, 95%CI = 1.20–1.73); those exposed to home SHS and THS had higher odds of inadequate sleep (AOR = 1.83, 95%CI = 1.20–2.78).ConclusionsTSE is associated with school-aged children having inadequate sleep, even when smokers did not smoke inside the home. Promoting parental smoking cessation is essential to fully protect children from related risks.     

Psychotropic medication treatment patterns among school-aged children in foster care.

This study describes the level of psychotropic medication use and patterns of such treatment among school-aged children in foster care. Structured survey interviews were conducted in the foster homes of 302 randomly selected children, aged 6-12 years, who were living in foster care for 6 months or more and placed from three county service areas. Follow-up mental health assessments using the existing system of care format were completed on 255 children. Sixteen percent of these school-aged children in foster care were found to have taken psychotropic medication during their lifetime. The most common class of medication used in the past year was stimulants (62%). Children who were older, from Caucasian and biracial backgrounds, and who lived in a group home more likely to have taken psychotropic medication in the past year. Among those children who received a clinician diagnosis of a severe psychiatric disorder for which medication is an accepted component of care, boys were more likely to receive medication treatment than girls. Sociodemographic characteristics and placement history variables may be influential in the level of psychotropic medication use among this population. Further research to examine the appropriateness and level of benefit of medication treatment in this population is needed.     

The association between sleep and injury among school-aged children in rural China: a case-control study

OBJECTIVE: To explore the association between sleep and accidental injury among school-aged children in a rural area of China. METHODS: Information was collected regarding parent-reported sleep patterns and problems of 182 children with a history of a medically attended injury in the previous 12 months and of 207 non-injured control children, and data were analyzed to compare differences between the two groups of children. RESULTS: Global sleep disturbance (Children's Sleep Habits Questionnaire [CSHQ] total score) was significantly higher in the injured group (IG) than in the non-injured group (NIG), and a greater percentage of the IG scored above the clinical cut-off score on the CSHQ. Stepwise multivariate logistic regression analysis showed that the CSHQ parasomnias and daytime sleepiness subscale scores were significantly and positively related to injury. Sleep duration was also shorter in the IG, and this group had a greater percentage (23% vs 12%) of "short sleepers" (<9h). In addition, a greater percentage of "short sleepers" (91% vs 27%) had more than two injuries. CONCLUSION: This study supports an association between injuries and sleep disturbances, including shorter sleep duration and daytime sleepiness, in Chinese children.     

Prevalence and correlates of sleep problems among Chinese prisoners

Purpose

This study aimed to investigate the prevalence and correlates of sleep problems in a large prison in China.

Methods

A total of 1491 incarcerated male adults (35.44 ± 9.67 years, range 18–69) were assessed by a self-administered structured questionnaire. Sleep duration, insomnia, sleep quality, substance abuse history, gambling history, traumatic life events, posttraumatic stress disorder (PTSD) and depressive symptoms were measured. Type of offense, history of incarceration, sentence length, and duration in prison were recorded. Multivariate logistic regression was used to examine correlated factors of sleep problems.

Results

Overall, 17.4% (95% CI 15.6–19.5%) slept less than 6 h at night, 35.6% (95% CI 33.2–38.0%) slept 6–7 h, and 47.0% (95% CI 44.5–49.6%) slept 7 h or more. The prevalence rates were 26.2% (95% CI 24.0–28.5%) for insomnia and 45.9% (95% CI 43.4–48.4%) for poor sleep quality. Multiple models showed that older age, being divorced/widowed, poor physical health, long duration in prison, drug use before incarceration, PTSD and depression were associated with short sleep duration; while older age, poor physical health, PTSD, depression, and gambling before incarceration were associated with increased incidence of insomnia, and that being divorced/widowed, poor physical health, PTSD, depression, smoking before incarceration were related to poor sleep quality.

Conclusions

These findings indicate that sleep loss, insomnia, and poor sleep quality are common in prisoners, and that sleep problems are associated with multiple psychosocial factors.

     

Periodic limb movements in sleep: Prevalence and associated sleepiness in the Wisconsin Sleep Cohort

Objectives

Periodic limb movements in sleep (PLMS) are thought to be prevalent in elderly populations, but their impact on quality of life remains unclear. We examined the prevalence of PLMS, impact of age on prevalence, and association between PLMS and sleepiness.

Sleep architecture in school-aged children with primary snoring

ObjectiveWe aimed to examine if sleep architecture was altered in school-aged children with primary snoring (PS).MethodsChildren ages 6 to 13 years from 13 primary schools were randomly recruited. A validated obstructive sleep apnea (OSA) screening questionnaire was completed by their parents. Children at high risk for OSA and a randomly chosen low-risk group were invited to undergo overnight polysomnography (PSG) and clinical examination. Participants were classified into healthy controls, PS, mild OSA, and moderate to severe OSA (MS OSA) groups for comparison.ResultsA total of 619 participants underwent PSG (mean age, 10.0 ± 1.8 years; 396 (64.0%) boys; 524 (84.7%) prepubertal). For the cohort as a whole, there were no significant differences in measures of sleep architecture between PS and nonsnoring healthy controls. In the multiple regression model, percentage of nonrapid eye movement (NREM) stage 1 (N1) sleep had a significantly positive association, whereas percentage of slow-wave sleep (SWS) had a significantly negative association with sleep-disordered breathing (SDB) severity after controlling for age, gender, body mass index (BMI) z score, and pubertal status. In prepubertal children with PS, no significant disruption of sleep architecture was found. However, pubertal adolescent PS participants had significantly higher adjusted percentage of N1 sleep and wake after sleep onset (WASO) compared to healthy controls.ConclusionsPS did not exert significant adverse influences on normal sleep architecture in prepubertal school-aged children. Nevertheless, pubertal adolescents with PS had increased N1 sleep and WASO.     

Sleep disturbances among nursing home residents

STUDY OBJECTIVES: This study assesses the prevalence and characteristics of sleep disturbances among an entire nursing home population, consisting of 29, mainly demented, long-term patients. DESIGN AND SETTING: Sleep was evaluated for 14 consecutive days using actigraphic measurements and nursing staff observations. No alterations were made in every-day routines or medications during the observation period. MEASUREMENTS AND RESULTS: Actigraphy showed a mean sleep onset latency of one hour and a mean wake after sleep onset of more than two hours, while there was no findings of early morning awakening. Mean sleep efficiency was 75%, and more than 13 hours were spent in bed. 72% of the subjects had sleep efficiency below 85%. Nursing staff reported sleep onset latency of more than 30 minutes in 158 of the 203 analysed days, while early morning awakening was reported in only 12 of 203 days. Actigraphical measurements and nursing staff observations gave similar results. The validity of actigraphy in this population is discussed. CONCLUSION: Sleep disturbances were common among the residents in this nursing home. Sleep onset latency was prolonged, and the patients experienced frequent wake bouts after sleep onset. The diminished ability of sustained sleep may have been influenced by the prolonged time in bed.